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1.
Rev Soc Bras Med Trop ; 54: e05192020, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533817

RESUMEN

INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.


Asunto(s)
Dengue , Dengue Grave , Adulto , Niño , Dengue/diagnóstico , Hematócrito , Humanos , India/epidemiología , Recuento de Leucocitos , Estudios Retrospectivos , Dengue Grave/diagnóstico
2.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33370956

RESUMEN

COVID-19, caused by SARS-CoV-2, has spread globally. Coinfection with other endemic viruses is likely to complicate the clinical presentation and outcome. Information on clinical manifestations and management strategies on COVID-19 coinfection with endemic diseases in children is yet to evolve. The risk of dengue infection exists in 129 countries and it is endemic in more than 100 countries. The SARS-CoV-2 pandemic might overlap with the dengue epidemics in tropical countries. We report the first paediatric case to the best of our knowledge of COVID-19 encephalitis with dengue shock syndrome. This clinical syndrome could be attributed to serological cross-reactivity, incidental coinfection or perhaps a warning for dengue-endemic regions to face the unique challenge of differentiating and managing two disease entities together. Enhanced understanding of potential COVID-19 and dengue coinfection warrants immediate attention of researchers and international health policy makers.


Asunto(s)
/epidemiología , Coinfección/epidemiología , Virus del Dengue/inmunología , Pandemias , Dengue Grave/epidemiología , Adolescente , Anticuerpos Antivirales/análisis , Femenino , Humanos , Dengue Grave/diagnóstico , Tomografía Computarizada por Rayos X
3.
BMC Infect Dis ; 20(1): 948, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33308178

RESUMEN

BACKGROUND: Dengue patients develop different disease severity ranging from mild (dengue fever [DF]) to severe forms (dengue hemorrhagic fever [DHF] and the fatal dengue shock syndrome [DSS]). Host genetics are considered to be one factor responsible for the severity of dengue outcomes. To identify genes associated with dengue severity that have not been studied yet, we performed genetic association analyses of interferon lambda 3 (IFNL3), CD27, and human leukocyte antigen-DPB1 (HLA-DPB1) genes in Thai dengue patients. METHODS: A case-control association study was performed in 877 children (age ≤ 15 years) with dengue infection (DF, n = 386; DHF, n = 416; DSS, n = 75). A candidate single nucleotide polymorphism of each of IFNL3, CD27, and HLA-DPB1 was selected to be analyzed. Genotyping was performed by TaqMan real-time PCR assay, and the association with dengue severity was examined. RESULTS: The rs9277534 variant of HLA-DPB1 was weakly associated with DHF. The genotype GG and G allele conferred protection against DHF (p = 0.04, odds ratio 0.74 for GG genotype, p = 0.03, odds ratio 0.79 for G allele). The association became borderline significant after adjusting for confounders (p = 0.05, odds ratio 0.82). No association was detected for IFNL3 or CD27. CONCLUSIONS: The present study demonstrated the weak association of the rs9277534 variant of HLA-DPB1 with protection against DHF. This variant is in the 3' untranslated region and affects HLA-DPB1 surface protein expression. Our finding suggests that HLA-DPB1 may be involved in DHF pathogenesis.


Asunto(s)
Virus del Dengue/genética , Virus del Dengue/inmunología , Cadenas beta de HLA-DP/genética , Interferones/genética , Dengue Grave/epidemiología , Dengue Grave/genética , Índice de Severidad de la Enfermedad , Miembro 7 de la Superfamilia de Receptores de Factores de Necrosis Tumoral/genética , Regiones no Traducidas 3'/genética , Adolescente , Alelos , Estudios de Casos y Controles , Niño , Virus del Dengue/aislamiento & purificación , Femenino , Estudios de Asociación Genética , Genotipo , Humanos , Masculino , Oportunidad Relativa , Polimorfismo de Nucleótido Simple , Dengue Grave/virología , Tailandia/epidemiología
4.
PLoS Comput Biol ; 16(10): e1008292, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33075052

