Fatal outcome of chikungunya virus infection in Brazil.

BACKGROUND: Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused ~2.1 million cases and over 600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological and virus genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil. METHODS: Sera, cerebrospinal fluid (CSF) and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue (DENV) and Zika virus (ZIKV). Clinical, epidemiological and death reports were obtained for patients with confirmed CHIKV infection. Logistic regression analysis was undertaken to identify independent factors associated with risk of death during CHIKV infection. Phylogenetic analysis was conducted using whole genomes from a subset of cases. RESULTS: 68 fatal cases had CHIKV infection confirmed by RT-qPCR (52.9%), viral antigen (41.1%), and/or specific-IgM (63.2%). Co-detection of CHIKV with DENV were found in 22% of fatal cases, ZIKV in 2.9%, and DENV and ZIKV in 1.5%. A total of 39 CHIKV-deaths presented with neurological signs and symptoms, and CHIKV-RNA was found in the CSF of 92.3% of these patients. Fatal outcomes were associated with irreversible multiple organ dysfunction syndrome. Patients with diabetes appear to die at a higher frequency during the sub-acute phase. Genetic analysis showed circulation of two CHIKV-East Central South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome. CONCLUSION: The investigation of the largest cross-sectional cohort of CHIKV-deaths to date reveals that CHIKV-ECSA strains can cause death in individuals from both risk and non-risk groups, including young adults

Acidentes na infância e adolescência: uma revisão bibliográfica Accidentes en la infancia y adolescencia: una revisión bibliográfica Accidents in childhood and adolescence: a bibliographic review

O estudo objetivou apresentar uma revisão bibliográfica dos acidentes entre menores de 15 anos. Em todo o Brasil, as lesões e envenenamentos são responsáveis por 5 a 6% do total das internações conveniadas pelo Sistema Único de Saúde, gerando gastos hospitalares de 8% do total de gastos com as internações. Os países com menores taxas de mortalidade por causas externas em menores de 15 anos são a Suécia e Itália. A Dinamarca, a Alemanha e o Japão são considerados países com taxas intermediárias. A França, a Bélgica, a Áustria e o Canadá são considerados países com taxas altas de mortalidade por causas externas em menores de 15 anos. O Brasil está, junto com os Estados Unidos da América, Portugal, México e Coréia, entre os países com taxas muito altas de óbitos por acidentes em menores de 15 anos. A literatura aponta para a magnitude dos acidentes infantis, necessitando-se de ações preventivas. Os estudos enfatizam, ainda, a importância de se conhecer a natureza e a realidade acerca dos acidentes na infância a fim de se formar um diagnóstico que auxilie na elaboração e implantação de estratégias específicas de prevenção.<br>El estudio tuvo como objetivo presentar una revisión bibliográfica de los accidentes entre menores de 15 años. En todo Brasil, las lesiones y envenenamientos son responsables por el 5 a 6% del total de las internaciones por convenio del Sistema Único de Salud, generando gastos de hospital de un 8% del total de gastos con las internaciones. Los países con menores tasas de mortalidad por causas externas en menores de 15 años son Suecia e Italia. Dinamarca, Alemania y Japón son considerados países con tasas intermedias. Francia, Bélgica, Austria y Canadá son considerados países con tasas altas de mortalidad por causas externas en menores de 15 años. Los Estados Unidos de América, Portugal, México y Corea son países con tasas muy altas de óbitos por accidentes en menores de 15 años. La literatura apunta para la magnitud de los accidentes infantiles, haciéndose necesarias acciones preventivas. Los estudios enfatizan, aún, la importancia de conocer la naturaleza y la realidad acerca de los accidentes en la infancia a fin de formar un diagnóstico que dé auxilio en la elaboración e implantación de estrategias específicas de prevención.<br>This study aims at reviewing the literature on accidents among young under the age of 15. Throughout Brazil, lesions and poisonings are responsible for 5 to 6 percent of total internments by the National Health System (SUS), generating 8 percent of the total hospital internment expenses. Sweden and Italy are the countries that have the lowest mortality rates related to external causes among youngsters under the age of 15. The rates of Denmark, Germany and Japan are regarded as intermediate. France, Belgium, Austria and Canada are regarded as countries with high mortality rates related to external causes among youngsters under the age of 15. Brazil together with the United States, Portugal, Mexico and Korea are considered countries with very high mortality rates related to childhood accidents, needing preventive actions. Furthermore, studies reinforce the importance of recognizing the nature and reality of childhood accidents in order to form a diagnosis that helps elaborate and accomplish specific prevention policies