Molecular epidemiology and clinical manifestations of human cryptosporidiosis in Sweden

SUMMARYThis study describes the epidemiology and symptoms in 271 cryptosporidiosis patients in Stockholm County, Sweden. Species/genotypes were determined by polymerase chain reaction–restriction fragment-length polymorphism (PCR–RFLP) of theCryptosporidiumoocyst wall protein (COWP) and 18S rRNA genes. Species wereC. parvum(n=111),C. hominis(n=65),C. meleagridis(n=11),C. felis(n=2),Cryptosporidiumchipmunk genotype 1 (n=2), and a recently described species,C. viatorum(n=2). Analysis of the Gp60 gene revealed fiveC. hominisallele families (Ia, Ib, Id, Ie, If), and fourC. parvumallele families (IIa, IIc, IId, IIe). MostC. parvumcases (51%) were infected in Sweden, as opposed toC. hominiscases (26%). Clinical manifestations differed slightly by species. Diarrhoea lasted longer inC. parvumcases compared toC. hominisandC. meleagridiscases. At follow-up 25–36 months after disease onset, 15% of the patients still reported intermittent diarrhoea. In four outbreaks and 13 family clusters, a single subtype was identified, indicating a common infection source, which emphasizes the value of genotyping for epidemiological investigations.

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Toxoplasmosis Outbreak Associated With Toxoplasma gondii-Contaminated Venison—High Attack Rate, Unusual Clinical Presentation, and Atypical Genotype

Clinical Infectious Diseases ◽

10.1093/cid/ciaa285 ◽

2020 ◽

Cited By ~ 2

Author(s):

Amy C Schumacher ◽

Lina I Elbadawi ◽

Traci DeSalvo ◽

Anne Straily ◽

Daniel Ajzenberg ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Clinical Manifestations ◽

Febrile Illness ◽

Wisconsin Department ◽

Department Of Health ◽

Clinical Presentations ◽

Infection Source ◽

Polymerase Chain ◽

Acute Toxoplasmosis ◽

Prior Infection

Abstract Background During 2017, in response to a physician’s report, the Wisconsin Department of Health Services, Division of Public Health, began investigating an outbreak of febrile illness among attendees of a retreat where never frozen, intentionally undercooked, locally harvested venison was served. Preliminary testing tentatively identified the illness as toxoplasmosis. Methods Confirmatory human serology panels and testing of the venison to confirm and categorize the presence and type of Toxoplasma gondii were completed by French and American national reference laboratories. All 12 retreat attendees were interviewed; medical records were reviewed. Results All attendees were male; median age was 51 years (range: 22–75). After a median incubation period of 7 days, 9 (82%) of 11 exposed persons experienced illness lasting a median of 12 days. All 9 sought outpatient healthcare for symptoms including fever, chills, sweats, and headache (100%) and ocular disturbances (33%). Testing confirmed the illness as toxoplasmosis and venison as the infection source. Multiple laboratory results were atypical for toxoplasmosis, including transaminitis (86%), lymphocytopenia (88%), thrombocytopenia (38%), and leukopenia (63%). One exposed but asymptomatic person was seronegative; the other had immunity from prior infection. The T. gondii strain was identified as closely related to an atypical genotype (haplogroup 12, polymerase chain reaction restriction fragment length polymorphism genotype 5) common in North American wildlife but with previously uncharacterized human clinical manifestations. Conclusions The T. gondii strain contaminating the venison might explain the unusual clinical presentations. In North America, clinicians and venison consumers should be aware of risk for severe or unusual presentations of acute toxoplasmosis after consuming undercooked game meat.

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Comparison of rhizobia that nodulate Medicago laciniata and Medicago truncatula present in a single Tunisian arid soil

Canadian Journal of Microbiology ◽

10.1139/w06-130 ◽

2007 ◽

Vol 53 (2) ◽

pp. 277-283 ◽

Cited By ~ 9

Author(s):

Y. Badri ◽

K. Zribi ◽

M. Badri ◽

T. Huguet ◽

P. van Berkum ◽

...

Keyword(s):

16S Rrna ◽

Medicago Truncatula ◽

Host Species ◽

Sinorhizobium Meliloti ◽

Fragment Length Polymorphism ◽

16S Rrna Genes ◽

Rrna Genes ◽

Pcr Rflp ◽

Apparent Relationship ◽

Polymerase Chain

The rhizobia present in a single arid region Tunisian soil that nodulate Medicago laciniata and Medicago truncatula were compared. All isolates, 40 from each host, were Sinorhizobium meliloti based on 16S rRNA polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP) patterns and subsequent confirmation by sequence analysis of the 16S rRNA genes in four representatives from each host species. There was no apparent relationship between Medicago host species of isolation and the nodulating rhizobial genome as determined by repetitive extragenic palandromic PCR. The isolates of M. laciniata were distinguished from those of M. truncatula present in the same soil by variation in PCR–RFLP of nifDK, indicating that this dissimilarity is originally genetic and not geographic. While forming effective symbioses with their own respective isolates, both M. laciniata and M. truncatula formed ineffective true nodules, nodule-like structures, or no nodules at all in cross-inoculation tests, as confirmed by the histological observations.

