Coxiella burnetii est l’agent pathogène responsable de la fièvre Q. Dans le cadre de cette thèse nous nous sommes intéressés à l'étude de souches de C.burnetii responsables d'événements épidémiques. Nous avons séquencé une souche de génotype MST33 (Z3055), proche de la souche responsable de l'épidémie de fièvre Q aux Pays-Bas, et une souche de génotype MST17 (Cb175) clone provoquant l'une des formes les plus virulentes de fièvre Q aiguë jamais décrite auparavant et retrouvée à ce jour uniquement en Guyane Française. Les résultats de ces analyses montrent que le génome de la souche Z3055 était très similaire à celui de la souche de référence Nine Mile I. Les différences observées sont liées à la présence de mutations non synonymes dans le génome de Z3055. Le pourcentage élevé de protéines membranaires mutées pourrait expliquer l’ampleur de cette épidémie en Hollande. En effet, le changement de profil antigénique pourrait être à l’origine de la formation d’un nouveau sérotype capable d'échapper à la réponse immunitaire de l'hôte et de diffuser facilement dans une population au système immunitaire naïf. Nous avons d’ailleurs montré que la souche responsable de la fièvre Q en Guyane (Cb175) présente des différences chromosomiques importantes par rapport à NMI. Ces différences se manifestent principalement par la présence d’une délétion d’une région de 6105pb contenant l’opéron hlyCABD du système de sécrétion de type 1 (T1SS). Ce résultat est cohérent avec ce qui a été observé chez les bactéries épidémiques les plus dangereuses comparées à leurs espèces non-épidémiques plus proches qui ont un génome réduit et contiennent moins de protéines du système de sécrétion. / Coxiella burnetii is a human pathogen that causes the zoonotic disease Q fever. In this work, we focused on the study of strains responsible for epidemic events. Particularly, we sequenced the clone of the strain responsible for Netherlands outbreak having genotype MST33 (Z3055), and strain having MST17 (Cb175) responsible for one of the most severe form of acute Q fever never reported in literature and uniquely described in French Guiana. Our findings showed that the Netherlands outbreak responsible strain (clone Z3055) was highly similar to the reference strain Nine Mile I. Only slight differences were observed, which were related to non-synonymous mutations in Z3055 genome. The high proportion of mutated membrane proteins could explain this large-scale outbreak. Change of antigenic profile may have led to a new serotype, conferring to the novel clone the capacity to escape the host immune response and to disseminate easily in a immunologically naïve population. On the contrary, the type strain responsible for Q fever in Guiana (Cb175) showed an important difference in its chromosome sequence compared to the reference NMI because of the deletion of a sequence of 6105bp containing the Type 1 secretion systems (T1SS) hlyCABD operon. This result appear consistent with previous findings that showed the most dangerous epidemic bacteria compared with their closest non-epidemic species are characterized by reduced genomes accompanied by significant decrease in ORF content and contain less secretion system proteins.

