Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil

Objectives: To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. Methods: From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. Results: Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95–2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01–1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48–1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). Conclusions: These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.Fil: Silva, Monaíse M. O.. Fundación Oswaldo Cruz; BrasilFil: Kikuti, Mariana. Universidade Federal da Bahia; Brasil. Fundación Oswaldo Cruz; BrasilFil: Anjos, Rosângela O.. Fundación Oswaldo Cruz; BrasilFil: Portilho, Moyra M.. Fundación Oswaldo Cruz; BrasilFil: Santos, Viviane C.. Fundación Oswaldo Cruz; BrasilFil: Gonçalves, Thaiza S.F.. Fundación Oswaldo Cruz; BrasilFil: Tauro, Laura Beatriz. Fundación Oswaldo Cruz; Brasil. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Moreira, Patrícia S. S.. Fundación Oswaldo Cruz; BrasilFil: Jacob Nascimento, Leile C.. Fundación Oswaldo Cruz; BrasilFil: Santana, Perla M.. Fundación Oswaldo Cruz; BrasilFil: Campos, Gúbio S.. Universidade Federal da Bahia; BrasilFil: Siqueira, André M.. Fundación Oswaldo Cruz; BrasilFil: Kitron, Uriel D.. University of Emory; Estados Unidos. Fundación Oswaldo Cruz; BrasilFil: Reis, Mitermayer G.. University of Yale; Estados Unidos. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; BrasilFil: Ribeiro, Guilherme S.. Fundación Oswaldo Cruz; Brasil. Universidade Federal da Bahia; Brasi

The emergence of arboviruses changes the profile of viral meningitis in Salvador, Bahia: A case series

Background: Recently, different arboviruses became endemic in Brazil mostlycausing acute febrile illnesses, however, neurological manifestations have alsobeen reported. This study aimed to investigate which viruses were involved inthe meningitis etiology and the contribution of the circulating arboviruses inSalvador, Bahia, Brazil.Methods: From June 2014 to February 2016, 170 patients with suspected viralmeningitis were identified in Couto Maia Hospital, Salvador-BA, Brazil. TheirCSF samples were investigated for possible viral etiology by reversetranscription-PCR (RT-PCR) for different arboviruses: DENV, ZIKV and CHIKV;and for the EV; and by PCR for the HHV1-5 complex (HSV1-2, VZV, EBV andCMV). Also, ELISA was carried out in a subgroup of remaining samples fordetection of DENV IgM and NS1 antigen, CHIKV IgM and ZIKV IgM.Results: Thirty-seven patients were PCR or ELISA positive for at least one of thestudied viruses (overall positivity 21.8%). EV was the agent most frequentlydetected (10 cases; 27.0%), along with all four DENV serotypes (10 cases;27.0%); followed by CHIKV (6 cases; 16.2%), ZIKV (6 cases; 16.2%), and Varicellazoster virus (VZV) (1 case; 2.7%). Four cases (10.8%) presented viral co-infectiondetected: DENV1 + CHIKV, DENV1 + EV, DENV4 + ZIKV, and CHIKV + ZIKV.Arboviruses (DENV, CHIKV and ZIKV) accounted for the great majority of cases(26 cases; 70.3%) of all single and co-infections: DENV has been the mostfrequently detected arbovirus (13 cases; 35.1%). Among non-arboviralmeningitis,the most common etiology was the EV (11 cases; 29.7%).Conclusions: Arboviruses accounted for the majority of identified virusesamong patients with suspected viral meningitis. In areas where they areendemic it is crucial to increase viral surveillance and consider them in thedifferential diagnosis of meningitis.Fil: Dias, Tamiris T.. Fundación Oswaldo Cruz; BrasilFil: Tauro, Laura Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Macêdo, Lara E. N.. Fundación Oswaldo Cruz; BrasilFil: Brito, Liz O.. Fundación Oswaldo Cruz; BrasilFil: Ribeiro, Victor H. O.. Fundación Oswaldo Cruz; BrasilFil: Santos, Cleiton S.. Fundación Oswaldo Cruz; BrasilFil: Jacob-Nascimento, Leile C.. Fundación Oswaldo Cruz; BrasilFil: Vilas-Boas, Letícia S.. Fundación Oswaldo Cruz; BrasilFil: Amado, Caio. Fundación Oswaldo Cruz; BrasilFil: Barbosa, Paula S.. Fundación Oswaldo Cruz; BrasilFil: Reis, Joice N.. Fundación Oswaldo Cruz; BrasilFil: Soares Campos, Gubio. Fundación Oswaldo Cruz; BrasilFil: Ribeiro, Guilherme S.. Fundación Oswaldo Cruz; BrasilFil: Siqueira, Isadora C.. Fundación Oswaldo Cruz; BrasilFil: Silva, Luciano K.. Fundación Oswaldo Cruz; BrasilFil: Reis, Mitermayer G.. Fundación Oswaldo Cruz; Brasi

