Zika virus epidemic in Brazil. I. Fatal disease in adults

Clinical and laboratorial aspects

Raimunda S S Azevedo, Marialva T. Araujo, Arnaldo J. Martins Filho, Consuelo S. Oliveira, Bruno T D Nunes, Ana C R Cruz, Ana G P A C Nascimento, Rita C. Medeiros, Cezar A M Caldas, Fernando C. Araujo, Juarez A S Quaresma, Barbara C B Vasconcelos, Maria G L Queiroz, Elizabeth S Travassos da Rosa, Daniele F. Henriques, Eliana V P Silva, Jannifer O. Chiang, Lívia C. Martins, Daniele B A Medeiros, Juliana A. Lima & 7 others Márcio R T Nunes, Jedson F. Cardoso, Sandro P. Silva, Pei-Yong Shi, Robert B. Tesh, Sueli G. Rodrigues, Pedro F C Vasconcelos

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives To determine the etiology of three fatal adult cases. Study design Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.

Original languageEnglish (US)
Pages (from-to)56-64
Number of pages9
JournalJournal of Clinical Virology
Volume85
DOIs
StatePublished - Dec 1 2016

Fingerprint

Brazil
Microcephaly
Viscera
Autopsy
Antigens
Autoimmune Hemolytic Anemia
Sick Leave
Guillain-Barre Syndrome
Idiopathic Thrombocytopenic Purpura
RNA Viruses
Antinuclear Antibodies
Prednisone
Zika Virus Infection
Zika Virus
Reverse Transcriptase Polymerase Chain Reaction
Thrombocytopenia
Anemia
Real-Time Polymerase Chain Reaction
Pneumonia
Fever

Keywords

  • Autoimmune disorders
  • Erythematous lupus
  • Evans syndrome
  • Histopathology
  • Immunohistochemistry
  • Zika virus

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology

Cite this

Azevedo, R. S. S., Araujo, M. T., Martins Filho, A. J., Oliveira, C. S., Nunes, B. T. D., Cruz, A. C. R., ... Vasconcelos, P. F. C. (2016). Zika virus epidemic in Brazil. I. Fatal disease in adults: Clinical and laboratorial aspects. Journal of Clinical Virology, 85, 56-64. https://doi.org/10.1016/j.jcv.2016.10.024

Zika virus epidemic in Brazil. I. Fatal disease in adults : Clinical and laboratorial aspects. / Azevedo, Raimunda S S; Araujo, Marialva T.; Martins Filho, Arnaldo J.; Oliveira, Consuelo S.; Nunes, Bruno T D; Cruz, Ana C R; Nascimento, Ana G P A C; Medeiros, Rita C.; Caldas, Cezar A M; Araujo, Fernando C.; Quaresma, Juarez A S; Vasconcelos, Barbara C B; Queiroz, Maria G L; da Rosa, Elizabeth S Travassos; Henriques, Daniele F.; Silva, Eliana V P; Chiang, Jannifer O.; Martins, Lívia C.; Medeiros, Daniele B A; Lima, Juliana A.; Nunes, Márcio R T; Cardoso, Jedson F.; Silva, Sandro P.; Shi, Pei-Yong; Tesh, Robert B.; Rodrigues, Sueli G.; Vasconcelos, Pedro F C.

In: Journal of Clinical Virology, Vol. 85, 01.12.2016, p. 56-64.