Thesis (Ph.D. (Biochemistry)) -- University of Limpopo, 2021 / Introduction: Rift Valley fever virus (RVFV) is an arthropod-born RNA zoonotic virus causing Rift Valley fever (RVF) disease. RVFV is prevalent across sub-Saharan Africa and the Arabian Peninsula with no existing effective and approved antiviral remedies for humans or animals. RVFV has developed mechanisms to hide from immune recognition and induce anti-apoptosis processes to keep the infected host cells viable in an attempt to advance their viral progeny. RVFV is a single-stranded enveloped RNA genome virus composed of 3 segments; the L, M and S segments. The S segment is known to encode a non-structural protein (NSs) identified to be the main virulence factor promoting viral replication through immune suppression. RVFV elicits a set of diverse symptoms ranging from a febrile illness to more severe symptoms that usually culminate in life-threatening haemorrhagic fever with high fatality rates. Thus, this study was designed to investigate the efficacy of lithium as a potential drug for reduction of RVFV load and amelioration of imbalanced and dysregulated inflammatory responses observed in Huvec and Raw 264.7 macrophages infected with this virus. Methods and results: The MTT and Cyquant viability assays were used to demonstrate that lithium exerts no cytotoxic effects on non-infected Raw 264.7 macrophage cells but rather promotes cell growth and proliferation. Conversely, lithium was shown to significantly induce cell death in RVFV-infected Raw 264.7 macrophages. The Annexin-V/PI apoptosis assay was employed to demonstrate that RVFV induces apoptosis as a mode of cell death on Raw 264.7 cells. RVFV-induced apoptosis was accompanied by antagonistic Bax/Bcl-2 protein expression ratios. RVFV-infected cells treated with lithium resulted in higher levels of apoptosis signals compared to untreated RVFV-infected cells. Analysis of apoptosis stages using the real-time cell analyser (RTCA) also revealed that lithium induced early forms of apoptosis in RVFV-infected cells. Interestingly, induction of early apoptosis in these cells corresponds with lower viral load, probably as a result of early inhibition of viral progeny replication, as determined using viral titration assay. Immune response profiles elicited in Raw 264.7 macrophages infected with RVFV and treated with lithium were monitored. An ELISA assay was used to determine the effect of lithium on cytokines and chemokine production in this cell model. The results obtained showed that lithium significantly stimulated production of IFN-γ as RVFV-infected lithium-treated cells produced high levels of IFN-γ compared to lithium-free RVFV-infected control cells. Furthermore, in the same setting, the secondary pro-inflammatory cytokine, IL-6, and chemokine, RANTES, were stimulated by lithium 12 hrs post-infection (pi). Lithium was shown to significantly stimulate TNF-α production as early as 3 hrs pi. In addition to TNF-α expression, the expression of the regulatory cytokine, IL-10, was significantly stimulated by lithium with the highest expression peak at 12 hrs pi. As determined using the H2DCF-DA and DAF-2 DA florigenic assays, reduced production of the ROS and RNS was observed in RVFV-infected lithium-treated cells as opposed to untreated RVFV-infected controls. This was further supported by the Western blot assay results that showed low expression of the iNOS while upregulating expression of heme oxygenase and IκB in RVFV-infected lithium-treated cells. Results from immunocytochemistry and Western blot assays revealed that lithium inhibits NF-κB nuclear translocation in RVFV-infected cells compared to lithium-free RVFV-infected cells and 5 mg/ml LPS controls. This study hypothesises persistent and deregulated inflammation as the central phenomenon responsible for endothelial damage and haemorrhagic fever in RVFV pathogenesis. Supernatants were collected from RVFV-infected macrophage cells treated with lithium and their effects on the integrity of endothelial cells were evaluated. The xcelligence real-time cell analyser system (RTCA) and transwell assay that measure endothelial monolayer integrity were used to demonstrate that lithium protects endothelial cells from RVFV-induced cellular damage. Moreover, lithium was shown to upregulate expression of cytoplasmic molecules such as α and β-catenins involved in attaching the cadherin molecules to the actin cytoskeleton on the endothelial cell. Expression of α-catenins, talins, zyxins and vinculins that attach integrins to the extracellular matrix and to other cells were observed to be upregulated by supernatants from RVFV-infected Raw 264.7 macrophage cells treated with lithium. Endothelial cell monolayer exposed to supernatants from RVFV-infected lithium-treated Raw 264.7 cells displayed upregulated expression of transmembrane molecules such as E-cadherins and N-cadherins. However, expression of VE-cadherins was observed to be lower compared to those treated with supernatants from lithium-free RVFV-infected Raw 264.7 control cells. Conclusion: These findings propose that lithium limits viral replication and viral load in macrophages by inducing early apoptosis in RVFV-infected cells. Since lithium was shown to promote Raw 264.7 macrophage proliferation, it is thus suggested