Detection of Chikungunya Virus RNA in Oral Fluid and Urine: An Alternative Approach to Diagnosis?

To evaluate whether oral fluids (OF) and urine can serve as alternative, non-invasive samples to diagnose chikungunya virus (CHIKV) infection via RT-qPCR, we employed the same RNA extraction and RT-qPCR protocols on paired serum, OF and urine samples collected from 51 patients with chikungunya during the acute phase of the illness. Chikungunya patients were confirmed through RT-qPCR in acute-phase sera (N = 19), IgM seroconversion between acute- and convalescent-phase sera (N = 12), or IgM detection in acute-phase sera (N = 20). The controls included paired serum, OF and urine samples from patients with non-arbovirus acute febrile illness (N = 28) and RT-PCR-confirmed dengue (N = 16). Nine (47%) of the patients with positive RT-qPCR for CHIKV in sera and two (17%) of those with CHIKV infection confirmed solely via IgM seroconversion had OF positive for CHIKV in RT-qPCR. One (5%) patient with CHIKV infection confirmed via serum RT-qPCR was positive in the RT-qPCR performed on urine. None of the negative control group samples were positive. Although OF may serve as an alternative sample for diagnosing acute chikungunya in specific settings, a negative result cannot rule out an infection. Further research is needed to investigate whether OF and urine collected later in the disease course when serum becomes RT-qPCR-negative may be helpful in CHIKV diagnosis and surveillance, as well as to determine whether urine and OF pose any risk of CHIKV transmission

Evaluation of two commercially available chikungunya virus IgM enzyme-linked immunoassays (ELISA) in a setting of concomitant transmission of chikungunya, dengue and Zika viruses

