Publications by authors named "Maria Paula Gomes Mourao"

26 Publications

  • Page 1 of 1

A prospective, multicentre, cohort study to assess the incidence of dengue illness in households from selected communities in Brazil (2014-2018).

Int J Infect Dis 2021 Jul 21;108:443-453. Epub 2021 Apr 21.

Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos/Fiocruz, Avenida Brasil 4.365, Manguinhos, Rio de Janeiro - RJ, 21.040-900, Brazil.

Objectives: To estimate the incidence of dengue infection across geographically distinct areas of Brazil.

Methods: This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014-2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology.

Results: Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8-7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6).

Conclusions: Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials.

Clinical Trial Registration: NCT01751139.
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http://dx.doi.org/10.1016/j.ijid.2021.04.062DOI Listing
July 2021

Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19; Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial.

Clin Infect Dis 2021 05;72(9):e373-e381

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.

Background: Steroid use for coronavirus disease 2019 (COVID-19) is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19.

Methods: A parallel, double-blind, placebo-controlled, randomized, Phase IIb clinical trial was performed with hospitalized patients aged ≥18 years with clinical, epidemiological, and/or radiological suspected COVID-19 at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution) twice daily for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality.

Results: From 18 April to 16 June 2020, 647 patients were screened, 416 were randomized, and 393 were analyzed as mITT, with 194 individuals assigned to MP and 199 to placebo. SARS-CoV-2 infection was confirmed by reverse transcriptase polymerase chain reaction in 81.3%. The mortality rates at Day 28 were not different between groups. A subgroup analysis showed that patients over 60 years old in the MP group had a lower mortality rate at Day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until Day 7.

Conclusions: The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.

Clinical Trials Registration: NCT04343729.
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http://dx.doi.org/10.1093/cid/ciaa1177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454320PMC
May 2021

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial.

JAMA Netw Open 2020 04 24;3(4):e208857. Epub 2020 Apr 24.

Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.

Importance: There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the antiviral effect of chloroquine diphosphate (CQ) requires a high concentration of the drug.

Objective: To evaluate the safety and efficacy of 2 CQ dosages in patients with severe COVID-19.

Design, Setting, And Participants: This parallel, double-masked, randomized, phase IIb clinical trial with 81 adult patients who were hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at a tertiary care facility in Manaus, Brazilian Amazon.

Interventions: Patients were allocated to receive high-dosage CQ (ie, 600 mg CQ twice daily for 10 days) or low-dosage CQ (ie, 450 mg twice daily on day 1 and once daily for 4 days).

Main Outcomes And Measures: Primary outcome was reduction in lethality by at least 50% in the high-dosage group compared with the low-dosage group. Data presented here refer primarily to safety and lethality outcomes during treatment on day 13. Secondary end points included participant clinical status, laboratory examinations, and electrocardiogram results. Outcomes will be presented to day 28. Viral respiratory secretion RNA detection was performed on days 0 and 4.

Results: Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%).

Conclusions And Relevance: The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19.

Trial Registration: ClinicalTrials.gov Identifier: NCT04323527.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.8857DOI Listing
April 2020

Clinical relevance of gallbladder wall thickening for dengue severity: A cross-sectional study.

PLoS One 2019 30;14(8):e0218939. Epub 2019 Aug 30.

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.

Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13-84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients' selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients' electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218939PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716627PMC
February 2020

Wuchereria bancrofti infection in Haitian immigrants and the risk of re-emergence of lymphatic filariasis in the Brazilian Amazon.

Rev Soc Bras Med Trop 2017 Mar-Apr;50(2):256-259

Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.

Introduction:: Lymphatic filariasis (LF) is a public health problem in Haiti. Thus, the emigration of Haitians to Brazil is worrisome because of the risk for LF re-emergence.

Methods:: Blood samples of Haitian immigrants, aged ≥18 years, who emigrated to Manaus (Brazilian Amazon), were examined using thick blood smears, membrane blood filtration, and immunochromatography.

Results: : Of the 244 immigrants evaluated, 1 (0.4%) tested positive for W. bancrofti; 11.5% reported as having received LF treatment in Haiti.

Conclusions: : The re-emergence of LF in Manaus is unlikely, due to its low prevalence and low density of microfilaremia among the assessed Haitian immigrants.
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http://dx.doi.org/10.1590/0037-8682-0407-2016DOI Listing
July 2017

Divergent cerebrospinal fluid cytokine network induced by non-viral and different viral infections on the central nervous system.