that the use of lithium as an RVFV antiviral drug is less likely to elicit leukocytopenia. Lithium seems to regulate excessive inflammation in RVFV-infected Raw 264.7 macrophages by modulating the NF-kB signalling pathway. The endothelial integrity observed in the permeability assays has been supported by the expression of the molecules involved in keeping the cell to cell adhesion intact. This study links endothelial integrity patterns exerted by lithium with lowered production of inflammatory mediators such as ROS and RNS as these molecules are involved in destabilisation of cell junctions. Results from this study point towards the use of lithium as a potential treatment for RVFV infections by limiting viral replication, restricting viral spread and restoring the inflammation-regulating machinery. Key words. Lithium, Rift Valley fever virus, NF-kB, endothelial integrity, inflammation and apoptosis / Poliomyelitis Research foundation and National Research Foundation

Dissertation submitted to the University of the Witwatersrand, in partial fulfilment of an MSc in Child Health. Johannesburg 1997 / AC2017

Le virus de la fièvre hémorragique de Crimée-Congo (VFHCC) est un Nairovirus appartenant à la famille des Bunyaviridae, responsable d’une maladie hémorragique sévère chez l’Homme, associée à des symptômes non spécifiques et à une forte mortalité. La transmission se fait par morsure de tique ou par contact direct avec des fluides corporels contaminés. N’ayant ni vaccin ni traitement spécifique, un apport de connaissances sur les interactions cellulaires VFHCC-hôte ainsi que sur les mécanismes développés en réponse à l’infection est nécessaire.Nous avons tout d’abord étudié le potentiel antiviral de molécules sur la réplication du VFHCC. La chloroquine et la chlorpromazine ont été identifiées et inhibent efficacement la réplication virale avec une protection induite chez la souris contre l’infection, en particulier en combinaison avec la ribavirine.De nombreux virus sont connus pour être ciblés par, ou pour détourner la voie de l’autophagie. Nous avons regardé si l’infection par le VFHCC était associée à une modulation de l’autophagie et si la réplication virale était impactée par l’activité autophagique. L’étude de cellules hépatocytaires et épithéliales a montré une mobilisation massive du LC3, principal marqueur des vésicules autophagiques, par le VHFCC. Celle-ci reflète une induction du flux autophagique d’un nouveau type, n’impliquant pas les voies classiques de recrutement du LC3. La réplication virale n’est pas directement modulée par cette autophagie atypique mais des effets indirects sont à étudier. La plupart de ces observations ont été montrées pour le Nairovirus Dugbe avec cependant une cinétique différente.Le dernier axe étudié porte sur l’analyse de l’impact des IFITMs, facteurs de restriction virale connu pour interférer avec les processus de fusion membranaire, sur la réplication du virus Dugbe. L’étude a révélé une inhibition de la réplication virale par certains IFITMs.Des études supplémentaires portant sur l’interaction virus-cellule hôte et les mécanismes moléculaires associés sont nécessaires pour mieux comprendre la physiopathologie induite par le VFHCC et mettre au point de nouvelles stratégies thérapeutiques. / Crimean-Congo hemorrhagic fever virus (CCHFV) belongs to Nairovirus genus and to Bunyaviridae family. It is responsible for a severe hemorrhagic disease in humans, associated with non-specific symptoms and high lethality. Transmission is made by tick’s bite or by direct contact with contaminated body fluids. Since no vaccines or treatments are available, there is a need to accumulate knowledge on all aspects of CCHFV-host cell interaction as well as on response mechanisms that are taking place during infection.We first investigated pharmacological ways to interfere with CCHFV replication. Chloroquine and chlorpromazine (known modulators of some viral infections) were efficiently inhibiting viral replication and induce a protection in mice against CCHFV infection, particularly in the presence of ribavirin. Since several viruses are targeted by, or take advantage of, the autophagy response of infected cells, we explored whether CCHFV infection was associated with modulation of autophagy and whether virus replication was impacted by the autophagic activity of infected cells. By using hepatocytes and epithelial cells, we found that CCHFV induced a massive mobilization of the major marker of autophagic vesicles LC3. This mobilization reflected an induced autophagy flux and was of a novel type since known pathways of LC3 recruitment were not involved. The replication of CCHFV was indeed not directly modulated by this atypical form of autophagy but indirect effects remain to be studied. Most of these observations were found to be valid for the related, Dugbe virus (DUGV) with however, a distinct kinetic.Finally, we analyzed whether DUGV was sensitive to the IFITMs, restriction factors that can interfere with membrane fusion processes. Studies revealed that DUGV replication could be inhibited by some IFITMs. Additional studies on virus host-cell interactions and their associated molecular mechanisms should help to better understand the physiopathology induced by CCHFV and to devise therapeutic strategies.