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Real-time PCRs for detection of Trichomonas vaginalis β-tubulin and 18S rRNA genes in female genital specimens

Journal of Medical Microbiology ◽

10.1099/jmm.0.47163-0 ◽

2007 ◽

Vol 56 (6) ◽

pp. 772-777 ◽

Cited By ~ 27

Author(s):

Paul Simpson ◽

Geoff Higgins ◽

Ming Qiao ◽

Russell Waddell ◽

Tuckweng Kok

Keyword(s):

Real Time ◽

Trichomonas Vaginalis ◽

18S Rrna ◽

Clinical Manifestations ◽

Developed Countries ◽

Rrna Genes ◽

Rrna Gene ◽

Wet Mount ◽

Increased Risk ◽

18S Rrna Genes

Trichomonas vaginalis is the cause of one of the most common types of vaginitis, trichomoniasis. The incidence of trichomoniasis in developed countries has decreased substantially during the past decade, but high prevalence of this disease can still be found in rural and remote areas of Australia. Clinical manifestations of symptomatic women are generally non-specific, but include vaginal discharge, vaginitis and irritation. T. vaginalis infection has also been linked to the increased risk of human immunodeficiency virus transmission. Current diagnosis of T. vaginalis relies on the visualization of motile organisms in a wet-mount preparation. Culture is used mainly in reference laboratories. The latter two methods require viable organisms and would not be suitable for use where transportation of specimens can be delayed. Two real-time fluorescence resonance energy transfer (FRET) hybridization probe PCR assays were used in this study to test for T. vaginalis DNA, targeting the β-tubulin and 18S rRNA genes. We tested 500 randomly selected female patients, in an STD setting, for T. vaginalis DNA. The FRET PCRs targeting the β-tubulin gene and the 18S rRNA gene detected 96 % (85/89) and 100 % (89/89) , respectively, of the positive specimens (first-void urine sample or genital swabs). Wet-mount microscopy was performed on 76 of these PCR-positive specimens and showed a sensitivity of 38 % (29/76). The prevalence, by PCR, of trichomoniasis was 18 % in this study. The two real-time PCRs developed in this study, targeting different genetic regions of the organism, provide a rapid, sensitive and specific diagnosis of T. vaginalis infection.

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Molecular and Symptom Analyses of Phytoplasma Strains from Lettuce Reveal a Diverse Population

Phytopathology ◽

10.1094/phyto.2004.94.8.842 ◽

2004 ◽

Vol 94 (8) ◽

pp. 842-849 ◽

Cited By ~ 44

Author(s):

Jianhua Zhang ◽

Saskia A. Hogenhout ◽

Lowell R. Nault ◽

Casey W. Hoy ◽

Sally A. Miller

Keyword(s):

Fragment Length Polymorphism ◽

Phylogenetic Analyses ◽

The Other ◽

16S Rrna Genes ◽

Rrna Genes ◽

Aster Yellows ◽

Pcr Rflp ◽

Horizontal Growth ◽

Polymerase Chain ◽

Leaf Distortion

Epidemics of aster yellows in lettuce in Ohio are caused by at least seven distinct phytoplasma strains in the aster yellows (AY) group. Five of the strains are newly reported: AY-BW, AY-WB, AY-BD3, AY-SS, and AY-SG. All seven strains were characterized based on symptoms in aster and lettuce, and by polymerase chain reaction (PCR). Strain AY-BD2 (formerly ‘Bolt’) causes yellowing and leaf distortion in lettuce and bolting in aster, whereas strain AY-S (formerly ‘Severe’) causes stunting, leaf clustering, and phyllody. Strain AY-WB causes yellowing and wilting in lettuce and witches'-broom in aster. Strain AY-SG induces horizontal growth in lettuce and aster plants. Strain AY-BW causes chlorosis of emerging leaves and abnormally upright growth of leaf petioles. AY-SS causes symptoms similar to those caused by AY-S but has a different PCR-restriction fragment length polymorphism (RFLP) banding pattern. Strains AY-BD2 and AY-BD-3 cause mild leaf and stem distortion in lettuce but are differentiated by PCR-RFLP. All phytoplasma strains collected from lettuce in Ohio belong to the 16SrI group. AY-WB belongs to the 16SrI-A subgroup and the other six belong to the 16SrI-B subgroup. Five of the seven strains were distinguished from each other by primer typing. The results of phylogenetic analyses of sequences of the 16S rRNA genes were basically consistent with the classification based on PCR-RFLP, in which AY-WB clustered with phytoplasmas of the 16rIA subgroup and the other Ohio lettuce strains clustered with phytoplasmas in the 16SrI-B subgroup.

