FATAL OUTCOME OF INFECTION BY DENGUE 4 IN A PATIENT WITH THROMBOCYTOPENIC PURPURA AS A COMORBID CONDITION IN BRAZIL

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Frederico Figueiredo Amâncio, Maira Alves Pereira, Felipe Campos de Melo Iani, Lorena D'anunciação, Jorge Luís Carvalho de Almeida, Janer Aparecida Silveira Soares, Marcela Lencine Ferraz, Thiago Cardoso Vale, José Roberto Lambertucci, Mariângela Carneiro
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2014
• Subjects: Dengue; Risk factors; Dengue serotype 4; Epidemiology; Minas Gerais; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/S0036-46652014000300014; https://doaj.org/article/216bd1cf4eea49a7880911accb5cc29e

Dengue is currently a major public-health problem. Dengue virus (DENV) is classified into four distinct serotypes, DENV 1-4. After 28 years of absence, DENV-4 was again detected in Brazil in 2010 in Roraima State, and one year later, the virus was identified in the northern Brazilian states of Amazonas and Pará, followed by Rio de Janeiro and São Paulo. In Minas Gerais, the first confirmed case of DENV-4 occurred in the municipality of Frutal in 2011 and has now been isolated from a growing number of patients. Although DENV-2 is associated with the highest risk of severe forms of the disease and death due to the infection, DENV-4 has also been associated with severe forms of the disease and an increasing risk of hemorrhagic manifestations. Herein, the first fatal case of confirmed DENV-4 in Brazil is reported. The patient was an 11-year-old girl from the municipality of Montes Claros in northern Minas Gerais State, Brazil. She had idiopathic thrombocytopenic purpura as a comorbid condition and presented with a fulminant course of infection, leading to death due to hemorrhagic complications. Diagnosis was confirmed by detection of Dengue-specific antibodies using IgM capture enzyme-linked immunosorbent assay and semi-nested RT-PCR. Primary care physicians and other health-care providers should bear in mind that DENV-4 can also result in severe forms of the disease and lead to hemorrhagic complications and death, mainly when dengue infection is associated with coexisting conditions.