Zika virus epidemic in Brazil. I. Fatal disease in adults: Clinical and laboratorial aspects
Zika virus epidemic in Brazil. I. Fatal disease in adults: Clinical and laboratorial aspects
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DOI：
10.1016/j.jcv.2016.10.024
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发表时间：
2016-12-01
影响因子：
8.8
通讯作者：
Vasconcelos, Pedro F. C.
中科院分区：
文献类型：
--
作者：
Azevedo, Raimunda S. S.;Araujo, Marialva T.;Vasconcelos, Pedro F. C.
背景：寨卡病毒（ZIKV）于2015年5月在巴西首次被发现，该国经历了一次爆炸性流行。然而，最近的研究表明，寨卡病毒的传入发生在2013年底。2015年11月在巴西发现了与寨卡病毒感染相关的小头症和死亡病例。目的：探讨3例成人死亡病例的病因。研究设计：我们报告了三例致命的成人寨卡病毒病例。通过细胞培养和/或实时逆转录聚合酶链反应（RT-qPCR）以及免疫组织化学抗原检测，证实这些患者感染寨卡病毒。对3例患者尸检时采集的脑和其他器官样本进行了组织病理学和免疫组织学检查。结果：第一例患者是一名患有狼疮并接受强的松治疗的36岁男性，发生了暴发性寨卡病毒感染。尸检时，血液和组织的RT-qPCR呈寨卡病毒RNA阳性，病毒是从器官匀浆中培养出来的。第二名患者是一名以前健康的16岁女性，她出现了寨卡热的典型症状，但后来出现了严重的血小板减少症、贫血和出血性症状并死亡。患者发病第7天采集的血样寨卡病毒RNA RT-PCR阳性，血清抗核因子细斑（1/640）阳性，提示继发于寨卡病毒感染的Evans综合征（溶血性贫血和免疫性血小板减少性紫癜的自身免疫性疾病）。第三例患者为一名20岁女性，因发热、肺炎和出血住院，入院13天后死亡。各脏器均见组织病理学改变。采用免疫组化方法对患者1、3脏器标本进行ZIKV抗原检测。这三个病例表明，除了小头畸形和格林-巴利综合征（GBS）外，寨卡病毒感染还有其他潜在的并发症，它们表明，免疫抑制和/或自身免疫性疾病患者如果感染了寨卡病毒，可能会有更高的发生严重疾病的风险。(C) 2016 Elsevier B.V.版权所有
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 organ staken at autopsy from three patients were also analyzed by histopathological and immunohistologicalexamination.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 positivefor 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. (C) 2016 Elsevier B.V. All rights reserved.