Laboratory Surveillance of Dengue in Rio Grande do Sul, Brazil, from 2007 to 2013

Tumioto, Gabriela Luchiari; Gregianini, Tatiana Schäffer; Dambrós, Bibiana Paula; Cestari, Beatriz Carneiro; Nunes, Zenaida Marion Alves; Veiga, Ana Beatriz Gorini da

doi:10.1371/journal.pone.0104394

Cited by 19 publications

(30 citation statements)

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“…Dengue virus (DENV) has been circulating in Brazil since the 1980s, with the first outbreaks occurring mainly in the southeast and northern regions . By the 1990s, most Brazilian states were reporting DENV infection, including autochthonous cases; however, in Rio Grande do Sul (RS), the southernmost Brazilian state, the first autochthonous case was reported only in 2007, more than 40 years after the introduction of DENV into the country …”

Section: Introductionmentioning

confidence: 99%

Dengue in Rio Grande do Sul, Brazil: 2014 to 2016

Gregianini

Tumioto-Giannini

Favreto

et al. 2017

Reviews in Medical Virology

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The main symptoms of dengue fever are headache, sudden onset of fever, retro-orbital pain, body aches, nausea and vomiting, joint pains, weakness, and rash. With the recent introduction of Chikungunya virus (CHIKV) and Zika virus (ZIKV) in Brazil in 2014, which infect humans causing symptoms similar to dengue fever, the correct diagnosis of these infections became challenging. Even though laboratory tests have been developed to discriminate among DENV, CHIKV, and ZIKV, these assays might yield confounding results mainly due to cross-reacting antibodies presented by people who had been previously infected or vaccinated against a flavivirus (such as yellow fever). 3 Therefore, diagnosis of these arboviral diseases relies not only Samples that were collected after 6 or more days of onset of symptoms were analyzed by using either the dengue IgM capture | RESULTSFrom January 2014 to December 2016, 13,420 suspected cases of DENV infection were notified in RS, with a total of 3938 positive cases (29.3%). Of these, 3109 were confirmed based on laboratory results, while 829 were considered DENV-positive based on clinical and epidemiological criteria (Table 1). As can be observed in Table 1 Dengue virus 1 was the most prevalent serotype circulating in RS during this period (97.5% of the cases). Although DENV-2, DENV-3, and DENV-4 were also identified, they referred to imported cases, except for 1 autochthonous case of DENV-4 that was confirmed in 2014.Dengue fever occurred mainly in adults, with similar distribution among age groups. Nevertheless, some age groups showed frequencies higher than the statistically expected: in 2014, prevalence was high in the age group 21 to 30 years old, in 2015 in adults older than 41 years old, and in 2016 in the age group 11 to 20 years old (Table 1).There was no difference in prevalence of DENV infection between men and women in the period analyzed (P = .4) ( Table 1). Of note, of all patients investigated, 87 were pregnant women and, of these, 19 were positive for DENV (Table 1).The symptoms most reported by infected patients were fever, myalgia, and headache, followed by retro-orbital pain, nausea, exanthema, and arthralgia; vomiting, leucopenia, and petechia, though less common symptoms, were also reported ( Figure 1A). Data of other clinical conditions were available only in Notification Forms in 2016, and the main one found was hypertension, in 52.6% of the cases;other comorbidities observed were diabetes, hematologic diseases, hepatopathies, chronic kidney disease, and autoimmune disease ( Figure 1B).As expected, the highest incidence of dengue cases in RS occurred | DISCUSSIONDengue virus was introduced into Brazil more than 30 years ago, causing outbreaks in most states. In RS, however, the first notification The results presented herein reinforce that a significant and constant increase in the number of DENV cases is occurring in RS.The recent introduction of CHIKV and ZIKV in the state 15 has posed a concern to the population and health authorities, and this might have c...

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Section: Introductionmentioning

confidence: 99%

Dengue in Rio Grande do Sul, Brazil: 2014 to 2016

Gregianini

Tumioto-Giannini

Favreto

et al. 2017

Reviews in Medical Virology

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“…Dengue is caused by four types of DENV: DENV-1, DENV-2, DENV-3, and DENV-4 [13]. More recently, a new serotype, DEN-5, was identified in serum samples collected during an epidemic of dengue in Malaysia in 2007, still under study [14].…”

Section: Introductionmentioning

confidence: 99%

Low sensitivity of the tourniquet test for differential diagnosis of dengue: an analysis of 28,000 trials in patients

et al. 2016

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BackgroundThe aim of this study was to evaluate the utility of the tourniquet test (TT) for dengue diagnosing. To our knowledge, no previous study with such a large sample, of this duration, with as many laboratory methods referenced, or relating the results of the TT to the 2009 WHO classification of severity has been conducted thus far.MethodsIn this study, we analyzed the records of 119,589 suspected dengue cases in a Brazilian city, with 30,670 confirmed cases. The Cohen’s Kappa test was applied to evaluate the degree of agreement between the tests, and the sensitivity and specificity was calculated for the TT.ResultsTwenty-eight thousand six hundred thirty-five TT were performed. No association between the outcome of the TT and greater severity of infection, according to the 2009 guideline, was observed (P = 0.28); furthermore, relevant agreement with the final diagnosis (κ = 0.01; 95 % CI = 0.00 to 0.02) or individually with the IgM enzyme-linked immunoassay was not observed (κ = 0.05; 95 % CI = 0.04 to 0.06), and was even lower with PCR (κ = 0.27; 95 % CI = 0.06 to 0.49). Most importance of the TT was shown in relation to specificity (88.9 %; 95 % CI = 0.88 to 0.89) and negative predictive value (70.3 %; CI 95 % = 0.70 to 0.71).ConclusionsTT was more effective in detecting cases that were truly negative than positive. These results suggest that the TT should not be used as diagnosis of dengue.

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“…Accordingly, the State reported the first autochthonous case of Dengue Fever only in 2007, nearly 30 years after the virus had entered the country, and since then, the number of DENV cases has increased in RS. 19 Recently, the State of Rio Grande do Sul has also experienced outbreaks of CHIKV and ZIKV infection, with notification of cases starting in 2014, 20 shortly after being reported in the rest of the country. 7,[21][22][23][24] Though cases of CHIKV and ZIKV are notified in RS, there are no studies reporting the situation in the State.…”

Section: Zikamentioning

confidence: 99%

“…For many years, the State was free of arboviral diseases, but increase in traveling, urbanization—population of RS is 11.3 million people, with 81% living in urban areas—and sociocultural events favored the emergence of diseases in RS. Accordingly, the State reported the first autochthonous case of Dengue Fever only in 2007, nearly 30 years after the virus had entered the country, and since then, the number of DENV cases has increased in RS …”

Section: Introductionmentioning

confidence: 99%