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POS0755 PREVALENCE AND RELEVANCE OF ANTIBODIES AGAINST CITRULLINATED ALPHA ENOLASE (ANTI-CEP1) IN CONNECTIVE TISSUE DISEASES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2825 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 630.1-630

Author(s):

A. Alunno ◽

O. Bistoni ◽

F. Carubbi ◽

M. Antonucci ◽

S. Calvacchi ◽

...

Keyword(s):

Connective Tissue ◽

Lupus Erythematosus ◽

Bone Erosion ◽

Disease Onset ◽

Connective Tissue Diseases ◽

Clinical Manifestations ◽

Igg Antibodies ◽

Serum Samples ◽

Healthy Donors

Background:Anti-citrullinated alpha enolase antibodies have been investigated in rheumatoid arthritis and associated with bone erosion and interstitial lung disease but little is known about their prevalence and role in connective tissue diseases (CTDs).Objectives:The aim of this study was to investigate the prevalence and relevance of anti-CEP1 antibodies in CTDs.Methods:Serum samples from five independent patient cohorts were assessed: 1) established (est) primary Sjogren’s syndrome (pSS) N=78, 2) est-systemic lupus erythematosus (SLE) N=52, 3) est-systemic sclerosis (SSc) N=71, 4) pSS at disease onset N=30, 5) SLE at disease onset N=46 (cohorts 4 and 5 had at least 3 years of follow-up). Samples from ninety sex and age matched healthy donors (HD) and 200 patients with est-RA (disease controls) were also tested. Anti-CEP1 IgG antibodies were measured with a commercially available ELISA kit (Euroimmun, Luebeck, Germany).Results:Anti-CEP1 titer was significantly higher in est-pSS, est-SLE and est-SSc compared to HD, significantly lower in est-pSS and est-SSc compared to est-RA and comparable in est-SLE versus est-RA. We divided patients in every CTD group based on whether their anti-CEP1 titer was below or above the 25th, 50th and 75th percentile. In est-SLE anti-CEP1 values over the 25th percentile were associated with articular involvement (odds ratio, OR (95% confidence interval, CI)=11.5; 1.9-70.6, p=0.008). In est-pSS, no relationship between anti-CEP1>25th percentile and articular involvement was found but rather an association with rheumatoid factor positivity (OR (95% CI)=4.8, 1.6-14.1, p=0.004) and salivary gland swelling (OR (95% CI)=6.2, 1.3-29.1, p=0.021). In est-SSc no difference could be detected across the 3 groups. Anti-CEP-1 titers in pSS and SLE at onset did not differ from each other, were comparable also to those of HD and significantly lower than those of est-pSS, est-SLE and est-RA patients (all p<0.0001).). Of interest, we could retrieve a serum sample collected at the time of diagnosis for 5 patients from the cohort of established pSS and we observed that anti-CEP1 titers were significantly lower at pSS onset than during follow up (at least 12 months after the diagnosis, p=0.0024). No difference was observed in the clinical presentation at disease onset according to different anti-CEP1 titer and they did not predict the development of new clinical manifestations during follow-up.Conclusion:Anti-CEP-1 antibodies can be detected in CTDs at different title during the disease course and may increase overtime, at least in pSS. Although anti-CEP1 antibodies are associated with specific clinical manifestation in est-CTDs, such as articular involvement in est-SLE, they seem to lack a predictive value for future manifestations when measured at disease onset.References:[1]Alunno A, Bistoni O, Pratesi F et al Rheumatology (Oxford) 2018.[2]Manca ML, Alunno A, D’Amato C et al. Joint Bone Spine 2018.Disclosure of Interests:None declared

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Recurrent Nephritis and/or Pulmonary Hemorrhage in Patients with Anti-Glomerular Basement Membrane Disease with and without ANCA Positivity

Glomerular Diseases ◽

10.1159/000515388 ◽

2021 ◽

pp. 1-8

Author(s):

Nicole Droz ◽

Alexis Katz ◽

Aditi Patel ◽

Isaac Briskin ◽

John Sedor ◽

...