RESUMEN

The lack of effective vaccines for many endemic diseases often forces policymakers to rely on non-immunizing control measures, such as vector control, to reduce the massive burden of these diseases. Controls can have well-known counterintuitive effects on endemic infections, including the honeymoon effect, in which partially effective controls cause not only a greater initial reduction in infection than expected, but also large outbreaks during control resulting from accumulation of susceptibles. Unfortunately, many control measures cannot be maintained indefinitely, and the results of cessation are poorly understood. Here, we examine the results of stopped or failed non-immunizing control measures in endemic settings. By using a mathematical model to compare the cumulative number of cases expected with and without control, we show that deployment of control can lead to a larger total number of infections, counting from the time that control started, than without any control-the divorce effect. This result is directly related to the population-level loss of immunity resulting from non-immunizing controls and is seen in a variety of models when non-immunizing controls are used against an infection that confers immunity. Finally, we examine three control plans for minimizing the magnitude of the divorce effect in seasonal infections and show that they are incapable of eliminating the divorce effect. While we do not suggest stopping control programs that rely on non-immunizing controls, our results strongly argue that the accumulation of susceptibility should be considered before deploying such controls against endemic infections when indefinite use of the control is unlikely. We highlight that our results are particularly germane to endemic mosquito-borne infections, such as dengue virus, both for routine management involving vector control and for field trials of novel control approaches, and in the context of non-pharmaceutical interventions aimed at COVID-19.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Enfermedades Endémicas/prevención & control , Programas de Inmunización , Animales , Número Básico de Reproducción , Infecciones por Coronavirus/prevención & control , Culicidae , Vacunas contra el Dengue/uso terapéutico , Política de Salud , Humanos , Insectos Vectores , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública , Rubéola (Sarampión Alemán)/prevención & control , Vacuna contra la Rubéola/uso terapéutico , Estaciones del Año , Dengue Grave/prevención & control , Vacunas Virales/uso terapéutico
5.
Cytokine ; 136: 155256, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32866898

RESUMEN

The COVID-19 pandemic has rapidly spread around the world with significant morbidity and mortality in a subset of patients including the elderly. The poorer outcomes are associated with 'cytokine storm-like' immune responses, otherwise referred to as 'hyperinflammation'. While most of the infected individuals show minimal or no symptoms and recover spontaneously, a small proportion of the patients exhibit severe symptoms characterized by extreme dyspnea and low tissue oxygen levels, with extensive damage to the lungs referred to as acute respiratory distress symptom (ARDS). The consensus is that the hyperinflammatory response of the host is akin to the cytokine storm observed during sepsis and is the major cause of death. Uncertainties remain on the factors that lead to hyperinflammatory response in some but not all individuals. Hyperinflammation is a common feature in different viral infections such as dengue where existing low-titer antibodies to the virus enhances the infection in immune cells through a process called antibody-dependent enhancement or ADE. ADE has been reported following vaccination or secondary infections with other corona, Ebola and dengue virus. Detailed analysis has shown that antibodies to any viral epitope can induce ADE when present in sub-optimal titers or is of low affinity. In this review we will discuss ADE in the context of dengue and coronavirus infections including Covid-19.


Asunto(s)
Acrecentamiento Dependiente de Anticuerpo/inmunología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/veterinaria , Peritonitis Infecciosa Felina/inmunología , Inflamación/patología , Pandemias/veterinaria , Neumonía Viral/inmunología , Neumonía Viral/veterinaria , Dengue Grave/inmunología , Animales , Gatos , Citocinas/metabolismo
6.
PLoS Negl Trop Dis ; 14(9): e0008603, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32925941

RESUMEN

BACKGROUND: The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. METHODOLOGY/PRINCIPAL FINDINGS: We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were designated SD using an adapted WHO 2009 classification for SD case definition. Systematic use of ultrasound at patient admission was crucial for detecting plasma leakage. No difference was observed in the concentration of secreted NS1 protein between different dengue severity groups. Lipid profiles were different between DWWS and SD at admission, characterized by a decrease in total cholesterol, HDL cholesterol, and LDL cholesterol, in SD. CONCLUSIONS/SIGNIFICANCE: Our results show discrepancies between the two classifications, including misclassification of severe dengue cases as mild cases by the WHO 1997 classification. Using an adapted WHO 2009 classification, SD more precisely defines the group of patients requiring careful clinical care at a given time during hospitalization.