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2019-12-10T17:38:28Z No. of bitstreams: 1 Kikuti M Evaluation...pdf: 366431 bytes, checksum: 068dafd1d3db10c2333615678a271257 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-12-10T17:51:29Z (GMT) No. of bitstreams: 1 Kikuti M Evaluation...pdf: 366431 bytes, checksum: 068dafd1d3db10c2333615678a271257 (MD5)Made available in DSpace on 2019-12-10T17:51:29Z (GMT). No. of bitstreams: 1 Kikuti M Evaluation...pdf: 366431 bytes, checksum: 068dafd1d3db10c2333615678a271257 (MD5) Previous issue date: 2019-01-05Brazilian National Council for Scientific and Technological Development (grants 400830/2013-2 and 440891/2016-7 to GSR; and scholarships to UK, MGR, and GSR); the Bahia Foundation for Research Support (grants PET0026/ 2013, APP0044/2016, and PET0022/2016 to GSR); the Coordination for the Improvement of Higher Education Personnel, Brazilian Ministry of Education (grant 88887.130746/2016-00 to GSR and scholarship to MK); the Oswaldo Cruz Foundation; the Federal University of Bahia; and the Department of Science and Technology, Secretariat of Science, Technology and Strategic Inputs, Brazilian Ministry of Health.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Instituto de Biología Subtropical. Nodo Iguazú. Puerto Iguazu, Misiones, Argentina.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal da Bahia. Salvador, BA, Brasil.University of Texas Medical Branch. Galveston, TX, USA.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Emory University. Atlanta, GA, USA.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, Brasil.To evaluate the diagnostic performance of the Inbios (Seattle, US) and Euroimmun (Luebeck, Germany) chikungunya virus (CHIKV) IgM enzyme-linked immunoassays (ELISAs). Methods: We evaluated the tests’ accuracy on sera from 372 patients enrolled in an acute febrile illness surveillance study performed in Salvador, Brazil from Sept/2014 to Jul/2016, a period of simultaneous CHIKV, dengue (DENV), and Zika (ZIKV) virus transmission. We assessed the sensitivity on acute and paired convalescent sera from RT-PCR-confirmed CHIKV cases (collected at median one and 19 days postonset of symptoms, respectively), and the specificity on sera of RT-PCR-confirmed DENV and ZIKV cases, and on negative patients. Results: The Inbios and Euroimmun tests’ sensitivities for acute samples were 4.0% and 10.3%, while for convalescent samples they were 92.4% and 96.9%, respectively. Overall, Inbios IgM ELISA specificities for acute and convalescent samples were 97.7% and 90.5%, respectively, and Euroimmun specificities were 88.5% and 83.9%, respectively. Conclusions: Both tests presented high sensitivity for convalescent samples. However, the Euroimmun test returned more equivocal results and presented a slightly lower specificity, which might result in a higher rate of false positives if the test is used in scenarios of low CHIKV transmission, when the chance of CHIKV infection is lower

Does immunity after Zika virus infection cross-protect against dengue?

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-03-15T13:47:18Z No. of bitstreams: 1 Ribeiro GS Does immunity after Zika virus infection....pdf: 349909 bytes, checksum: 6c4e81ba8f9ba41c4283097fe22dcc18 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-03-15T14:12:33Z (GMT) No. of bitstreams: 1 Ribeiro GS Does immunity after Zika virus infection....pdf: 349909 bytes, checksum: 6c4e81ba8f9ba41c4283097fe22dcc18 (MD5)Made available in DSpace on 2018-03-15T14:12:33Z (GMT). No. of bitstreams: 1 Ribeiro GS Does immunity after Zika virus infection....pdf: 349909 bytes, checksum: 6c4e81ba8f9ba41c4283097fe22dcc18 (MD5) Previous issue date: 2018Brazilian National Council for Scientific and Technological Development (grant 550160/2010-8 to MGR, grants 400830/2013-2 and 440891/2016-7Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Secretaria Municipal de Saúde de Salvador. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Yale University. New Haven, CT, USAEmory University. Atlanta, GA, USA / University of Texas Medical Branch. Galveston, TX, USAFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasi

Effect of an intervention in storm drains to prevent Aedes aegypti reproduction in Salvador, Brazil

