Febre amarela: diagnóstico laboratorial e manifestações clínicas

Xavier, Analúcia R.; Freitas, Gabriela S.; Santos, Caroline F.; Januzzi, Werlley A.; Lacerda, Gilmar S.; Carvalho, Edimilson R. M.; Kanaan, Salim

doi:10.5935/1676-2444.20180050

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Jornal Brasileiro de Patologia e Medicina Laboratorial

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Sumário

LABORATORY MEDICINE, Review article • J. Bras. Patol. Med. Lab. 54 (5) • Set-Oct 2018 • https://doi.org/10.5935/1676-2444.20180050 copiar

Febre amarela: diagnóstico laboratorial e manifestações clínicas

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

A febre amarela é uma doença infecciosa de evolução aguda, a princípio não contagiosa, transmitida por um vírus do ácido ribonucleico (RNA) que pertence à família Flaviviridae. No período de dezembro de 2016 a 17 de março de 2017, foram notificados ao Ministério da Saúde, 1.561 casos suspeitos de febre amarela silvestre no Brasil. Destes, 850 (54, 8%) permanecem em investigação; 448 (28, 7%) foram confirmados e 263 (16, 9%), descartados. Do total dos casos notificados, 264 evoluíram para óbito, sendo 144 (54, 5%) confirmados para a doença; 110 (41, 7%) em investigação e 10 (3, 8%), descartados. A taxa de letalidade entre os casos confirmados foi de 32, 2%. O diagnóstico específico para determinação da etiologia da infecção pode ser feito por meio da demonstração da resposta humoral dos anticorpos, do isolamento do vírus ou do estudo histopatológico do fígado. Apenas mediante o diagnóstico laboratorial precoce e o abastecimento de dados epidemiológicos é que governo e organizações cooperativas poderão estabelecer políticas públicas de combate a futuras epidemias da doença, bem como campanhas de conscientização social.

Unitermos:
febre amarela; sinais e sintomas; diagnóstico clínico; diagnóstico diferencial

Yellow fever presentation form	Differential diagnosis with other diseases	Observations to be considered
Mild	Infectious diseases of urinary, digestive and respiratory tract Subacute hepatitis	Discreet increase in the transaminases reinforces the suspicion of yellow fever
Moderate
Severe	Leptospirosis	Possible diagnostic hypotheses should be corroborated by epidemiological, clinical and specific examination data
	Malaria
	Viral hepatitis
	Septicemia with jaundice
	Mountain fever
	Viral hemorrhagic fevers
	Phosphorus, halothane and other intoxications

Age	Situation	Vaccination scheme/indication
0-6 months	-	Vaccination contraindicated
6-9 months	-	Administer a dose only on suspicion of outbreak, epizootic or confirmation of viral circulation in wild vectors. This dose will not be validated for routine coverage purposes. Revaccinate according to the scheme of children from 9 months to 5 years of age
9 months-5 years	-	Administer a dose from 9 months and a booster dose at 4 years of age, respecting a 30-day period between applications
From 5 years	With a dose administered before completing 5 years	Administer a booster dose, respecting a 30-day period between applications
	No proof of vaccination or no vaccine	Administer the first dose, and 10 years later, apply a booster dose
	With two doses of vaccine administered	Consider immunized. No other doses are required
Individuals from 60 years	No proof of vaccination or without administered vaccines	The risk/benefit ratio should be evaluated by the doctor. They are considered: the risk of the disease, the risk of adverse effects for the age range and/or arising from comorbidities
In case of trips	International trip	Comply with recommendations of the International Health Regulation
In case of trips	National trip to areas in which the vaccine is recommended	Inoculation of the vaccine at least 10 days before the trip in case of an individual never vaccinated. In the case of revaccination, the minimum 10-day interval does not apply
Individuals with compromised immunity	Primary immunodeficiency In treatment with immunosuppressant drugs (corticosteroids, chemotherapy, radiotherapy, immunomodulators) History of anaphylactic reaction related to the substances present in the vaccine (chicken egg and its derivatives, bovine gelatin, for example) Former history of thymus diseases (myasthenia gravis, thymoma, cases of absence of thymus or surgical removal) With neoplasia HIV+ patients with severe immunosuppression, with CD4 cell count < 200 cells/mm³, or less than 15% of total lymphocytes for children under 6 years old Organs transplanted	Vaccination contraindicated
Women in special situations	Pregnant (regardless of vaccination status)	There is no indication for vaccination. If vaccination cannot be postponed (an outbreak, epidemiological emergency, epidemics or trip to risk areas), the risk/benefit should be assessed by the doctor
Women in special situations	Breastfeeding children up to 6 months old (regardless of vaccination status)	Vaccination is not indicated and should be postponed until the child is 6 months old. If it is not possible to postpone it (situations cited above), the risk/benefit should be evaluated by the doctor. For women who have received the vaccine and are breastfeeding, breastfeeding should be interrupted for 15 to 28 days

Sociedade Brasileira de Patologia Clínica, Rua Dois de Dezembro,78/909 - Catete, CEP: 22220-040v - Rio de Janeiro - RJ, Tel.: +55 21 - 3077-1400 / 3077-1408, Fax.: +55 21 - 2205-3386 - Rio de Janeiro - RJ - Brazil
E-mail: jbpml@sbpc.org.br

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[1] CORRESPONDING AUTHOR: Analúcia Rampazzo Xavier, Rua Marquês do Paraná, 303; Centro. CEP: 24033-900; Niterói-RJ, Brasil, Phone: +55 (21) 2629-9111. e-mail: analuciaxavier@id.uff.br