Asunto(s)
Dengue Grave/clasificación , Dengue Grave/patología , Índice de Severidad de la Enfermedad , Adolescente , Cambodia , Niño , Niño Hospitalizado , Preescolar , Colesterol/sangre , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Estudios Prospectivos , Dengue Grave/diagnóstico , Triglicéridos/sangre , Proteínas no Estructurales Virales/metabolismo , Organización Mundial de la Salud
7.
Lakartidningen ; 1172020 09 04.
Artículo en Sueco | MEDLINE | ID: mdl-32885406

RESUMEN

Dengue is a mosquito-borne viral disease found in tropical and sub-tropical climates worldwide. Due to globalization and climate change dengue is an increasing global concern. Symptoms typically appear 3-14 days after inoculation by the Aedes mosquito and most commonly manifests as a self-limiting febrile illness. However, in severe dengue, plasma leakage may be profound and result in hemorrhage, disseminated intravascular coagulation and circulatory collapse. The dengue virus may also cause organ dysfunction. Cases of myocarditis, myocardial dysfunction and arrhythmias including atrioventricular block have been reported. The atrioventricular block often resolves spontaneously but pharmacological and pacing support may be required. We report a case of dengue in a patient who was admitted to a Swedish hospital after visiting India. In this case total atrioventricular block without ventricular escape rhythm resolved spontaneously and no pacemaker was necessary.


Asunto(s)
Arritmias Cardíacas , Virus del Dengue , Dengue , Dengue Grave , Animales , Arritmias Cardíacas/virología , Dengue/complicaciones , Humanos , India
8.
Science ; 369(6507): 1055-1056, 2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32855325
9.
Science ; 369(6507): 1123-1128, 2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32855339

RESUMEN

The Zika pandemic sparked intense interest in whether immune interactions among dengue virus serotypes 1 to 4 (DENV1 to -4) extend to the closely related Zika virus (ZIKV). We investigated prospective pediatric cohorts in Nicaragua that experienced sequential DENV1 to -3 (2004 to 2015), Zika (2016 to 2017), and DENV2 (2018 to 2020) epidemics. Risk of symptomatic DENV2 infection and severe disease was elevated by one prior ZIKV infection, one prior DENV infection, or one prior DENV infection followed by one ZIKV infection, compared with being flavivirus-naïve. By contrast, multiple prior DENV infections reduced dengue risk. Further, although high preexisting anti-DENV antibody titers protected against DENV1, DENV3, and ZIKV disease, intermediate titers induced by previous ZIKV or DENV infection enhanced future risk of DENV2 disease and severity, as well as DENV3 severity. The observation that prior ZIKV infection can modulate dengue disease severity like a DENV serotype poses challenges to development of dengue and Zika vaccines.


Asunto(s)
Virus del Dengue/inmunología , Dengue Grave/epidemiología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/inmunología , Virus Zika/inmunología , Anticuerpos Antivirales/sangre , Vacunas contra el Dengue/inmunología , Humanos , Inmunogenicidad Vacunal , Nicaragua/epidemiología , Riesgo , Serogrupo
10.
PLoS One ; 15(8): e0237141, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764789

