Machado Clarisse Martins, Pereira Bárbara Brito de Souza, Felix Alvina Clara, Oliveira Maria Carolina, Darrigo Luiz Guilherme, de Souza Mair Pedro, Paton Eduardo José de Alencar, Neves Fabia, Colturato Vergilio Rensi, Simoes Belinda Pinto
Virology Laboratory, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.
HSCT Program, Amaral Carvalho Foundation, Jahu, São Paulo, Brazil.
Blood Adv. 2017 Apr 10;1(10):624-627. doi: 10.1182/bloodadvances.2016003285. eCollection 2017 Apr 11.
mosquitoes are well adapted in domestic environments and widespread in tropical regions. Since 2015, Brazil has been experiencing a triple epidemic of dengue (DENV), chikungunya (CHKV), and Zika (ZIKV) viruses. The last 2 viruses are likely following the path of DENV, which has been endemic in most parts of the country since the 1980s. Given this triple epidemic, we proposed a prospective and collaborative study to assess the prevalence, morbidity, and mortality of DENV, CHKV, and ZIKV infections in hematopoietic stem cell transplant (HSCT) recipients and oncohematological patients. A case definition strategy (fever and rash) was used to prompt diagnostic investigation of DENV, ZIKV, and CHKV, which was accomplished by real-time polymerase chain reaction with plasma and urine samples. Clinical follow-up was performed 7 and 30 days after symptom onset. We report here the first cases of ZIKV and CHKV infections diagnosed in this ongoing study. From February to May 2016, 9 of the 26 patients (34.6%) fulfilling case definition criteria were diagnosed with DENV (3 cases), ZIKV (4 cases), or CHKV (2 cases) infections. Prolonged viremia and viruria were observed in dengue and Zika fever cases, respectively. Thrombocytopenia was the most frequent complication. Delayed engraftment was noted in 1 patient who acquired ZIKV 25 days before HSCT. All patients survived without sequelae. With the geographic expansion of arboviruses, donor and recipient screening may become mandatory. Patients living in areas where these viruses are not endemic are also at risk, since these viruses can be transmitted by blood as well as organ or tissue transplantation.
蚊子很好地适应了家庭环境，在热带地区广泛分布。自2015年以来，巴西一直在经历登革热病毒（DENV）、基孔肯雅病毒（CHKV）和寨卡病毒（ZIKV）的三重疫情。后两种病毒很可能沿着登革热病毒的传播路径传播，自20世纪80年代以来，登革热病毒在该国大部分地区一直呈地方性流行。鉴于这种三重疫情，我们开展了一项前瞻性合作研究，以评估造血干细胞移植（HSCT）受者和血液肿瘤患者中DENV、CHKV和ZIKV感染的患病率、发病率和死亡率。采用病例定义策略（发热和皮疹）促使对DENV、ZIKV和CHKV进行诊断调查，这通过对血浆和尿液样本进行实时聚合酶链反应来完成。在症状出现后7天和30天进行临床随访。我们在此报告在这项正在进行的研究中首次诊断出的ZIKV和CHKV感染病例。2016年2月至5月，26例符合病例定义标准的患者中有9例（34.6%）被诊断为DENV（3例）、ZIKV（4例）或CHKV（2例）感染。登革热和寨卡热病例分别观察到病毒血症和病毒尿持续时间延长。血小板减少是最常见的并发症。1例在HSCT前25天感染ZIKV的患者出现植入延迟。所有患者均存活且无后遗症。随着虫媒病毒地理范围的扩大，供体和受体筛查可能会成为强制性要求。生活在这些病毒非地方性流行地区的患者也有风险，因为这些病毒可通过血液以及器官或组织移植传播。