Keyword(s):

Basement Membrane ◽

Glomerular Basement Membrane ◽

Statistical Significance ◽

Disease Onset ◽

Clinical Manifestations ◽

Pulmonary Hemorrhage ◽

High Incidence ◽

Long Term Follow Up ◽

Antibody Positivity

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is characterized by rapidly progressive glomerular nephritis with or without pulmonary hemorrhage with disease severity correlating with antibody titer. Following treatment, relapse is rare but has been reported in the literature. The objective of this study was to assess for clinical, serologic, and histologic differences associated with disease relapse in patients with anti-GBM disease. Methods: Patients seen at our facility between 1997 and 2017 were screened for anti-GBM disease by ICD 9/10 codes. They were included if the diagnosis was confirmed by a board-certified rheumatologist or nephrologist and had positive antibodies and/or biopsy results consistent with anti-GBM disease. Relapsing disease was defined as recurrence of pulmonary or renal manifestations after achieving remission following the initial presentation. All charts were reviewed for baseline demographics, clinical manifestations, and antibody positivity and compared between groups. Results: 40 patients were confirmed as having anti-GBM disease. Mean follow-up from disease onset to the date of last follow-up was 56.2 months. 8 patients had relapsing disease and 32 patients had nonrelapsing disease. Baseline characteristics and clinical manifestations were similar between groups. Patients with relapsing disease had a high incidence of anti-neutrophilic cytoplasmic antibody (ANCA) co-positivity as compared to nonrelapsing patients (50 vs. 15.6%, respectively, p = 0.059), but this did not reach statistical significance. In patients with relapsing disease, only one had positive anti-GBM antibodies at time of relapse. Conclusions: In this study, patients with relapsing disease had a high incidence of ANCA co-positivity (50%). In patients with newly diagnosed anti-GBM disease, ANCAs should be obtained to assess for the risk of relapse and to help guide long-term follow-up and treatment.

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Variants of MIRNA146A rs2910164 and MIRNA499 rs3746444 are associated with the development of cutaneous leishmaniasis caused by Leishmania guyanensis and with plasma chemokine IL-8

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009795 ◽

2021 ◽

Vol 15 (9) ◽

pp. e0009795

Author(s):

Tirza Gabrielle Ramos de Mesquita ◽

José do Espírito Santo Junior ◽

Thais Carneiro de Lacerda ◽

Krys Layane Guimarães Duarte Queiroz ◽

Cláudio Marcello da Silveira Júnior ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Wide Spectrum ◽

Interleukin 1 ◽

Clinical Manifestations ◽

Cellular Functions ◽

Pcr Rflp ◽

Plasma Cytokines ◽

Polymerase Chain ◽

Leishmania Guyanensis ◽

Necrosis Factor

Leishmania are intracellular protozoan parasites that cause a wide spectrum of clinical manifestations in genetically susceptible individuals with an insufficient or balanced Th1 immune response to eliminate the parasite. MiRNAs play important regulatory role in numerous biological processes including essential cellular functions. miR146-a acts as an inhibitor of interleukin 1 receptor associated kinase 1 (IRAK1) and tumour necrosis factor (TNF) receptor associated factor 6 (TRAF6) present in the toll-like receptors pathway while miR499a modulates TGF-β and TNF signalling pathways. Here, we investigated whether MIRNA146A rs2910164 and MIRNA499 rs3746444 variants are associated with the development of L. guyanensis (Lg)-cutaneous leishmaniasis (CL). The variants MIR146A rs2910164 and MIR499A rs3746444 were assessed in 850 patients with Lg-CL and 891 healthy controls by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Plasma cytokines were measured using the BioPlex assay. Carriers of rs2910164 CC genotype have 30% higher odds of developing CL (ORadjage/sex = 1.3 [95%CI 0.9–1.8]; Padjage/sex 0.14) compared to individuals with the genotype GG (ORadjage/sex = 0.77 [95%CI 0.56–1.0]; Padjage/sex 0.14) if exposed to Lg-infection. Heterozygous GC individuals also showed lower odds of developing CL (ORadjage/sex = 0.77 [95%CI 0.5–1.1]; Padjage/sex 0.09). Homozygosity for the allele C is suggestive of an association with the development of Lg-CL among exposed individuals to Lg-infection. However, the odds of developing CL associated with the CC genotype was evident only in male individuals (ORadjage = 1.3 [95% CI = 0.9–2.0]; Padjage = 0.06). Individuals homozygous for the G allele tend to have higher plasma IL-8 and CCL5. Similarly, for the MIR499A rs3746444, an association with the G allele was only observed among male individuals (OR = 1.4 [1.0–1.9]; P = 0.009). In a dominant model, individuals with the G allele (GG-GA) when compared to the AA genotype reveals that carriers of the G allele have 40% elevated odds of developing Lg-CL (ORadjage = 1.4 [1.1–1.9]). Individuals with the GG genotype have higher odds of developing Lg-CL (ORadjage/sex = 2.0 [95%CI 0.83–5.0]; Padjage = 0.01. Individuals homozygous for the G allele have higher plasma IL-8. Genetic combinations of both variants revealed that male individuals exposed to Lg bearing three or four susceptible alleles have higher odds of developing Lg-CL (OR = 2.3 [95% CI 1.0–4.7]; p = 0.017). Both MIR146A rs2910164 and MIR499A rs3746444 are associated with the development of Lg-CL and this association is prevalent in male individuals.