RESUMEN

Severe dengue can be lethal caused by manifestations such as severe bleeding, fluid accumulation and organ impairment. This study aimed to investigate the role of dengue non-structural 1 (NS1) protein and host factors contributing to severe dengue. Electrical cell-substrate impedance sensing system was used to investigate the changes in barrier function of microvascular endothelial cells treated NS1 protein and serum samples from patients with different disease severity. Cytokines and metabolites profiles were assessed using a multiplex cytokine assay and liquid chromatography mass spectrometry respectively. The findings showed that NS1 was able to induce the loss of barrier function in microvascular endothelium in a dose dependent manner, however, the level of NS1 in serum samples did not correlate with the extent of vascular leakage induced. Further assessment of host factors revealed that cytokines such as CCL2, CCL5, CCL20 and CXCL1, as well as adhesion molecule ICAM-1, that are involved in leukocytes infiltration were expressed higher in dengue patients in comparison to healthy individuals. In addition, metabolomics study revealed the presence of deregulated metabolites involved in the phospholipid metabolism pathway in patients with severe manifestations. In conclusion, disease severity in dengue virus infection did not correlate directly with NS1 level, but instead with host factors that are involved in the regulation of junctional integrity and phospholipid metabolism. However, as the studied population was relatively small in this study, these exploratory findings should be confirmed by expanding the sample size using an independent cohort to further establish the significance of this study.


Asunto(s)
Citocinas/sangre , Virus del Dengue/inmunología , Interacciones Huésped-Patógeno/inmunología , Dengue Grave/sangre , Proteínas no Estructurales Virales/sangre , Línea Celular , Citocinas/inmunología , Citocinas/metabolismo , Virus del Dengue/metabolismo , Células Endoteliales/inmunología , Células Endoteliales/metabolismo , Endotelio Vascular/citología , Endotelio Vascular/inmunología , Endotelio Vascular/patología , Humanos , Fosfolípidos/metabolismo , Cultivo Primario de Células , Dengue Grave/inmunología , Dengue Grave/metabolismo , Dengue Grave/patología , Proteínas no Estructurales Virales/inmunología
11.
Arch Virol ; 165(9): 2029-2035, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32617762

RESUMEN

Only a minority of dengue infections lead to plasma leakage (critical phase [CP]). Early identification of the risk for CP is helpful for triage of patients. This study aimed to identify early clinical predictors of CP that will aid in patient triage during early illness. A retrospective, case-record-based analysis was performed on all microbiologically confirmed (NS1-antigen- or dengue-IgM-antibody-positive), dengue patients (n = 697), admitted to our unit from 01.01.2017 to 30.06.2017. Bivariate analysis was performed to identify clinical and laboratory parameters that predicted CP. Stepwise multivariate logistic regression with backward elimination (p < 0.05) was used to identify independent risk factors for CP. CP developed in 226 (32.4%) patients. Mortality was 1.0%. Predictors for CP (p < 0.05) within the first three days included age category 41-50 years (OR = 1.96), females (OR = 2.09), diabetes (OR = 1.30), persistent vomiting (OR = 2.18), platelet count < 120,000/mm-3 (OR = 1.91) and AST > 60 IU/L (OR = 3.72). On multivariate analysis, other variables except diabetes remained significant. Elevated transaminase levels remained the strongest independent predictor of CP (OR 2.83). The absence of all five risk factors excluded CP (negative predictive value: 97.2%). Age 41-50 years, female gender, persistent vomiting, thrombocytopenia, and elevated transaminases were early predictors of CP in dengue fever. The absence of these can be used to identify patients who may not require hospital admission. Elevated transaminase was the strongest predictor of CP during early illness.


Asunto(s)
Virus del Dengue/aislamiento & purificación , Dengue Grave/virología , Adolescente , Adulto , Anciano , Virus del Dengue/clasificación , Virus del Dengue/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Estudios Retrospectivos , Dengue Grave/sangre , Dengue Grave/diagnóstico , Adulto Joven
12.
Am J Trop Med Hyg ; 103(3): 1223-1227, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32618241

