Jungle yellow fever: clinical and laboratorial sudies emphasizing viremia on a human case

Nassar, Elza da S.; Chamelet, Esther Luiza Bocato; Coimbra, Terezinha Lisieux Moraes; Souza, Luiza Terezinha Madia de; Suzuki, Akemi; Ferreira, Ivani B.; Silva, Marcos; Rocco, Iray Maria; Rosa, A.P.A. Travassos da

doi:10.1590/s0036-46651995000400009

Cited by 17 publications

(6 citation statements)

References 4 publications

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“…These results agree with recent case report showing persistent viral detection in the urine 21 days after resolution of an acute YF infection. 34 The long-term maintenance of YFV in the urine was also seen in other reports 35 , 36 suggesting a viral related pathogenic process for the renal damage in the YF. Detection of YFV in urine is possible in some infected patients up to 47 days.…”

Section: Discussionsupporting

confidence: 72%

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases

Casadio

Salles

Malta

et al. 2019

Mem. Inst. Oswaldo Cruz

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BACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVEThe aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913).MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.

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Section: Discussionsupporting

confidence: 72%

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases

Casadio

Salles

Malta

et al. 2019

Mem. Inst. Oswaldo Cruz

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“…However, higher levels have been reported in wild-type infections (2,14) and severe YFVAE (4,7,13). The results presented are in agreement with these observations and deserve being thoroughly studied.…”

supporting

confidence: 89%

Detection of Yellow Fever 17D Genome in Urine

et al. 2011

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“…Since YF vaccination certificates are not required for travel within Kenya, unvaccinated persons visiting the YF-endemic area and returning to the cities increase the risk for an urban outbreak. 26 This potential risk was underscored by the recognition of YF cases outside of the area affected by the 1992-1993 outbreak. Surveillance through 1995 has identified four persons with confirmed YF infection who live south of the Eldama Ravine along the borders with the Kericho and Nakuru Districts, districts that were not targeted by the YF vaccination effort in 1993.…”

Section: Discussionmentioning

confidence: 99%

First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations.

Sanders¹,

Marfin²,

Tukei³

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cases of hemorrhagic fever (HF) were reported in the Kerio Valley to the Kenya Ministry of Health. Early in 1993, the disease was confirmed as YF and a mass vaccination campaign was initiated. Cases of suspected YF were identified through medical record review and hospital-based disease surveillance by using a clinical case definition. Case-patients were confirmed serologically and virologically. We documented 55 persons with HF from three districts of the Rift Valley Province in the period of September 10, 1992 through March 11, 1993 (attack rate ϭ 27.4/100,000 population). Twenty-six (47%) of the 55 persons had serologic evidence of recent YF infection, and three of these persons were also confirmed by YF virus isolation. No serum was available from the other 29 HF cases. In addition, YF virus was isolated from a person from the epidemic area who had a nonspecific febrile illness but did not meet the case definition. Five patients with confirmed cases of YF died, a case-fatality rate of 19%. Women with confirmed cases of YF were 10.9 times more likely to die than men (P ϭ 0.010, by Fisher's exact test). Of the 26 patients with serologic or virologic evidence of YF, and for whom definite age was known, 21 (81%) were between 10 and 39 years of age, and 19 (73%) were males. All patients with confirmed YF infection lived in rural areas. There was only one instance of multiple cases within a single family, and this was associated with bush-clearing activity. This was the first documented outbreak of YF in Kenya, a classic example of a sylvatic transmission cycle. Surveillance in rural and urban areas outside the vaccination area should be intensified.

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Jungle yellow fever: clinical and laboratorial sudies emphasizing viremia on a human case

Cited by 17 publications

References 4 publications

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases

Detection of Yellow Fever 17D Genome in Urine

First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations.

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