Clinical profiles and factors associated with mortality in adults with yellow fever admitted to an intensive care unit in Minas Gerais, Brazil

Ávila, Renata Eliane de; Fernandes, Herbert José; Barbosa, Gerdson Magno; Araújo, Argus Leão; Gomes, Tatiane Cristina Caldeira; Barros, Teresa Gamarano; Moreira, Ricardo Luiz Fontes; Silva, Guilherme Lima Castro; Oliveira, Neimy Ramos de

doi:10.1016/j.ijid.2020.01.039

Cited by 12 publications

(15 citation statements)

References 24 publications

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“… 22 , 23 , 24 , 25 , 26 YF is considered a systemic disease and, despite the liver being the most affected organ, previous works have demonstrated evidence of cardiac involvement. 6 , 7 , 8 , 9 , 10 We confirmed this hypothesis and explored its mechanisms from a pathology perspective. We did not find YFV-antigens or viral particles by IHC or EM, respectively, within cardiomyocytes, suggesting that YFV does not have direct tropism for the cardiac cell, unlike recent evidence in an experimental model of infection by the Zika virus, another endemic arbovirus in the Brazil.…”

Section: Discussionsupporting

confidence: 58%

“… 6 Other cohorts of hospitalized patients with YF described bradycardia, arrhythmias and myocarditis. 7 , 8 Experimental studies have shown bradycardia, atrioventricular block and repolarization abnormalities in non-human primates infected with YF, with histopathological findings of cardiomyocyte degeneration, myolysis and, in few animals, lymphocytic perivascular inflammatory infiltrate in the myocardium. 9 , 10 Regarding human pathology, non-specific findings were described in the heart of autopsied patients, such as edema, hemorrhages and hypertrophy.…”

Section: Introductionmentioning

confidence: 99%

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Understanding yellow fever-associated myocardial injury: an autopsy study

Giugni,

Aiello,

Faria

et al. 2023

eBioMedicine

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Understanding yellow fever-associated myocardial injury: an autopsy study

Giugni,

Aiello,

Faria

et al. 2023

eBioMedicine

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“…Many studies stated numbers of cases and fatalities without specifying symptoms [ 44 , 66 – 71 ], which included studies from the recent outbreak in Angola [ 66 , 67 ]. Studies representing cases from the recent YF outbreak in Brazil, though not stating that all cases reported showed the symptoms, were added to the analyses to show whether inclusion of confirmed cases from a clinical setting might impact substantive results [ 50 – 53 ]. While the symptom requirements in this study led to potentially useful sources of information to be excluded from analysis, they do increase confidence that the CFR estimated applies directly to severe YF cases by not including potentially mild cases.…”

Section: Discussionmentioning

confidence: 99%

Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis

2021

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Background Case fatality risk (CFR), commonly referred to as a case fatality ratio or rate, represents the probability of a disease case being fatal. It is often estimated for various diseases through analysis of surveillance data, case reports, or record examinations. Reported CFR values for Yellow Fever vary, offering wide ranges. Estimates have not been found through systematic literature review, which has been used to estimate CFR of other diseases. This study aims to estimate the case fatality risk of severe Yellow Fever cases through a systematic literature review and meta-analysis. Methods A search strategy was implemented in PubMed and Ovid Medline in June 2019 and updated in March 2021, seeking reported severe case counts, defined by fever and either jaundice or hemorrhaging, and the number of those that were fatal. The searches yielded 1,133 studies, and title/abstract review followed by full text review produced 14 articles reporting 32 proportions of fatal cases, 26 of which were suitable for meta-analysis. Four studies with one proportion each were added to include clinical case data from the recent outbreak in Brazil. Data were analyzed through an intercept-only logistic meta-regression with random effects for study. Values of the I2 statistic measured heterogeneity across studies. Results The estimated CFR was 39 % (95 % CI: 31 %, 47 %). Stratifying by continent showed that South America observed a higher CFR than Africa, though fewer studies reported estimates for South America. No difference was seen between studies reporting surveillance data and studies investigating outbreaks, and no difference was seen among different symptom definitions. High heterogeneity was observed across studies. Conclusions Approximately 39 % of severe Yellow Fever cases are estimated to be fatal. This study provides the first systematic literature review to estimate the CFR of Yellow Fever, which can provide insight into outbreak preparedness and estimating underreporting.

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“…Leukopenia is a well-known indicator of frailty, particularly when one is suffering an infectious disease. Its presence has been shown to be highly prevalent in hospitalized patients with confirmed COVID-19 infection [50], is associated with increased severity of respiratory disease by Klebsiella pneumoniae [28], Staphylococcus aureus [29], and Mycobacterium tuberculosis [51], and is a predictor of mortality in patients with yellow fever [27] and after acute care surgery [52]. Low WBC counts are known to appear in nutritional deficits, chronic use of certain medications, and clinical outcomes such as autoimmune diseases, cancers of the immune system, infections, and bone marrow, blood, and spleen disorders [32,33].…”

Section: Discussionmentioning

confidence: 99%

“…However, no intervention study has assessed the effects of MedDiet on other immune-related responses such as white blood cell (WBC) count. High and low WBC count have both been associated with increased mortality [26][27][28][29] and are related to inadequate responses of the immune system. On the one hand, high counts are intimately linked to chronic low-grade inflammation [30] and the incidence of inflammation-related disease in the general population and in individuals at high cardiovascular risk [31].…”

Section: Introductionmentioning

confidence: 99%

Mediterranean Diet and White Blood Cell Count—A Randomized Controlled Trial

Hernáez

Lassale

Castro‐Barquero

et al. 2021

Foods

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We aimed to assess the effects of the antioxidant-rich Mediterranean diet (MedDiet) on white blood cell count. Our study population included participants in the PREvención con DIeta MEDiterránea study (average age 67 years old, 58% women, high cardiovascular risk). We assessed whether a MedDiet intervention enriched in extra-virgin olive oil or nuts, versus a low-fat control diet, modified the incidence of leukocytosis (>11 × 109 leukocytes/L), mild leukopenia (<4.5 × 109 leukocytes/L), or severe leukopenia (<3.5 × 109 leukocytes/L) in individuals without the condition at baseline (n = 3190, n = 2925, and n = 3190, respectively). We also examined whether MedDiet modified the association between leukocyte count alterations and all-cause mortality. Both MedDiet interventions were associated with a lower risk of developing leukopenia (incidence rates: 5.06% in control diet, 3.29% in MedDiet groups combined; hazard ratio [95% confidence interval]: 0.54 [0.36–0.80]) and severe leukopenia (incidence rates: 1.26% in control diet, 0.46% in MedDiet groups combined; hazard ratio: 0.25 [0.10–0.60]). High cumulative adherence to a MedDiet was linked to lower risk of leukocytosis (incidence rates: 2.08% in quartile 1, 0.65% in quartile 4; HRQ4-Q1: 0.29 [0.085–0.99]) and attenuated the association between leukopenia and all-cause mortality (P-interaction = 0.032). In brief, MedDiet decreased the incidence of white blood cell count-related alterations in high cardiovascular risk individuals.

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Clinical profiles and factors associated with mortality in adults with yellow fever admitted to an intensive care unit in Minas Gerais, Brazil

Cited by 12 publications

References 24 publications

Understanding yellow fever-associated myocardial injury: an autopsy study

Understanding yellow fever-associated myocardial injury: an autopsy study

Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis

Mediterranean Diet and White Blood Cell Count—A Randomized Controlled Trial

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