Coinfección de la SARS-CoV 2 y virus del Dengue: Reporte de caso

Se presenta el caso de coinfección del SARS-CoV-2 y el virus del dengue serotipo 1 (DENV-1), ambas infecciones confirmadas a través de técnicas moleculares. En paciente adulto del norte de Perú, con buena evolución clínica y dado de alta médica. Con presentación rara, por la coincidencia del curso crítico del dengue junto al proceso hiperinflamatorio de la COVID-19

Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru

Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016–2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior

Mayaro Virus Infection, Amazon Basin Region, Peru, 2010–2013

During 2010–2013, we recruited 16 persons with confirmed Mayaro virus infection in the Peruvian Amazon to prospectively follow clinical symptoms and serologic response over a 12-month period. Mayaro virus infection caused long-term arthralgia in more than half, similar to reports of other arthritogenic alphaviruses

Early Release - Guaroa Virus and Plasmodium vivax Co-Infections, Peruvian Amazon - Volume 26, Number 4—April 2020 - Emerging Infectious Diseases journal - CDC

During April-June 2014 in a malaria-endemic rural community close to the city of Iquitos in Peru, we detected evidence of Guaroa virus (GROV) infection in 14 febrile persons, of whom 6 also had evidence of Plasmodium vivax malaria. Cases were discovered through a long-term febrile illness surveillance network at local participating health facilities. GROV cases were identified by using a combination of seroconversion and virus isolation, and malaria was diagnosed by thick smear and PCR. GROV mono-infections manifested as nonspecific febrile illness and were clinically indistinguishable from GROV and P. vivax co-infections. This cluster of cases highlights the potential for GROV transmission in the rural Peruvian Amazon, particularly in areas where malaria is endemic. Further study of similar areas of the Amazon may provide insights into the extent of GROV transmission in the Amazon basin

Kinetic profile of cytokines and chemokines similar to the concentrations detected in healthy donor controls following MAYV infection.

<p>Serum samples were collected at the acute visit as well as the convalescent visit (20±10 days), at 90±10 days, at 180±15 days, and at 360±30 days after the acute visit. The serum concentrations of a variety of cytokines were assessed by a multiplex cytokine bead array. The box plot denotes the median, 25^th percentile, and 75^th percentile cytokine levels. The whiskers denote the minimum and maximum cytokine levels observed at each time point. The horizontal dotted line represents the median cytokine values for the healthy donor controls. Comparisons between MAYV infected subjects and healthy donors were performed by a 2-tailed Mann-Whitney test (*p<0.05).</p

Long-Term Arthralgia after Mayaro Virus Infection Correlates with Sustained Pro-inflammatory Cytokine Response

<div><p>Mayaro virus (MAYV), an alphavirus similar to chikungunya virus (CHIKV), causes an acute debilitating disease which results in the development of long-term arthralgia in more than 50% of infected individuals. Currently, the immune response and its role in the development of MAYV-induced persistent arthralgia remain unknown. In this study, we evaluated the immune response of individuals with confirmed MAYV infection in a one-year longitudinal study carried out in Loreto, Peru. We report that MAYV infection elicits robust immune responses that result in the development of a strong neutralizing antibody response and the secretion of pro-inflammatory immune mediators. The composition of these inflammatory mediators, in some cases, differed to those previously observed for CHIKV. Key mediators such as IL-13, IL-7 and VEGF were strongly induced following MAYV infection and were significantly increased in subjects that eventually developed persistent arthralgia. Although a strong neutralizing antibody response was observed in all subjects, it was not sufficient to prevent the long-term outcomes of MAYV infection. This study provides initial immunologic insight that may eventually contribute to prognostic tools and therapeutic treatments against this emerging pathogen.</p></div

Induction of cytokine/chemokine immune mediators in MAYV-infected subjects with or without persistent arthralgia.

<p>Serum samples were collected at the acute visit as well as the convalescent visit (20±10 days), at 90±10 days, at 180±15 days, and at 360±30 days after the acute visit. The serum concentrations of a variety of cytokines were assessed by a cytokine bead array. The cytokine concentrations in subjects with (open circles) or without (closed circles) persistent arthralgia were compared to healthy donor controls by a 2-tailed Mann-Whitney test. An asterisk (*) indicates statistical significance (p<0.05) when compared to healthy controls. Comparisons between MAYV infected groups were also performed by a 2-tailed Mann-Whitney test. No statistical significance (p<0.05) between the MAYV infected groups was found. The horizontal dotted line represents the median cytokine values for the healthy donor controls. Each circle corresponds to the cytokine concentration of an individual subject and the solid horizontal line represents the mean cytokine concentration of the group.</p

Neutralizing antibody titers to alphaviruses and disease profile of study patients.

<p>Plaque reduction neutralization tests were carried-out in convalescent phase samples collected at follow up visit 20 (±10) days after Mayaro (MAYV) infection. EEEV = Eastern equine encephalitis virus; VEEV = Venezuelan equine encephalitis virus.</p><p>*Persistent arthralgia was defined as the presence of arthralgia for at least three months after the acute presentation.</p><p>Neutralizing antibody titers to alphaviruses and disease profile of study patients.</p

Kinetic profile of cytokines and chemokines significantly affected following MAYV infection.

<p>Serum samples were collected at the acute visit as well as the convalescent visit (20±10 days), at 90±10 days, at 180±15 days, and at 360±30 days after the acute visit. The serum concentrations of a variety of cytokines were assessed by a multiplex cytokine bead array. Three kinetic profiles are presented based on the peak of cytokine expression: <b>Acute:</b> cytokines/chemokines that peak during the acute phase (upon enrollment); <b>Convalescent:</b> cytokines/chemokines that peak during the convalescent phase 20 (±10) days post enrollment and may remain elevated for few months after MAYV infection; and <b>Sustained:</b> cytokines/chemokines whose expression remain elevated up to 12 months following MAYV infection. The box plot denotes the median, 25^th percentile, and 75^th percentile cytokine levels. The whiskers denote the minimum and maximum cytokine levels observed at each time point. The horizontal dotted line represents the median cytokine values for the healthy donor controls. Data sets were evaluated by using Wilcoxon non-parametric tests to evaluate the evolution of cytokine levels at each time point post-infection (*p<0.05).</p