O risco de transmissão placentária para o feto, associados à susceptibilidade de neuroinvasão pelo vírus 17D levaram à recomendação de que a vacina contra febre amarela (FA) não fosse administrada durante a gravidez. Pretendeu-se avaliar o efeito desta no desempenho gestacional de camundongos prenhes. Os resultados mostraram decréscimo na viabilidade fetal causado pela vacinação. Reatividade ao antígeno da FA foi observada nos tecidos hepáticos maternos e de fetos vivos. Na placenta, o antígeno viral não foi observado na barreira materno-fetal. Nos fetos natimortos e em reabsorção, esta passagem pareceu mais acentuada; reatividade foi observada em diversos órgãos. O antígeno viral foi detectado em todas as regiões placentárias. A detecção de RNA viral nas amostras indica que há atividade viral nos tecidos fetais. Nossos achados indicam que há fases gestacionais mais susceptíveis à infecção viral vacinal e que podem determinar perdas fetais. A presença do antígeno e de atividade viral no fígado fetal sugere que o vírus vacinal é transmitido da mãe para o feto. / The risk of placental transmission to the fetus, associated with susceptibility to neuroinvasion of the 17D virus led to the recommendation that the vaccine against yellow fever (YF) was not administered during pregnancy. Intended to evaluate the effect of the vaccine in gestational performance of pregnant mice. The results showed a decrease in fetal viability caused by vaccination. Antigen reactivity of YF was observed in maternal and live fetuses liver tissue. In the placenta, the viral antigen was not observed in maternal-fetal barrier. In the stillborn fetuses and resorption, this passage seemed more pronounced; reactivity was observed in several organs. The viral antigen was detected in all placental regions. The detection of viral RNA in the samples indicates that there is viral activity in fetal tissues. Our findings indicate that there are stages of pregnancy more susceptible to viral vaccine infection that could determine fetal loss. The presence of the antigen and viral activity in fetal liver suggests that the vaccine virus is transmitted from mother to fetus.

Neste projeto, objetivou-se o diagnóstico de riquétsias, utilizando metodologia molecular, em material de humanos, carrapatos, pulgas, cães e equinos de áreas endêmicas dos estados de São Paulo (SP) e Rio de Janeiro (RJ). Diagnosticou-se Rickettsia rickettsii infectando Amblyomma cajennense e humanos no estado de SP, indicando ser esta a única espécie responsável pela doença. Rickettsia conorii foi diagnosticada em um paciente procedente de Portugal. No estado do RJ, Rickettsia felis foi detectada Ctenocephalides felis e em Am. cajennense enquanto que R. rickettsii em Amblyomma aureolatum, Am. cajennense, Anocentor nitens, Boophilus microplus, Ct. felis e Rhipicephalus sanguineus. As frequências mínimas de vetores infectados do estado do RJ apresentaram valores superiores àqueles registrados em outras regiões do país. Demonstrou-se, de forma inédita, o envolvimento de algumas destas espécies no ciclo da bactéria. R. rickettsii foi diagnosticada em cães e equinos indicando a importância dos animais domésticos na manutenção do ciclo da riquetsiose. / This project aimed to diagnose rickettsial diseases using molecular analysis methods on human, tick, flea, dog and horse samples from endemic areas in the States of São Paulo (SP) and Rio de Janeiro (RJ). A diagnosis of Rickettsia rickettsii infecting Amblyomma cajennense and humans in the State of SP was made, indicating that this is the only species responsible for the disease. Rickettsia conorii was diagnosed in a patient from Portugal. In RJ, Rickettsia felis was detected in Ctenocephalides felis and Am. cajennense, while R. rickettsii was detected in Amblyomma aureolatum, Am. cajennense, Anocentor nitens, Boophilus microplus, Ct. felis and Rhipicephalus sanguineus. In the State of RJ the minimum frequency of infected vectors presented higher values than those recorded in other regions of the country. The involvement of some of these species in the bacterium cycle has been demonstrated for the first time. R. rickettsii was diagnosed in dogs and horses indicating the importance of livestock in the maintenance cycle of rickettsial infection.