Abstract Background Aedes aegypti, the principal vector for dengue, chikungunya and Zika viruses, is a synanthropic species that uses stagnant water to complete its reproductive cycle. In urban settings, rainfall water draining structures, such as storm drains, may retain water and serve as a larval development site for Aedes spp. reproduction. Herein, we describe the effect of a community-based intervention on preventing standing water accumulation in storm drains and their consequent infestation by adult and immature Ae. aegypti and other mosquitoes. Methods Between April and May of 2016, local residents association of Salvador, Brazil, after being informed of water accumulation and Ae. aegypti infestation in the storm drains in their area, performed an intervention on 52 storm drains. The intervention consisted of placing concrete at the bottom of the storm drains to elevate their base to the level of the outflow tube, avoiding water accumulation, and placement of a metal mesh covering the outflow tube to avoid its clogging with debris. To determine the impact of the intervention, we compared the frequency at which the 52 storm drains contained water, as well as adult and immature mosquitoes using data from two surveys performed before and two surveys performed after the intervention. Results During the pre-intervention period, water accumulated in 48 (92.3%) of the storm drains, and immature Ae. aegypti were found in 11 (21.2%) and adults in 10 (19.2%). After the intervention, water accumulated in 5 (9.6%) of the storm drains (P < 0.001), none (0.0%) had immatures (P < 0.001), and 3 (5.8%) contained adults (P = 0.039). The total number of Ae. aegypti immatures collected decreased from 109 to 0 (P < 0.001) and adults decreased from 37 to 8 (P = 0.011) after the intervention. Collection of immature and adult non-Aedes mosquitoes (mainly Culex spp.) in the storm drains also decreased after the intervention. Conclusion This study exemplifies how a simple intervention targeting storm drains can result in a major reduction of water retention, and, consequently, impact Ae. aegypti larval populations. Larger and multi-center evaluations are needed to confirm the potential of citywide structural modifications of storm drains to reduce Aedes spp. infestation level

Concomitant transmission of dengue, chikungunya and Zika viruses in Brazil: Clinical and epidemiological findings from surveillance for acute febrile illness

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2019-02-07T18:07:09Z No. of bitstreams: 1 SILVA, S.M. Concomitant transmission ...2018.pdf: 719972 bytes, checksum: e90bcec47139442a6ef64742f1d50ab7 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-02-07T18:28:23Z (GMT) No. of bitstreams: 1 SILVA, S.M. Concomitant transmission ...2018.pdf: 719972 bytes, checksum: e90bcec47139442a6ef64742f1d50ab7 (MD5)Made available in DSpace on 2019-02-07T18:28:23Z (GMT). No. of bitstreams: 1 SILVA, S.M. Concomitant transmission ...2018.pdf: 719972 bytes, checksum: e90bcec47139442a6ef64742f1d50ab7 (MD5) Previous issue date: 2018Brazilian National Council for Scientific and Technological Development [grants 400830/2013-2, and 440891/2016-7 to G.S.R.; and scholarships to I.A.D.P., L.B.T., U.K., M.G.R., and G.S.R.]; the Bahia Foundation for Research Support [PET0026/2013, APP0044/2016, and PET0022/2016 to G.S.R., and scholarship to M.M.O.S.]; the Coordination for the Improvement of Higher Education Personnel, Brazilian Ministry of Education [440891/2016-7 to G.S.R. and scholarship to M.K.]; the National Institutes of Health (USA) [R01 TW009504, R01 AI121207, and U01 AI088752 to A.I.K.], [R24 AI AI120942 to SCW]; the Yale School of Public Health; the Federal University of Bahia; and the Oswaldo Cruz.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Instituto Nacional de Medicina Tropical. Puerto Iguazú, Argentina.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / University of Minnesota. USA.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Ciências da Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Yale School of Public Health. New Haven, USA.University of Texas Medical Branch. Galveston, USA.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Emory University. Atlanta, USA.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. Methods. Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil between Sep/2014-Jul/2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or non-specific flavivirus (FLAV) diagnosis. Results. Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV: 32, or 3.4%; CHIKV: 159, 16.7%; ZIKV: 13, 1.4%; and FLAV: 20, 2.1%), and 23 (2.4%) co-infections (DENV/CHIKV: 13, 1.4%; CHIKV/FLAV: 9, 0.9%; and DEN/ZIKV: 1, 0.1%). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with Zika presented rash (69.2%) and pruritus (69.2%) more frequently than those with dengue (37.5% and 31.2%, respectively) and chikungunya (22.9% and 14.7%, respectively) (P<0.001 for both comparisons). Conversely, arthralgia was more common in chikungunya (94.9%) and FLAV/CHIKV (100.0%) than in dengue (59.4%) and Zika (53.8%) (P<0.001). A correct presumptive clinical diagnosis was made for 9-23% of the confirmed patients