BMC Infect Dis 2015 Aug 19;15:345. Epub 2015 Aug 19.

Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.

Background: Meningoencephalitis is one of the most common disorders of the central nervous system (CNS) worldwide. Viral meningoencephalitis differs from bacterial meningitis in several aspects. In some developing countries, bacterial meningitis has appropriate clinical management and chemotherapy is available. Virus-associated and virus not detected meningoencephalitis are treatable, however, they may cause death in a few cases. The knowledge of how mediators of inflammation can induce disease would contribute for the design of affordable therapeutic strategies, as well as to the diagnosis of virus not detected and viral meningoencephalitis. Cytokine-induced inflammation to CNS requires several factors that are not fully understood yet.

Methods: Considering this, several cytokines were measured in the cerebrospinal fluid (CSF) of patients with undiagnosed and viral meningoencephalitis, and these were correlated with cellularity in the CSF.

Results: The results demonstrate that an altered biochemical profile alongside increased cellularity in the cerebrospinal fluid is a feature of patients with meningoencephalitis that are not associated with the detection of virus in the CNS (P < 0.05). Moreover, HIV-positive patients (n = 10) that evolve with meningoencephalitis display a distinct biochemical/cytological profile (P < 0.05) in the cerebrospinal fluid. Meningoencephalitis brings about a prominent intrathecal cytokine storm regardless of the detection of virus as presumable etiological agent. In the case of Enterovirus infection (n = 13), meningoencephalitis elicits robust intrathecal pro-inflammatory cytokine pattern and elevated cellularity when compared to herpesvirus (n = 15) and Arbovirus (n = 5) viral infections (P < 0.05).

Conclusion: Differences in the cytokine profile of the CSF may be unique if distinct, viral or presumably non-viral pathways initially trigger the inflammatory response in the CNS.
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http://dx.doi.org/10.1186/s12879-015-1035-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541733PMC
August 2015

Epidemiology of infectious meningitis in the State of Amazonas, Brazil.

Rev Soc Bras Med Trop 2015 ;48 Suppl 1:79-86

Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.

Introduction: In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012.

Methods: Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests.

Results: The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas.

Conclusions: Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.
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http://dx.doi.org/10.1590/0037-8682-0116-2014DOI Listing
October 2015

Arboviral diseases in the Western Brazilian Amazon: a perspective and analysis from a tertiary health & research center in Manaus, State of Amazonas.

Rev Soc Bras Med Trop 2015 ;48 Suppl 1:20-6

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.

The Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), located in Manaus, the capital of the State of Amazonas (Western Brazilian Amazon), is a pioneering institution in this region regarding the syndromic surveillance of acute febrile illness, including arboviral infections. Based on the data from patients at the FMT-HVD, we have detected recurrent outbreaks in Manaus by the four dengue serotypes in the past 15 years, with increasing severity of the disease. This endemicity has culminated in the simultaneous circulation of all four serotypes in 2011, the first time this has been reported in Brazil. Between 1996 and 2009, 42 cases of yellow fever (YF) were registered in the State of Amazonas, and 71.4% (30/42) were fatal. Since 2010, no cases have been reported. Because the introduction of the yellow fever virus into a large city such as Manaus, which is widely infested by Aedes mosquitoes, may pose a real risk of a yellow fever outbreak, efforts to maintain an appropriate immunization policy for the populace are critical. Manaus has also suffered silent outbreaks of Mayaro and Oropouche fevers lately, most of which were misdiagnosed as dengue fever. The tropical conditions of the State of Amazonas favor the existence of other arboviruses capable of producing human disease. Under this real threat, represented by at least 4 arboviruses producing human infections in Manaus and in other neighboring countries, it is important to develop an efficient public health surveillance strategy, including laboratories that are able to make proper diagnoses of arboviruses.
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http://dx.doi.org/10.1590/0037-8682-0133-2013DOI Listing
October 2015

Malaria in the State of Amazonas: a typical Brazilian tropical disease influenced by waves of economic development.

Rev Soc Bras Med Trop 2015 ;48 Suppl 1:4-11

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.

In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.
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http://dx.doi.org/10.1590/0037-8682-0275-2014DOI Listing
October 2015

Clinical and virological descriptive study in the 2011 outbreak of dengue in the Amazonas, Brazil.

PLoS One 2014 30;9(6):e100535. Epub 2014 Jun 30.

Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil.