O atual projeto propôs elaborar e validar uma Tecnologia Educacional sobre Febre Maculosa, com o intuito de oferecer um método inovador de ensino para promover/facilitar a aprendizagem sobre Febre Maculosa. Trata-se de um estudo metodológico, que percorreu as seguintes etapas: análise e diagnóstico; planejamento instrucional, desenho didático, revisão e validação e produção da tecnologia. A análise e diagnóstico foi realizada a partir das experiências vivenciadas em atividades de extensão em educação e saúde para Febre Maculosa no Campus-USP de Ribeirão Preto (2014- 2015). No planejamento instrucional definiu-se que a Tecnologia Educacional sobre Febre Maculosa, seria apresentada em forma de Laboratório Interativo, com estações de aprendizagem. Para a produção do Laboratório contamos com a colaboração de uma equipe multidisciplinar que envolveu pesquisadores enfermeiros, eletricista, marceneiro, artista plástico, alfaiate e designer. O processo de revisão e validação foi dividido em dois momentos: validação de aparência e conteúdo e validação semântica. A validação de aparência e conteúdo foi realizado por 9 (nove) juízes, com experiência na área de biologia e educação; já a validação semântica foi realizada por 8 (oito) alunos do curso de enfermagem e pedagogia. Os resultados da validação de aparência e conteúdo mostraram um IVC superior a 0,8 para a grande maioria das variáveis. Na validação semântica, o Laboratório também teve boa aceitação e compreensão pelos participantes, assim se manteve a mesma organização e conteúdo. Considera-se que a trajetória percorrida para a elaboração do Laboratório Interativo sobre Febre Maculosa confere sustentação acadêmica e científica ao produto construído e ainda contribui para seu potencial pedagógico enquanto um recurso que pode favorecer a aprendizagem significativa, além de contribuir para a transformação das práticas de educação em saúde / The objective of this research was to elaborate and validate an Educational Technology about Rocky Mountain Spotted Fever (RMSF) in order to offer an innovative method of teaching to promote and facilitate learning about RMSF. This methodological study used diagnosis, instructional planning, didactic design, revision, validation, and production of the technology. The analysis and diagnosis were carried out based on an extension activity in education and health related to RMSF at the Campus-USP, Ribeirão Preto (2014-2015). In the instructional planning, we defined that the Educational Technology would be presented in the form of an Interactive Laboratory, with learning stations. The Laboratory production counted with a multidisciplinary team collaboration involving researchers, nurses, electrician, carpenter, plastic artist, tailor and designer. The revision and validation process was divided in appearance and content validation and semantic validation. The appearance and content validation was carried out by 9 (nine) judges, with experience in biology and education areas. The semantic validation was performed by 8 (eight) undergraduates from nursing and pedagogy courses. The results of the appearance and content validation showed a CVI greater than 0.8 to the majority of the variables. In the semantic validation, the Laboratory presented a good acceptance and understanding by the participants, thus maintaining the same organization and content. We considered that the trajectory used for the elaboration of the Interactive Laboratory on RMSF confers academic and scientific support to the constructed product and contributes with its pedagogical potential as a resource that can provide significant learning; furthermore, it contributes with health practices transformation