RESUMEN

Dengue-related mortality has significantly reduced with early and appropriate fluid resuscitation. However, we continue to see dengue-related fatalities in patients despite early intervention and advanced critical care support. This was a retrospective study conducted at a tertiary care private hospital in Mumbai, India. All patients dying of dengue in the calendar year 2017 were studied. Details related to age, gender, condition at presentation, laboratory parameters, treatment administered, and time to death were abstracted from case records. A total of 575 patients with a diagnosis of dengue were admitted to the hospital in 2017, of which 15 died (mortality rate 2.6%). Four patients died in the emergency medical unit; 11 patients who died after admission to the inpatient unit had multi-organ dysfunction at the time of presentation, with shock, severe liver dysfunction, and severe metabolic acidosis. Only 4/11 patients had hemoconcentration, and 10/11 patients had high white cell counts. In five patients where serum ferritin was performed, it was more than 40,000 ng/mL. Death occurred at a median time of 2 days after hospitalization despite good supportive care. Although there is scope for improvement of supportive care in these patients, it appears that other interventions are urgently needed to improve outcomes in severe dengue. This calls for more research into the immunopathology of dengue, evaluation of anti-inflammatory drugs, intravenous immunoglobulins, antivirals, and improved vaccines.


Asunto(s)
Dengue/diagnóstico , Dengue Grave/diagnóstico , Adolescente , Adulto , Anciano , Niño , Preescolar , Cuidados Críticos , Dengue/inmunología , Dengue/terapia , Dengue/virología , Femenino , Fluidoterapia , Hospitalización , Hospitales Privados , Humanos , India , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Dengue Grave/inmunología , Dengue Grave/terapia , Dengue Grave/virología , Atención Terciaria de Salud , Adulto Joven
14.
BMC Public Health ; 20(1): 923, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32532240

RESUMEN

BACKGROUND: The spread of Dengue virus (DENV) infections, as well as their signs and symptoms, are the result of a complex interaction between several factors. In Brazil, especially in the Northeastern, dengue is an important public health problem. Here, we report an epidemiological analysis of dengue cases in Pernambuco state, Northeastern Brazil, during 2015-2017. METHODS: This work is a retrospective cross-sectional observational study on the epidemiological profile of all dengue cases confirmed and reported to the Health Secretary of Pernambuco between 2015 and 2017. These data cover all municipalities of Pernambuco, except Fernando de Noronha. DENV-positive individuals were classified according to the dengue type (without and with warning signs, or severe dengue), age, gender, ethnicity and intermediate geographic region of residence (Recife, Caruaru, Serra Talhada or Petrolina). The distribution of cases over the years was assessed by χ2 test. Temperature and rainfall data were evaluated by Unpaired t-test. p-value < 0.05 and CI 95% were considered in all analyses. RESULTS: Most dengue cases was without warning signs. The most observed characteristics in the less severe dengue phenotypes were: female, mulatto ethnicity and age between 20 and 39 years old; this profile was more clearly observed in 2015. In 2016 and 2017, however, the numbers of dengue without and with warning signs were more evenly distributed and the difference in cases within groups decreased significantly. Regarding severe dengue, mulattoes were the most affected, but it is possible to note a trend towards a more uniform distribution between the genders and ages. Recife was the region with the highest numbers of both total cases and incidence rates and the highest rainfall levels. Overall, over the years, there has been a decrease in dengue cases in all regions of Pernambuco. CONCLUSIONS: We identified the epidemiological profile of dengue in Pernambuco, Brazil, reporting the gender, age, ethnicity and regions most affected by different dengue types. In addition, we observed that these cases were probably more influenced by rainfall than by temperature. Finally, we believe that this epidemiological knowledge is important to direct public health policies to the reality of each population.


Asunto(s)
Dengue/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Demografía , Dengue/etnología , Virus del Dengue , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Lluvia , Estudios Retrospectivos , Dengue Grave/epidemiología , Adulto Joven
15.
BMC Infect Dis ; 20(1): 335, 2020 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398134

