两个不同时期的登革热疫情揭示了同一情况下不同的流行病学、实验室和临床特征：对巴西南马托格罗索州2010年和2013年疫情的分析。

Dengue epidemics in two distinct periods reveal distinct epidemiological, laboratorial and clinical aspects in a same scenario: analysis of the 2010 and 2013 epidemics in Mato Grosso do Sul, Brazil.

作者信息

Faria Nieli Rodrigues da Costa, Solorzano Victor Edgar Fiestas, Nogueira Rita Maria Ribeiro, Chouin-Carneiro Thaís, Nunes Priscila Conrado Guerra, Simões Jaqueline Bastos Santos, de Bruycker Nogueira Fernanda, Lima Monique da Rocha Queiroz, de Oliveira Pinto Luzia Maria, Kubelka Claire Fernandes, da Cunha Rivaldo Venâncio, de Azeredo Elzinandes Leal, dos Santos Flavia Barreto

机构信息

Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.

Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.

出版信息

Trans R Soc Trop Med Hyg. 2016 Apr;110(4):228-36. doi: 10.1093/trstmh/trw013. Epub 2016 Mar 7.

DOI:10.1093/trstmh/trw013

PMID:26956779

Abstract

BACKGROUND

Dengue is a major problem in Brazil. Epidemiological and clinical aspects were characterized in patients from two epidemics which occurred in Mato Grosso do Sul, Brazil.

METHODS

Dengue cases were classified according to the 2009 WHO criteria, tested by serological and molecular biology tests and analysed for nonstructural protein 1 (NS1) antigenemia.

RESULTS

Dengue was confirmed in 78.7% (48/61) and 75.6% (118/156) of the cases studied in 2010 and 2013, respectively. DENV-1 and DENV-2 were the serotypes involved in the 2010 epidemic and DENV-4 in the 2013 one. Most of the cases were classified as dengue without warning; however, severe dengue was observed in 18.7% (9/48) of the cases in 2010 and less observed in DENV-4 cases. NS1 levels were higher in patients with dengue with warning signs and severe dengue in 2010. Circulating aspartate aminotransferase (AST) and alanine transferase (ALT) were altered in all groups, independently of the infecting serotype or epidemic. Patients with DENV-1 and DENV-2 presented significant lower monocyte counts when compared to patients with DENV-4. An inverse correlation was found between platelet count, leucocytes, monocytes and NS1 levels.

CONCLUSIONS

Epidemics caused by the prevalence of distinct DENV serotypes had different impacts and clinical characteristics in a same scenario and, despite the occurrence of secondary infections, the DENV-4 emergence was not associated with severe cases.

摘要

背景

登革热是巴西的一个主要问题。对巴西南马托格罗索州发生的两次登革热疫情中的患者的流行病学和临床特征进行了描述。

方法

根据2009年世界卫生组织标准对登革热病例进行分类，通过血清学和分子生物学检测进行检测，并分析非结构蛋白1（NS1）抗原血症。

结果

在2010年和2013年研究的病例中，分别有78.7%（48/61）和75.6%（118/156）的病例确诊为登革热。DENV-1和DENV-2是2010年疫情中的血清型，DENV-4是2013年疫情中的血清型。大多数病例被归类为无预警登革热；然而，2010年18.7%（9/48）的病例出现了严重登革热，在DENV-4病例中较少见。2010年有预警症状和严重登革热的患者NS1水平较高。所有组中循环天门冬氨酸氨基转移酶（AST）和丙氨酸转移酶（ALT）均有改变，与感染血清型或疫情无关。与DENV-4患者相比，DENV-1和DENV-2患者的单核细胞计数显著降低。血小板计数、白细胞、单核细胞与NS1水平之间呈负相关。