Background: Dengue is a vector-borne disease in the tropical and subtropical region of the world and is transmitted by the mosquito Aedes aegypti. In the state of Amazonas, Brazil during the 2011 outbreak of dengue all the four Dengue virus (DENV) serotypes circulating simultaneously were observed. The aim of the study was to describe the clinical epidemiology of dengue in Manaus, the capital city of the state of the Amazonas, where all the four DENV serotypes were co-circulating simultaneously.

Methodology: Patients with acute febrile illness during the 2011 outbreak of dengue, enrolled at the Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), a referral centre for tropical and infectious diseases in Manaus, were invited to participate in a clinical and virological descriptive study. Sera from 677 patients were analyzed by RT-nested-PCRs for flaviviruses (DENV 1-4, Saint Louis encephalitis virus-SLEV, Bussuquara virus-BSQV and Ilheus virus-ILHV), alphavirus (Mayaro virus-MAYV) and orthobunyavirus (Oropouche virus-OROV).

Principal Findings: Only dengue viruses were detected in 260 patients (38.4%). Thirteen patients were co-infected with more than one DENV serotype and six (46.1%) of them had a more severe clinical presentation of the disease. Nucleotide sequencing showed that DENV-1 belonged to genotype V, DENV-2 to the Asian/American genotype, DENV-3 to genotype III and DENV-4 to genotype II.

Conclusions: Co-infection with more than one DENV serotype was observed. This finding should be warning signs to health authorities in situations of the large dispersal of serotypes that are occurring in the world.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100535PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076277PMC
February 2015

From Haiti to the Amazon: public health issues related to the recent immigration of Haitians to Brazil.

PLoS Negl Trop Dis 2014 May 8;8(5):e2685. Epub 2014 May 8.

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil.

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http://dx.doi.org/10.1371/journal.pntd.0002685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014393PMC
May 2014

Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil.

Mem Inst Oswaldo Cruz 2014 Feb;109(1):93-8

Fundação de Medicina Tropical Dr Heitor Vieira Dourado, ManausAM, Brasil, Fundação de Medicina Tropical Dr Heitor Vieira Dourado , Manaus , AM , Brasil.

In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.
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http://dx.doi.org/10.1590/0074-0276140384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005528PMC
February 2014

Identification of dengue viruses in naturally infected Aedes aegypti females captured with BioGents (BG)-Sentinel traps in Manaus, Amazonas, Brazil.

Rev Soc Bras Med Trop 2013 Mar-Apr;46(2):221-2

Gerência de Virologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.

Introduction: In Manaus, the first autochthonous cases of dengue fever were registered in 1998. Since then, dengue cases were diagnosed by the isolation of viruses 1, 2, 3, and 4.

Methods: One hundred eighty-seven mosquitoes were collected with BioGents (BG)-Sentinel traps in 15 urban residential areas in the Northern Zone of Manaus and processed by molecular tests.

Results: Infections with dengue viruses 1, 2, 3, and 4 and a case of co-infection with dengue viruses 2 and 3 were identified.

Conclusions: These findings corroborate the detection of dengue in clinical samples and reinforce the need for epidemiological surveillance by the Health authorities.
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http://dx.doi.org/10.1590/0037-8682-1096-2013DOI Listing
October 2013

Simultaneous circulation of all four dengue serotypes in Manaus, State of Amazonas, Brazil in 2011.

Rev Soc Bras Med Trop 2012 Jun;45(3):393-4

Laboratório de Virologia, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.

Introduction: Manaus, the capital city of the state of Amazon with nearly 2 million inhabitants, is located in the middle of the Amazon rain forest and has suffered dengue outbreaks since 1998.

Methods: In this study, blood samples were investigated using reverse transcriptase-polymerase chain reaction (RT-PCR), aimed at identifying dengue virus serotypes.

Results: Acute phase sera from 432 patients were tested for the presence of dengue virus. Out of the 432 patients, 137 (31.3%) were found to be positive. All the four dengue virus serotypes were observed.

Conclusions: The simultaneous circulation of the four dengue serotypes is described for the first time in Manaus and in Brazil.
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http://dx.doi.org/10.1590/s0037-86822012000300022DOI Listing
June 2012

Identification of Oropouche Orthobunyavirus in the cerebrospinal fluid of three patients in the Amazonas, Brazil.

Am J Trop Med Hyg 2012 Apr;86(4):732-5

Fundação De Medicina Tropical - Dr. Heitor Vieira Dourado, University of State of Amazonas, Manaus, AM, Brazil.

