Memórias do Instituto Oswaldo Cruz Fundação Oswaldo Cruz, Fiocruz ISSN: 1678-8060 EISSN: 1678-8060 Vol. 90, Num. 3, 1995, pp. 345-346

RESEARCH NOTE

An Outbreak of Dengue in the State of Ceara, Brazil

Rogerio Vails de Souza, Rivaldo V da Cunha*, Marize P Miagostovich **, Maria Jose Timbo***, Fernanda Montenegro****, Eni TF Paula Pessoa*****, gita Maria R Nogueira**, Hermann G Schatzrnayr **

Hospital Evandro Chagas *Departamento de Medicina Tropical Departamento de Virologia, lustituto Oswaldo Cruz, Av.Bras. il 4365, 21045-900 Rio de Janeiro, R J, Brasil Fundacao Nacional de Saude/CE Av. Santos. pumont 1856, 60150-160 Fortaleza, CE, Brasil LACEN/CE, Av. Barao de Studaft 2045, 60120-002 Foflaleza, CE, Brasil *****Departmento de Epidemiologia, SESAICE, Av. Almirante Barroso 600, 60060-440 Fortaleza, CE, Brasil

Code Number: OC95068
Size of Files:
    Text: 5K
    Graphics: Line Drawings (gif) 8K

Key words: dengue epidemic - dengue fever hemoffhagic disease - clinical aspects

After a dengue virus type 1 (DEN-I) epidemic in Rio de Janeiro in 1986 (HG Schatzmayr et al. 1986 Mem Inst Oswaldo Cruz 81: 245-6) this serotype was introduced in Fortaleza (38 W 4 S), State of Ceara, causing a large outbreak with a peak of incidence between March and June, 1987 (FP Pinheiro 1989 Epidem Bull 10: 18).

The Department of Virology, Instituto Oswaldo Cruz/Rio de Janeiro, confirmed the presence of dengue infectious in Fonaleza in collaboration with LACEN/CE. Only DEN-I was present at that time. In 1990-1991 a new epidemic occurred, and from 1986 to 1993 about 54,000 cases were reported, but no cases of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) were reported.

In April 1994, an increase of dengue cases was observed. On 25 May, from classical dengue fever cases, four straius of dengue virus type 2 (DEN-2) were isolated for the first time in Fortaleza by the Department of Virology. Virus isolation was attempted from human acute phase sera by inoculation into cultures of the clone C6/36 Aedes albopictus cell line. Virus isolates were typed by indirect fluorescent antibody test using serotype-specific monoclonal antibodies (DJ Gubler et al. 1984 Am J Trop Med Hyg 33: 158-65).

The introduction of DEN-2 caused a large epidemic and by the end of July 28,019 cases had been reported in the state, with 13,788 cases in Fortaleza (Fig.). In this city an incidence of 623 cases/100,000 inhabitants was observed.

Fig. 1 Weekly distribution of notified dengue cases in the municipality of Fortaleza, 1994.

A preliminary study confirmed that 21 patients showed sigus of increased capillary permeability and so far, five cases have been confirmed by dengue IgM capture test (MAC-ELISA). WHO criteria for DHF/DSS (WHO 1986 Dengue haemorrhagic fever: diagnostic, treatment and prevention) were fulfilled in 11 out of 21 patients, considering plasma effusion, thrombocy- topenia and hemorrhagic manifestatious. The most important hemorrhagic manifestatious were petechiae, epistaxis and gums bleedings. The tourniquet test was positive in three out of five patients tested. Pleural effusion was observed in five cases, one of them also presented pericardial effusion. According to the severity of the disease, three cases were classified as grade II, in two patients as grade III, and six as grade IV.

DILP/DSS was confirmed according to WHO criteria in six out of 30 fatal cases. Three of them were submitted to autopsy being confirmed also by macroscopical examination. One case was as- sociated with cardiogenic shock due to a severe myocarditis. In the remaining patients the following diagnosis were made: septicemia (five cases), pneumonia (two cases), pericarditis, pulmonary embolism, cerebrovascular lesions and endocarditis; each one with one case. The other fatal cases are still under investigation.

DHF/DSS have been observed in patients from 13 years old to 93 years old (mean value 42 years) with a predominance of females 14]21 (66.6%). Most cases reported were from Fortaleza but two of them were from Pacajns county.

In conclusion, dengue virus activity started in Foflaleza in 1986 spreading to the whole State. In the following years classical dengue fever has been reported. In May 1994a new serotype (DEN-2) was introduced causing a large epidemic with more severe clinical features and fatal cases of DHF/DSS.

Copyright 1995 Fundacao Oswaldo Cruz

The following images related to this document are available:

Line drawing images