A dengue à transmitida por mosquitos hematÃfagos do gÃnero Aedes das espÃcies aegypti e albopictus. O vÃrus dengue (DENV) pertence à famÃlia Flaviviridae do gÃnero FlavivÃrus e possui quatro sorotipos que foram designados como: DENV-1, DENV-2, DENV-3 e DENV-4. A doenÃa pode manifestar-se como uma enfermidade infecciosa aguda, caracterizada por um amplo espectro clÃnico que varia desde formas de infecÃÃo assintomÃtica ou febre indiferenciada atà as formas graves, com hemorragia e/ou choque. Este estudo apresentou como objetivo descrever os aspectos epidemiolÃgicos, clÃnicos e laboratoriais de pacientes com suspeita de dengue atendidos no Hospital SÃo Josà de DoenÃas Infecciosas (HSJ) e no Hospital Nossa Senhora da ConceiÃÃo (HDNSC) no perÃodo de fevereiro a dezembro de 2010. Dessa forma, foram recrutados 93 pacientes, sendo que, 86 preencheram os critÃrios de inclusÃo. Os pacientes foram recrutados por busca ativa nas emergÃncias e nas enfermarias dos referidos hospitais e submetidos a um protocolo de acompanhamento por meio de uma ficha de avaliaÃÃo clÃnica inicial (1 ao 5Âdia de doenÃa) e de uma ficha de avaliaÃÃo subsequente (6 ao 7 dia de doenÃa). Foram realizadas pelo menos duas mensuraÃÃes de hematÃcrito, plaquetas, alÃm de exames bioquÃmicos e exames especÃficos para dengue. Os sinais e os sintomas mais prevalentes nos pacientes com suspeita de dengue foram: febre, cefaleia e mialgia. Vinte e cinco pacientes (29%) apresentavam manifestaÃÃes hemorrÃgicas espontÃneas, sendo que, as hemorragias cutÃneas (petÃquias e equimoses) foram as mais encontradas (15%). Quando avaliada a populaÃÃo feminina em idade reprodutiva, 6% apresentaram metrorragia. A prova do laÃo foi realizada em 80 pacientes, sendo positiva em 20 pacientes (25%). Dos 86 pacientes, 48 (55,8%) foram positivos para dengue por pelo menos uma das tÃcnicas: imunocromatografia NS1 (16%), RT-PCR (19%), ELISA IgM (44%), imunocromatografia IgM (42%) e ELISA NS1 (27%). O vÃrus dengue foi detectado em 16 pacientes, sendo, DENV-1 em 1 paciente (6,2%), DENV-2 em 14 pacientes (87,5%) e DENV-3 em 1 paciente (6,2%). Vinte e seis pacientes (54,1%) preencheram os critÃrios do MinistÃrio da SaÃde (MS) de Dengue ClÃssica (DC), 10 (20,8%) de Febre HemorrÃgica de Dengue (FHD) e 12 (25%) de Dengue com ComplicaÃÃo (DCC). A relaÃÃo entre sexo feminino e masculino foi de aproximadamente 1,1/1, com predomÃnio maior de adultos jovens. Quanto ao critÃrio de gravidade do MS, 60% dos casos suspeitos de dengue foram classificados como grau II e nenhum caso como grau IV. Dos critÃrios de extravasamento plasmÃtico preconizado pelo MS, a hipoalbuminemia esteve presente em 5 pacientes (10,4%). A queda do hematÃcrito acima de 20% apÃs hidrataÃÃo foi observada em apenas 4 pacientes (8,3%). No perÃodo do estudo, foram diagnosticados dois pacientes com dengue e leptospirose, sendo que um paciente complicou com pÃrpura trombocitopÃnica idiopÃtica, esses pacientes tiveram evoluÃÃo benigna. Portanto salientamos a necessidade de um diagnÃstico precoce, antes do desenvolvimento das manifestaÃÃes graves, de polÃticas de erradicaÃÃo do Aedes e da estruturaÃÃo de um serviÃo de referÃncia. / Dengue is transmitted by blood-sucking mosquitoes of the species of the genus Aedes aegypti and albopictus. Dengue virus (DENV) belongs to the genus Flavivirus of the Flaviviridae family and has four serotypes that were designated as: DENV-1, DENV-2, DENV-3 and DENV-4. The disease can manifest as an acute infectious disease characterized by a wide clinical spectrum ranging from asymptomatic forms of infection or undifferentiated fever to severe forms, with bleeding and / or shock. This study had as objective to describe the epidemiological, clinical and laboratory features of patients with suspected dengue fever treated at the St Joseph Hospital of Infectious Diseases (HSJ) and the