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Artigo
Zika virus epidemic in Brazil. I. Fatal disease in adults : clinical and laboratorial aspects
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...
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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 serumwas positive for antinuclear factorfine 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. |