RESUMEN

BACKGROUND: Dengue fever is a hemorrhagic fever caused by flaviviruses. Hemorrhagic manifestations are well known to be associated with dengue fever, though the thrombotic events are only seldom reported. Underlying pathophysiology of thrombotic events is multifactorial and the management is challenging due to associated thrombocytopenia and bleeding tendency. We report a case of dengue shock syndrome with severe thrombocytopenia complicated by ilio-femoral deep vein thrombosis. CASE PRESENTATION: A 16 year old boy presented with dengue fever. He had dengue shock syndrome after entering the critical phase on the fifth day of the illness. With the recovery from the critical phase he developed deep vein thrombosis involving right external iliac, common femoral and superficial femoral veins. There were no provocative factors other than dengue fever itself. His platelet count was 12,000/µl at the time of diagnosis with deep vein thrombosis. Anticoagulation was started with intravenous unfractionated heparin 500 IU/hour while closely being observed for bleeding complications. 1000 IU/hour dose was commenced with the recovery of the platelet count above 50,000/µl. Thrombophilia screening was negative and he was discharged on warfarin. Venous duplex done after 6 weeks showed normal lower limb venous flow and warfarin was omitted after three months. CONCLUSIONS: With dengue fever, complications like deep vein thrombosis can be easily missed given its rarity and that the major concern is on hemorrhagic complications. Management is challenging due to associated thrombocytopenia and hemorrhagic complications.


Asunto(s)
Virus del Dengue/inmunología , Vena Femoral/patología , Extremidad Inferior/irrigación sanguínea , Dengue Grave/complicaciones , Trombocitopenia/complicaciones , Trombosis de la Vena/etiología , Administración Intravenosa , Adolescente , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Antígenos Virales/análisis , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Masculino , Resultado del Tratamiento , Trombosis de la Vena/tratamiento farmacológico , Warfarina/uso terapéutico
16.
Platelets ; 31(4): 412-414, 2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32310724

RESUMEN

Thrombocytopenia and vascular leakage are clinical hallmarks in dengue hemorrhagic fever. Sung et al. present a new mechanism where platelet-derived extracellular vesicles participate in increasing vascular permeability during dengue virus infection in mice.


Asunto(s)
Vesículas Extracelulares , Dengue Grave , Trombocitopenia , Animales , Plaquetas , Ratones
17.
PLoS Negl Trop Dis ; 14(3): e0008076, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32130212

RESUMEN

Severe dengue was perceived as one clinical disease entity until the WHO 2009 classification stratified it into severe vascular leakage, severe bleeding, and severe organ dysfunction. The objectives of this study were to investigate the potential use of severe dengue categories as endpoints for intervention research. 271 patients with severe dengue among 1734 confirmed dengue patients were followed prospectively in this hospital-based observational study in Latin America and Asia. We compared the distribution of severe dengue categories according to gender and age (below/above 15y), and determined the relative frequency and the overlap of severe dengue categories in the same patients. In a next step, we extended the analysis to candidate moderate severity categories, based on recently suggested definitions which were adapted for our purposes. Severe vascular leakage occurred in 244 (90%), severe bleeding in 39 (14%), and severe organ dysfunction in 28 (10%) of 271 severe dengue patients. A higher frequency of severe leakage was seen in children or adolescents (<15y) compared to adults. More than 80% of the severe leakage cases, and 30-50% of the cases with severe bleeding or severe organ dysfunction, were defined as severe on the basis of that feature alone. In 136 out of 213 patients with severe leakage alone, neither moderate bleeding manifestation nor hepatic involvement was recorded. On the other hand, moderate leakage manifestations were detected in 4 out of 12 cases that were classified as severe based on bleeding alone. A major proportion of severe dengue patients exhibited clinical manifestations of severe vascular leakage only, which may constitute a useful endpoint for intervention research or pathophysiology studies. Severe bleeding and severe organ manifestation were recorded less frequently and exhibited a higher degree of overlap with severe leakage. Severe bleeding without leakage may be associated with individual predisposition or the presence of comorbidities. More detailed assessments are needed to explore this hypothesis. Candidate moderate disease endpoints were investigated and need to be further validated.