Hospital Nossa Senhora da ConceiÃÃo (HDNSC) in the period from February to December 2010. Thus, we recruited 93 patients, 86 met the inclusion criteria. Patients were recruited by an active search in emergencies and in the ward of these hospitals and underwent a follow-up protocol through an initial clinical evaluation form (from day 1 to day 5 of illness) and an evaluation form following (from the 6 to 7 day of illness). Were performed at least two measurements of hematocrit, platelets, and biochemical tests and specific tests for dengue. The signs and symptoms more prevalent in patients with suspected dengue were fever, headache and myalgia. Twenty-five patients (29%) had spontaneous bleeding manifestations and the cutaneous bleeding (petechiae and ecchymosis) were the most frequent (15%). When evaluating the female population of reproductive age, 6% had metrorrhagia. The tourniquet test was performed in 80 patients and was positive in 20 patients. Of 86 patients, 48 (55,8%) were positive for dengue at least one of the techniques: immunochromatography NS1 (16%), RT-PCR (19%), IgM ELISA (44%), IgM immunochromatography (42%) and NS1 ELISA (27%). The dengue virus was detected in 16 patient and, DENV-1 in 1 patient (6.2%), DENV-2 in 14 patients (87.5%) and DENV-3 in 1 patient (6.2%). Twenty- six patients (54,1%) met the criteria of the Ministry of Health (MOH) Classic Dengue (DC), 10 (20,8%) of Dengue Hemorrhagic Fever (DHF) and 12 (25%) of Dengue with complication (DCC). The relationship bet ween females and males were approximately 1.1/1, with higher prevalence in young adults The criterion for severity of MOH, 60% of suspected dengue cases were classified as grade II and none as grade IV. Plasma extravasation of criteria recommended by MOH, hypoalbuminemia was present in 5 patients (10,4%). The drop in hematocrit higher than 20% after hydration was observed in only 4 patients (8,3%). During the study period, two patients were diagnosed with dengue and leptospirosis, and one patient complicated with idiopathic thrombocytopenic purpura, these patients had a benign outcome. Therefore we stress the need for early diagnosis, before the development of severe manifestations, of policies to eradicate Aedes and structure a reference service.

Thesis--Université de Paris Sud, Centre d'Orsay, 1977. / Summary in French and English. Includes bibliographical references (p. 225-228).

Abstract Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) is a syndrome characterized by regular, high-fever episodes with healthy periods in between. In a classic phenotype of the syndrome, the fevers begin in childhood before the age of five, and fever flares are accompanied by aphthous stomatitis, pharyngitis, and/or cervical adenitis. The etiology of the syndrome is unknown, but tonsillectomy (TE) has been shown to be an effective treatment for the disease. The purposes of this study were as follows: (1) to assess the long-term outcome of PFAPA patients treated by TE with either the classic or incomplete phenotype (later onset of the disease and/or missing oropharyngeal symptoms), (2) to compare the health and growth of PFAPA patients with healthy controls, and (3) to compare the histological and microbiological findings of the tonsils of PFAPA patients with controls via conventional and modern sequencing technologies. In this approximately 9-year follow up, 97% (n = 56) of patients with the classic phenotype and all patients (n = 50) with the incomplete phenotype achieved a prompt and constant response after TE. There were no differences in either the length of fever episodes or flares between patients with both the classic and incomplete phenotypes. The health and growth of 119 PFAPA patients was compared to that of sex- and age-matched