Research output: Contribution to journalArticle

Azevedo, RSS, Araujo, MT, Martins Filho, AJ, Oliveira, CS, Nunes, BTD, Cruz, ACR, Nascimento, AGPAC, Medeiros, RC, Caldas, CAM, Araujo, FC, Quaresma, JAS, Vasconcelos, BCB, Queiroz, MGL, da Rosa, EST, Henriques, DF, Silva, EVP, Chiang, JO, Martins, LC, Medeiros, DBA, Lima, JA, Nunes, MRT, Cardoso, JF, Silva, SP, Shi, P-Y, Tesh, RB, Rodrigues, SG & Vasconcelos, PFC 2016, 'Zika virus epidemic in Brazil. I. Fatal disease in adults: Clinical and laboratorial aspects', Journal of Clinical Virology, vol. 85, pp. 56-64. https://doi.org/10.1016/j.jcv.2016.10.024
Azevedo, Raimunda S S ; Araujo, Marialva T. ; Martins Filho, Arnaldo J. ; Oliveira, Consuelo S. ; Nunes, Bruno T D ; Cruz, Ana C R ; Nascimento, Ana G P A C ; Medeiros, Rita C. ; Caldas, Cezar A M ; Araujo, Fernando C. ; Quaresma, Juarez A S ; Vasconcelos, Barbara C B ; Queiroz, Maria G L ; da Rosa, Elizabeth S Travassos ; Henriques, Daniele F. ; Silva, Eliana V P ; Chiang, Jannifer O. ; Martins, Lívia C. ; Medeiros, Daniele B A ; Lima, Juliana A. ; Nunes, Márcio R T ; Cardoso, Jedson F. ; Silva, Sandro P. ; Shi, Pei-Yong ; Tesh, Robert B. ; Rodrigues, Sueli G. ; Vasconcelos, Pedro F C. / Zika virus epidemic in Brazil. I. Fatal disease in adults : Clinical and laboratorial aspects. In: Journal of Clinical Virology. 2016 ; Vol. 85. pp. 56-64.
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abstract = "Background Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives To determine the etiology of three fatal adult cases. Study design Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.",
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author = "Azevedo, {Raimunda S S} and Araujo, {Marialva T.} and {Martins Filho}, {Arnaldo J.} and Oliveira, {Consuelo S.} and Nunes, {Bruno T D} and Cruz, {Ana C R} and Nascimento, {Ana G P A C} and Medeiros, {Rita C.} and Caldas, {Cezar A M} and Araujo, {Fernando C.} and Quaresma, {Juarez A S} and Vasconcelos, {Barbara C B} and Queiroz, {Maria G L} and {da Rosa}, {Elizabeth S Travassos} and Henriques, {Daniele F.} and Silva, {Eliana V P} and Chiang, {Jannifer O.} and Martins, {L{\'i}via C.} and Medeiros, {Daniele B A} and Lima, {Juliana A.} and Nunes, {M{\'a}rcio R T} and Cardoso, {Jedson F.} and Silva, {Sandro P.} and Pei-Yong Shi and Tesh, {Robert B.} and Rodrigues, {Sueli G.} and Vasconcelos, {Pedro F C}",
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T1 - Zika virus epidemic in Brazil. I. Fatal disease in adults

T2 - Clinical and laboratorial aspects

AU - Azevedo, Raimunda S S

AU - Araujo, Marialva T.

AU - Martins Filho, Arnaldo J.

AU - Oliveira, Consuelo S.

AU - Nunes, Bruno T D

AU - Cruz, Ana C R

AU - Nascimento, Ana G P A C

AU - Medeiros, Rita C.

AU - Caldas, Cezar A M

AU - Araujo, Fernando C.

AU - Quaresma, Juarez A S

AU - Vasconcelos, Barbara C B

AU - Queiroz, Maria G L

AU - da Rosa, Elizabeth S Travassos

AU - Henriques, Daniele F.

AU - Silva, Eliana V P

AU - Chiang, Jannifer O.

AU - Martins, Lívia C.

AU - Medeiros, Daniele B A

AU - Lima, Juliana A.

AU - Nunes, Márcio R T

AU - Cardoso, Jedson F.

AU - Silva, Sandro P.

AU - Shi, Pei-Yong

AU - Tesh, Robert B.

AU - Rodrigues, Sueli G.

AU - Vasconcelos, Pedro F C

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives To determine the etiology of three fatal adult cases. Study design Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.

AB - Background Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives To determine the etiology of three fatal adult cases. Study design Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.

KW - Autoimmune disorders

KW - Erythematous lupus

KW - Evans syndrome

KW - Histopathology

KW - Immunohistochemistry

KW - Zika virus

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