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Prognostic value of 1q21 amplification in multiple myeloma

Terapevticheskii arkhiv ◽

10.17116/terarkh201789732-38 ◽

2017 ◽

Vol 89 (7) ◽

pp. 32-38 ◽

Cited By ~ 4

Author(s):

T V Abramova ◽

T N Obukhova ◽

L P Mendeleeva ◽

O S Pokrovskaya ◽

E O Gribanova ◽

...

Keyword(s):

Multiple Myeloma ◽

Survival Rate ◽

Disease Progression ◽

Chromosomal Abnormalities ◽

Disease Onset ◽

Clinical Manifestations ◽

Diagnostic Study ◽

Extra Copy ◽

Course Of Disease

Aim. To determine the prevalence of amp1q21 and its relationship to the clinical manifestations of multiple myeloma (MM). Subjects and methods. In December 2009 to March 2016, a total 134 patients aged 30 to 81 years (median 57 years) underwent a pretreatment FISH-study of bone marrow (BM) with centromeric and locus-specific DNA probes to identify amp1q21, t(11;14), t(4;14), t(14;16), t(14;20), t(6;14), trisomies of chromosomes 5, 9, 15, del13q14, del17p13/TP53, and t(8q24)/cMYC. Induction therapy with bortezomib-containing cycles was performed. Autologous stem cell transplantation was carried out in 48 patients. The median follow-up of patients was 19.3 months (3.2—77.4 months). Disease progression was diagnosed in 69 (51.5%) patients; 12 patients also underwent FISH study during disease progression. Results. At the onset of MM, amp1q21 was detected in 53 (39.6%) patients. The overall 5-year survival rate in patients with amp1q21 was almost 2 times lower than that in those without amp1q21 (43.5 and 79.4%, respectively; p=0.07). The overall 5-year survival rate in patients with one extra copy of 1q21 (only 3 copies) was 67.3%, that in those with 2 or more extra copies of 1q21 (only 4—7 copies) was 20.9% (p=0.0016). Nine (75%) of the 12 patients examined during disease progression were found to have amp1q21: 2 cases were detected in the period of progression to have amp1q21 in its absence at disease onset; 7 cases had amp1q21 both at MM onset and progression; however, the number of copies of 1q21 was unchanged. Conclusion. Аmp1q21 is one of the most common chromosomal abnormalities in patients with new-onset MM and may appear in the course of disease progression. The presence of аmp1q21 is an important prognostic factor and must have to be included in the diagnostic study both at disease onset and progression.

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Acute retinal necrosis: Clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction–positive patients

European Journal of Ophthalmology ◽

10.1177/1120672120936181 ◽

2020 ◽

pp. 112067212093618

Author(s):

Alireza Hedayatfar ◽

Nazanin Ebrahimiadib ◽

Mohammad Zarei ◽

Maryam Ashraf Khorasani ◽

Mirgholamreza Mahbod ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Clinical Diagnosis ◽

Disease Onset ◽

Acute Retinal Necrosis ◽

Therapeutic Interventions ◽

Viral Agent ◽

Chain Reaction ◽

Visual Outcomes ◽

Polymerase Chain

Purpose: To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. Methods: From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Results: Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6–25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1–2 quadrant vs 3–4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD. At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Conclusion: Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

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Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000600004 ◽

2012 ◽

Vol 45 (6) ◽

pp. 675-681 ◽

Cited By ~ 23

Author(s):

Ricardo Tristão-Sá ◽

Claire Fernandes Kubelka ◽

Eliana Zandonade ◽

Sônia Maria Oliveira Zagne ◽

Natally de Souza Maciel Rocha ◽

...

Keyword(s):

Cohort Study ◽

Disease Onset ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Denv Infection ◽

Duration Of Symptoms ◽

Persistent Symptoms ◽

Study Results ◽

Taste Alteration

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

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