controls (n = 230), and no differences in prevalence of chronic diseases or growth were found between the groups. Infections, oral thrush, and pollen allergy were more common in the history of the PFAPA patients than in the controls. Microbiological and histological findings of the tonsils of PFAPA patients (n = 31) were compared with the findings of the controls (n = 24) who had undergone TE for other reasons. Biofilm formation and Candida albicans were more frequently found among PFAPA patients than the controls, but Staphylococcus aureus, varicella zoster, and herpes simplex viruses were more common in the controls. While comparing the bacterial microbiota between the groups, we found significant differences in the presence and relative abundance of many bacteria. For example, Cyanobacteria were more common and abundant in the case samples than in the controls. Because the long-term outcome after TE was excellent, both in classic and incomplete PFAPA patients; a new diagnostic criteria for the syndrome is proposed. The microbes of the tonsils in PFAPA patients differ from that of the controls, which may play an important role in triggering the inflammatory processes that lead to symptoms of PFAPA. / Tiivistelmä Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrooma, on oireyhtymä, jossa potilaat kärsivät hyvin säännöllisesti ilmaantuvista, toistuvista kuumejaksoista, joiden välillä potilaat ovat terveitä. Klassisessa tautimuodossa kuumeilut alkavat lapsuudessa ennen viiden vuoden ikää ja kuumevaiheeseen liittyy liitännäisoireita: suun limakalvojen rakkuloita, nielutulehdusta ja/tai kaulan imusolmukkeiden suurentumista. Oireyhtymän syytä ei tiedetä, mutta nielurisaleikkaus (TE) on osoittautunut tehokkaaksi hoidoksi. Tutkimuksen tarkoituksena oli (1) arvioida PFAPA potilaiden vointia pitkäaikaisseurannassa TE:n jälkeen ja vertailla taudinkuvaa niiden PFAPA potilaiden välillä, joilla oli klassinen PFAPA tai epätyypillinen PFAPA. (2) Lisäksi tutkimme myös TE:lla hoidettujen PFAPA potilaiden sairastuvuutta, yleistä terveydentilaa ja kasvua vertaamalla näitä sukupuoli- ja ikävakioituihin kontrolleihin ja (3) selvitimme mikrobiologisia ja histologisia löydöksiä PFAPA potilaiden nielurisoissa verrattuna muista syistä TE:ssa käyneiden lasten nielurisoihin. Tässä noin yhdeksän vuoden seurannassa TE:n jälkeen oli täysin parantunut 97% (n = 56) potilaista, joilla oli klassinen PFAPA, ja kaikki (n = 50) potilaat, joilla oli epätyypillinen PFAPA (tauti oli alkanut viiden ikävuoden jälkeen ja/tai klassiset liitännäisoireet puuttuivat). Kuumeprofiilit eivät muilta osin eronneet ennen nielurisaleikkausta näissä ryhmissä. PFAPA potilaiden (n = 119) kasvu ja yleinen terveydentila eivät eronneet väestökontrolleista (n = 230). Krooniset ja autoimmuunisairaudet olivat yhtä harvinaisia molemmissa ryhmissä. Potilaat raportoivat sairastaneensa enemmän infektioita ja sammasta lapsuudessa ja heillä oli enemmän siitepölyallergioita. PFAPA potilaiden (n = 31) ja muista syistä TE:ssa käyneiden lasten (n = 24) nielurisojen mikrobiologiaa ja histologiaa tutkittiin ja vertailtiin. Biofilmimuodostusta nielurisan pinnalla ja Candida albicansia löytyi enemmän tapauksilta kuin kontrolleilta, kun taas Staphylococcus aureusta, varicella zoster- ja herpes simplex -viruksia tavattiin enemmän kontrolleilla. Myös mikrobiomi erosi ryhmien välillä, esimerkiksi syanobakteerit olivat yleisempiä PFAPA risoissa kuin kontrolleilla. Klassisten ja epätyypillisten PFAPA potilaiden terveydentila TE:n jälkeen oli pitkäaikaisseurannassamme erinomainen ja siksi ehdotamme, että PFAPA –syndrooman diagnostisia kriteereitä tulisi muuttaa. Nielurisojen mikrobisto on erilainen kontrolleihin verrattuna ja tällä voi olla merkitystä PFAPA syndrooman inflammatorisessa prosessissa.