title: Fatal outcome of infection by dengue 4 in a patient with thrombocytopenic purpura as a comorbid condition in Brazil.
abstract: 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.
authors.affiliation: Curso de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Frederico Figueiredo
authors.initials: FF
authors.lastname: Amâncio
authors.affiliation: Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil.
authors.forename: Maira Alves
authors.initials: MA
authors.lastname: Pereira
authors.affiliation: Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil.
authors.forename: Felipe Campos de Melo
authors.initials: FC
authors.lastname: Iani
authors.affiliation: Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil.
authors.forename: Lorena
authors.initials: L
authors.lastname: D'anunciação
authors.affiliation: Hospital Universitário Clemente Faria, Montes Claros, MG, Brazil.
authors.forename: Jorge Luís Carvalho
authors.initials: JL
authors.lastname: de Almeida
authors.affiliation: Universidade Estadual de Montes Claros, MG, Brazil.
authors.forename: Janer Aparecida Silveira
authors.initials: JA
authors.lastname: Soares
authors.affiliation: Secretaria de Estado de Saúde de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Marcela Lencine
authors.initials: ML
authors.lastname: Ferraz
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Thiago Cardoso
authors.initials: TC
authors.lastname: Vale
authors.affiliation: Curso de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Lambertucci
authors.affiliation: Curso de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Mariângela
authors.initials: M
authors.lastname: Carneiro
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D003715:Dengue / Q000150:complications / Q000821:virology*; D003716:Dengue Virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D011696:Purpura, Thrombocytopenic / Q000150:complications*; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M