Oropouche fever is the second most frequent arboviral infection in Brazil, surpassed only by dengue. Oropouche virus (OROV) causes large and explosive outbreaks of acute febrile illness in cities and villages in the Amazon and Central-Plateau regions. Cerebrospinal fluid (CSF) samples from 110 meningoencephalitis patients were analyzed. The RNA extracted from fluid was submitted to reverse transcription-polymerase chain reaction and sequencing to identify OROV. Three CSF samples showed the presence of OROV causing infection in the central nervous system (CNS). These patients are adults. Two of the patients had other diseases affecting CNS and immune systems: neurocysticercosis and acquired immunodeficiency syndrome, respectively. Nucleotide sequence analysis showed that the OROV from the CSF of these patients belonged to genotype I. We show here that severe Oropouche disease is occurring during outbreaks of this virus in Brazil.
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http://dx.doi.org/10.4269/ajtmh.2012.11-0485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403753PMC
April 2012

Serological evidence of hantavirus infection in rural and urban regions in the state of Amazonas, Brazil.

Mem Inst Oswaldo Cruz 2012 Feb;107(1):135-7

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.

Hantavirus disease is caused by the hantavirus, which is an RNA virus belonging to the family Bunyaviridae. Hantavirus disease is an anthropozoonotic infection transmitted through the inhalation of aerosols from the excreta of hantavirus-infected rodents. In the county of Itacoatiara in the state of Amazonas (AM), Brazil, the first human cases of hantavirus pulmonary and cardiovascular syndrome were described in July 2004. These first cases were followed by two fatal cases, one in the municipality of Maués in 2005 and another in Itacoatiara in 2007. In this study, we investigated the antibody levels to hantavirus in a population of 1,731 individuals from four different counties of AM. Sera were tested by IgG/IgM- enzyme-linked immune-sorbent assay using a recombinant nucleocapsid protein of the Araraquara hantavirus as an antigen. Ten sera were IgG positive to hantavirus (0.6%). Among the positive sera, 0.8% (1/122), 0.4% (1/256), 0.2% (1/556) and 0.9% (7/797) were from Atalaia do Norte, Careiro Castanho, Itacoatiara and Lábrea, respectively. None of the sera in this survey were IgM-positive. Because these counties are distributed in different areas of AM, we can assume that infected individuals are found throughout the entire state, which suggests that hantavirus disease could be a local emerging health problem.
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http://dx.doi.org/10.1590/s0074-02762012000100019DOI Listing
February 2012

Co-infection of Dengue virus by serotypes 3 and 4 in patients from Amazonas, Brazil.

Rev Inst Med Trop Sao Paulo 2011 Nov-Dec;53(6):321-3

Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.

The natural co-infection with dengue virus can occur in highly endemic areas where different serotypes have been observed for many years. We report here four cases of DENV-3/DENV-4 co-infection detected by serological and molecular tests among 674 patients with acute undifferentiated fever from the tropical medicine reference center of Manaus City, Brazil, between 2005 and 2010. Analysis of the sequences obtained indicated the presence of genotype 3 and 1 for DENV-3 and DENV-4 respectively.
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http://dx.doi.org/10.1590/s0036-46652011000600004DOI Listing
September 2012

Mayaro fever in the city of Manaus, Brazil, 2007-2008.

Vector Borne Zoonotic Dis 2012 Jan 16;12(1):42-6. Epub 2011 Sep 16.

Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Virology Department, Manaus, Amazonas, Brazil.

Mayaro Alphavirus is an arbovirus that causes outbreaks of acute febrile illness in the Amazon region of South America. We show here the cases of Mayaro fever that occurred in 2007-2008, in Manaus, a large city and capital of the Amazonas State, in Western Brazilian Amazon. IgM antibodies to Mayaro virus (MAYV) were detected by an enzyme immunoassay using infected cell cultures as antigen in the sera of 33 patients from both genera and 6-65 years old. MAYV genome was also detected by RT-PCR in the blood of 1/33 of these patients. The patients presented mainly with headache, arthralgia, myalgia, ocular pain, and rash. These cases of Mayaro fever are likely to represent the tip of an iceberg, and probably a much greater number of cases occurred in Manaus in the study period.
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http://dx.doi.org/10.1089/vbz.2011.0669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249893PMC
January 2012

Thrombocytopenia in malaria: who cares?

Mem Inst Oswaldo Cruz 2011 Aug;106 Suppl 1:52-63

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.

