TY - JOUR
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.
N1 - Publisher Copyright:
© 2016 Elsevier B.V.
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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U2 - 10.1016/j.jcv.2016.10.024
DO - 10.1016/j.jcv.2016.10.024
M3 - Article
C2 - 27835759
AN - SCOPUS:84999027744
SN - 1386-6532
VL - 85
SP - 56
EP - 64
JO - Journal of Clinical Virology
JF - Journal of Clinical Virology
ER -