Background: The infection caused by Mayaro virus (MAYV), which presents as an acute febrile illness, is considered a neglected tropical disease. The virus is an endemic and emerging pathogen in South America and the Caribbean, responsible for occasional and poorly characterized outbreaks. Currently there is limited information about its expansion and risk areas. Methods: A cross-sectional study was performed in 10 urban primary care health centers in the Cajamarca region of Peru from January to June 2017. A total of 359 patients with suspected febrile illness were assessed. RNA was extracted from serum samples, following which MAYV real-time reverse transcriptase PCR (RT-PCR) for the detection of the nsP1 gene was performed. Results: MAYV was detected in 11.1% (40/359) of samples after RT-PCR amplification and confirmatory DNA sequencing. Most infections were detected in the adult population aged 18–39 years (40%) and 40–59 years (32.5%). Headache was the most frequent symptom in patients with MAYV infection (77.5%), followed by fever (72.5%), myalgia (55.0%), and arthralgia (50.0%). During the study, most of the MAYV cases were seen in May (47.5%) and April (35.0%), corresponding to the dry season (months without rain). Conclusions: This study is novel in describing the presence of MAYV in Cajamarca, an Andean region of Peru. Symptoms are non-specific and can be confused with those of other arbovirus or bacterial infections. Molecular biology methods such as RT-PCR allow the timely and accurate detection of MAYV and could thus be considered as a tool for surveillance in endemic areas. / This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. 2015M3A9B6073666 ). This study was supported by CONCYTEC Peru , under the contract No 164-2016-FONDECYT, Lima, Peru. Incentive for Research of the Universidad Peruana de Ciencias Aplicadas (No. UPC-C-01-2019), Lima, Peru. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. / Revisión por pares

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-21T14:53:07Z No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-26T12:55:13Z (GMT) No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) / Made available in DSpace on 2017-09-26T12:55:13Z (GMT). No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) Previous issue date: 2014-03-27 / CAPES / Introdução: O gênero Alphavirus, família Togaviridae, alberga arbovírus de importância médica relatados em áreas tropicais mundialmente. Nas Américas, os alfavírus de maior importância compreendem os das encefalites equinas e o vírus Mayaro (MAYV). No Brasil, o MAYV tem sido relatado em epidemias de doença febril principalmente no norte do país. O principal objetivo deste estudo foi investigar a situação epidemiológica de alfavírus em pacientes febris durante epidemia de dengue em Mato Grosso (MT). Material e Métodos: Entre 2011 e 2012, 604 amostras de soro de pacientes com doença febril aguda suspeita de dengue durante epidemia em MT foram submetidas a Duplex-RT-PCR seguida de Multiplex-semi-nested-PCR para pesquisa dos alfavírus MAYV, vírus Aura e os vírus das encefalites equinas do Leste, Oeste e Venezuelana. Amostras positivas foram confirmadas em dois testes independentes e os produtos de PCR submetidos a sequenciamento nucleotídico. Amostras positivas foram submetidas a RT-PCR em tempo real (RT-qPCR) e isolamento viral em cultura de células. Todas as amostras foram também investigadas para flavivirus em um estudo paralelo. Resultados: Foram encontrados 15/604 (2,5 %) pacientes positivos para o MAYV em Cuiabá (9), Várzea Grande (3), Nossa Senhora do Livramento (1) e Sorriso (2). Destes, 12 (80,0 %) apresentaram co-infecções com DENV-4 e 3 (20,0 %) infecções únicas pelo MAYV. Dentre 13 amostras submetidas a RT-qPCR, 10 (76,9 %) apresentaram carga viral entre log 0,965-3,321 cópias/μL. Discussão: Casos esporádicos de infecção pelo MAYV foram identificados durante uma grande epidemia de dengue no MT em residentes de áreas urbanas, sem histórico recente de viagem ou visita a áreas rurais e/ou silvestres. A ocorrência do MAYV em estados adjacentes, em cidades afetadas pela rodovia Cuiabá-Santarém e soroprevalência em índios Xavantes no estado corroboram a evidência da circulação de MAYV no MT. Apesar do MAYV ser transmitido principalmente por Haemagogus janthinomys em áreas silvestres, as evidências encontradas no presente estudo sugerem a circulação de MAYV em área urbana de MT. Contudo, o ciclo de transmissão do vírus no estado não foi elucidado. A evidência de circulação do MAYV em indivíduos febris durante epidemia de dengue em área urbana deve ser motivo de atenção das autoridades locais de saúde pública para a eventual circulação silenciosa de outros arbovírus no estado. / Introduction: The Alphavirus genus, Togaviridae family, comprises arboviruses of medical importance reported in tropical areas worldwide. In the Americas, the most important alfaviruses are the equine encephalitis group and Mayaro virus (MAYV). In Brazil, MAYV has been reported in outbreaks of febrile illness mainly in the North region of the country. The aim of this study was to investigate the epidemiological situation of alfaviruses in febrile patients during a dengue outbreak in Mato Grosso (MT). Material and methods: Between 2011 and 2012 in MT, 604 serum samples collected from patients suspected of acute febrile illness were submitted to Duplex-RT-PCR followed by Multiplex-semi-nested-PCR for MAYV, Aura virus and East, West and Venezuelan equine encephalitis viruses. Positive samples were confirmed twice in independent tests and, PCR products were submitted to nucleotide sequencing. Positive samples were also submitted to Real time RT-PCR (RT-qPCR) and inoculation in cell culture. The samples were also investigated for flaviviruses in a parallel study. Amostras positivas foram submetidas a RT-PCR em tempo real (RT-qPCR) e isolamento viral em cultura de células. Todas as amostras foram também investigadas para flavivirus em um estudo paralelo. Results: 15/604 (2.5 %) patients from Cuiabá (9), Várzea Grande (3), Nossa Senhora do Livramento (1) and Sorriso (2) were positive for MAYV; 12 (80 %) are co-infected with DENV-4 and 3 (20 %) are single infections with MAYV. Co-infected patients presented a wider variety of clinical manifestations. Among 13 samples tested by RT-qPCR, 10 (76.9 %) presented viral load ranging from log 0,965-3,321 copies/μL. Discussion: Sporadic infections with MAYV were identified during a massive Dengue outbreak in MT in residents of urban areas without recent history of travel or visit to rural or sylvatic areas. The occurrence of MAYV infections in neighboring states, including cities affected by the Cuiabá-Santarém highway and seroprevalence in Xavante Indians from MT, corroborate the evidence of MAYV circulation in MT. Despite MAYV is transmitted mainly by Haemagogus janthinomys in sylvatic areas, the evidence found in this study suggests the circulation of MAYV in urban areas of MT. However, the transmission cycle of MAYV in MT remains to be determined. The evidence of MAYV circulation in febrile individuals during a dengue outbreak in urban areas should cause concerns in the local public health authorities about the eventual silent circulation of arboviruses in the state.