Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.

Zika virus (ZIKV) is a mosquito-borne flavivirus that has emerged as a global concern because of its impact on human health. ZIKV infection during pregnancy can cause microcephaly and other severe brain defects in the developing fetus and there have been reports of the occurrence of Guillain-Barré syndrome in areas affected by ZIKV. NK cells are activated during acute viral infections and their activity contributes to a first line of defense because of their ability to rapidly recognize and kill virus-infected cells. To provide insight into NK cell function during ZIKV infection, we have profiled, using mass cytometry, the NK cell receptor-ligand repertoire in a cohort of acute ZIKV-infected female patients. Freshly isolated NK cells from these patients contained distinct, activated, and terminally differentiated, subsets expressing higher levels of CD57, NKG2C, and KIR3DL1 as compared with those from healthy donors. Moreover, KIR3DL1⁺ NK cells from these patients produced high levels of IFN-γ and TNF-α, in the absence of direct cytotoxicity, in response to in vitro stimulation with autologous, ZIKV-infected, monocyte-derived dendritic cells. In ZIKV-infected patients, overproduction of IFN-γ correlated with STAT-5 activation (r = 0.6643; p = 0.0085) and was mediated following the recognition of MHC class 1–related chain A and chain B molecules expressed by ZIKV-infected monocyte-derived dendritic cells, in synergy with IL-12 production by the latter cells. Together, these findings suggest that NK cells contribute to the generation of an efficacious adaptive anti-ZIKV immune response that could potentially affect the outcome of the disease and/or the development of persistent symptoms. Key Points NK cells from ZIKV-infected patients produced high levels of IFN-γ and TNF-α. Overproduction of IFN-γ by NK cells is correlated with STAT-5 activation. Cytokine production is mediated by MIC molecules expressed by ZIKV⁺ cells.

Background: The prevalence of human T-lymphotropic virus type-1 (HTLV-1) infection is higher in women, and sexual intercourse has been described as an important route of male-to-female transmission. The present study aimed to quantify HTLV-1 proviral load (PVL) in vaginal fluid, and to investigate correlations with PVL in peripheral blood mononuclear cells (PBMCs). In addition, cytopathological alterations and vaginal microbiota were evaluated. Methods: HTLV-1-infected women were consecutively recruited at a multidisciplinary center for HTLV patients in Salvador, Brazil. All women underwent gynecological examinations to obtain cervicovaginal fluid and venipuncture for blood collection. PVL, as measured by real-time quantitative polymerase chain reaction (RT–qPCR), was expressed as the number of copies of HTLV-1/10⁶ cells in blood and vaginal fluid samples. Light microscopy was used to assess cervicovaginal cytopathology and vaginal microbiota. Results: In the 56 included women (43 asymptomatic carriers and 13 diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis—HAM/TSP), mean age was 35.9 (SD ± 7.2) years. PVL was higher in PBMCs (median: 23,264 copies/10⁶ cells; IQR: 6776–60,036) than in vaginal fluid (451.9 copies/10⁶ cells; IQR: 0–2490) (p < 0.0001). PVL in PBMCs was observed to correlate directly with PVL in vaginal fluid (R = 0.37, p = 0.006). PVL was detected in the vaginal fluid of 24 of 43 (55.8%) asymptomatic women compared to 12 of 13 (92.3%) HAM/TSP patients, p = 0.02. Cytopathologic analyses revealed no differences between women with detectable or undetectable PVL. Conclusion: HTLV-1 proviral load is detectable in vaginal fluid and correlates directly with proviral load in peripheral blood. This finding suggests that sexual transmission of HTLV-1 from females to males may occur, as well as vertical transmission, particularly in the context of vaginal delivery.

Objetivo: Caracterizar o perfil clínico e epidemiológico dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento (CTA) localizado no município de Paulo Afonso, no interior da Bahia. Casuística e métodos: Estudo retrospectivo, observacional, baseado em dados secundários obtidos mediante consulta aos registros dos usuários cadastrados no serviço durante o período de 2002 a 2019. Os dados foram tratados e analisados por estatística descritiva e inferencial. Resultados: Foram identificados 301 indivíduos vivendo com HIV/Aids, correspondendo a uma média de 12,4 ± 9,5 casos/ano; 58,4% eram do sexo masculino com idade média de 40,6 ± 13,8 anos. Os indivíduos mais afetados possuíam o ensino fundamental incompleto e eram provenientes de bairros periféricos. Dos 226 indivíduos avaliados laboratorialmente, 49 (21,7%) foram diagnosticados na fase de Aids. Diferenças significativas foram observadas na contagem de linfócitos T CD4⁺, razão entre os linfócitos T CD4⁺/CD8⁺ e linfócitos T CD45⁺ entre indivíduos vivendo com HIV e aqueles diagnosticados na fase de Aids (p<0,001). Conclusão: A taxa de detecção de pessoas vivendo com HIV/Aids aumentou nos últimos anos no município de Paulo Afonso, Bahia. Esse aumento no número de casos deve-se, possivelmente, aos avanços nos métodos diagnósticos, bem como da implementação do CTA na região. O perfil dos indivíduos avaliados segue a tendência nacional, com predomínio do sexo masculino, jovem, com ensino fundamental incompleto. Como esperado, indivíduos diagnosticados na fase Aids apresentam resultados laboratoriais diferentes dos indivíduos vivendo com HIV.