Despite not being a criterion for severe malaria, thrombocytopenia is one of the most common complications of both Plasmodium vivax and Plasmodium falciparum malaria. In a systematic review of the literature, platelet counts under 150,000/mm³ ranged from 24-94% in patients with acute malaria and this frequency was not different between the two major species that affected humans. Minor bleeding is mentioned in case reports of patients with P. vivax infection and may be explained by medullary compensation with the release of mega platelets in the peripheral circulation by megakaryocytes, thus maintaining a good primary haemostasis. The speculated mechanisms leading to thrombocytopenia are: coagulation disturbances, splenomegaly, bone marrow alterations, antibody-mediated platelet destruction, oxidative stress and the role of platelets as cofactors in triggering severe malaria. Data from experimental models are presented and, despite not being rare, there is no clear recommendation on the adequate management of this haematological complication. In most cases, a conservative approach is adopted and platelet counts usually revert to normal ranges a few days after efficacious antimalarial treatment. More studies are needed to specifically clarify if thrombocytopenia is the cause or consequence of the clinical disease spectrum.
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http://dx.doi.org/10.1590/s0074-02762011000900007DOI Listing
August 2011

[Aedes aegypti and associated fauna in the rural zone of Manaus, in the Brazilian Amazon].

Rev Soc Bras Med Trop 2009 Mar-Apr;42(2):213-6

Fundação de Medicina Tropical do Amazonas, Manaus, AM.

After detecting Aedes aegypti larvae in the rural zone of Manaus, entomological surveillance was carried out over two consecutive years in order to notify occurrences of this species in that area. The tool of entomological surveillance has an important role among the preventive measures against diseases transmitted by insects, particularly arbovirosis.
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http://dx.doi.org/10.1590/s0037-86822009000200025DOI Listing
July 2009

[Algid malaria: a syndromic diagnosis].

Rev Soc Bras Med Trop 2009 Jan-Feb;42(1):79-81

Fundação de Medicina Tropical do Amazonas, Manaus, AM.

Two patients with malaria due to Plasmodium falciparum who progressed to shock syndrome are reported. They received hemodynamic support in an intensive care unit without using antibiotics and presented improvements. Algid malaria should be a syndromic diagnosis of varying etiology (dehydration, bacterial infection, bleeding and/or adrenal insufficiency).
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http://dx.doi.org/10.1590/s0037-86822009000100017DOI Listing
May 2009

Dengue virus type 4, Manaus, Brazil.

Emerg Infect Dis 2008 Apr;14(4):667-9

Fundação de Medicina Tropical do Amazonas, Manaus, Brazil.

We report dengue virus type 4 (DENV-4) in Amazonas, Brazil. This virus was isolated from serum samples of 3 patients treated at a tropical medicine reference center in Manaus. All 3 cases were confirmed by serologic and molecular tests; 1 patient was co-infected with DENV-3 and DENV-4.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2570911PMC
http://dx.doi.org/10.3201/eid1404.071185DOI Listing
April 2008

Dengue hemorrhagic fever and acute hepatitis: a case report.

Braz J Infect Dis 2004 Dec 9;8(6):461-4. Epub 2005 May 9.

Tropical Medicine Foundation of Amazonas, Laboratory of Arbovirology, University of the State of Amazonas, Av. Pedro Texeira 25, Planalto, 69040-000 Manaus, Amazonas, Brazil.

Dengue fever is the world's most important viral hemorrhagic fever disease, the most geographically wide-spread of the arthropod-born viruses, and it causes a wide clinical spectrum of disease. We report a case of dengue hemorrhagic fever complicated by acute hepatitis. The initial picture of classical dengue fever was followed by painful liver enlargement, vomiting, hematemesis, epistaxis and diarrhea. Severe liver injury was detected by laboratory investigation, according to a syndromic surveillance protocol, expressed in a self-limiting pattern and the patient had a complete recovery. The serological tests for hepatitis and yellow fever viruses were negative. MAC-ELISA for dengue was positive.
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http://dx.doi.org/10.1590/s1413-86702004000600011DOI Listing
December 2004

[Dengue hemorrhagic fever in infants: report of two cases].

Rev Soc Bras Med Trop 2004 Mar-Apr;37(2):175-6. Epub 2004 Apr 13.

Laboratório de Arbovirologia, Fundação de Medicina Tropical do Amazonas, Manaus, AM, Brazil.

Two cases of infants assisted at the Tropical Medicine Foundation of Amazonas with febrile exanthematic syndrome and mild hemorrhagic manifestations, defining a picture of dengue hemorrhagic fever. The etiologic diagnose was confirmed by the MAC-ELISA and the Inhibition - ELISA, performed in both infants and respective mothers.
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http://dx.doi.org/10.1590/s0037-86822004000200012DOI Listing
June 2004
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