Asunto(s)
Hospitalización , Dengue Grave/clasificación , Dengue Grave/patología , Adolescente , Factores de Edad , Asia , Niño , Femenino , Hospitales , Humanos , Incidencia , Pacientes Internos , América Latina , Masculino , Estudios Prospectivos , Adulto Joven
19.
Am J Trop Med Hyg ; 102(5): 943-950, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32124729

RESUMEN

Dengue is the most common mosquito-borne flaviviral infection in the world today. Several factors contribute and act synergistically to cause severe infection. One of these is dysregulated host immunological mediators that cause transient pathophysiology during infection. These mediators act on the endothelium to increase vascular permeability, which leads to plasma leakage compromising hemodynamics and coagulopathy. We conducted a prospective study to explore the expression of pro- and anti-inflammatory cytokines and how they relate to clinical dengue manifestations, by assessing their dynamics through acute dengue infection in adults admitted to the Hospital for Tropical Diseases, Bangkok, Thailand. We performed cytokine analysis at three phases of infection for 96 hospitalized adults together with serotyping of confirmed dengue infection during the outbreaks of 2015 and 2016. The serum concentrations of seven cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor alpha, and interferon gamma) were measured in duplicate using a commercial kit (Bio-Plex Human Cytokine Assay). In this study, the cytokine profile was suggestive of a T-helper 2 response. Most patients had secondary infection, and the levels of viremia were higher in patients with plasma leakage than those without plasma leakage. In addition, we observed that bleeding and hepatitis were associated with significantly higher levels of IL-8 during the early phases of infection. Furthermore, IL-6 levels in the early phase of infection were also elevated in bleeding patients with plasma leakage. These results suggest that IL-6 and IL-8 may act in synergy to cause bleeding in patients with plasma leakage.


Asunto(s)
Citocinas/metabolismo , Dengue/metabolismo , Hemorragia/etiología , Hepatitis Viral Humana/etiología , Dengue Grave/metabolismo , Adulto , Citocinas/sangre , Dengue/complicaciones , Dengue/patología , Femenino , Hemorragia/metabolismo , Hemorragia/virología , Hepatitis Viral Humana/metabolismo , Hepatitis Viral Humana/virología , Humanos , Interferón gamma/sangre , Interferón gamma/metabolismo , Interleucina-10/sangre , Interleucina-10/metabolismo , Interleucina-4/sangre , Interleucina-4/metabolismo , Interleucina-6/sangre , Interleucina-6/metabolismo , Interleucina-8/sangre , Interleucina-8/metabolismo , Masculino , Estudios Prospectivos , Dengue Grave/complicaciones , Dengue Grave/patología , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/metabolismo , Carga Viral
20.
Rev. cuba. pediatr ; 92(1): e993, ene.-mar. 2020. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1093750

RESUMEN

Introducción: La forma más frecuente de dengue grave es el choque por dengue. Sin embargo, los lactantes con dengue no presentan las manifestaciones clinicas que lo caracterizan ni tienen tan a menudo esta complicación como lo hacen los pacientes con edades mayores. Objetivo: Dar a conocer las características clinicas y laboratoriales de una paciente menor de un año de edad cuyo síndrome de choque por dengue fue interpretado inicialmente como un caso de sepsis grave. Presentación del caso: Paciente femenina de 8 meses de edad con fiebre y diarreas que concurre a más de un centro hospitalario y la madre se niega a ingresarla. Al quinto dia de enfermedad apareció exantema y ya estando afebril presenta cianosis y otros signos de hipoperfusión tissular, haciéndole diagnóstico inicial de choque por sepsis. Responde satisfactoriamente a la reposición de líquidos cristaloides por via intravenosa administrados inicialmente y es enviada despues a una unidad de terapia intensiva pediátrica donde continua recibiendo tratamiento de rehidratacion y se inicia antibioticoterapia. Posteriormente, la sepsis fue descartada por la evolución del caso y los resultados de laboratorio clinico y microbiológicos, asi como una serología positiva a dengue. Conclusiones. El choque por dengue en el lactante puede expresarse sin su cuadro clinico típico y para su diagnostico es imprescindible considerar el antecedente epidemiológico(AU).


Introduction: The most common form of severe dengue is the dengue shock syndrome. However, infants with dengue don´t present the clinical manifestations that characterize it neither have this complication as often as older patients do. Objective: To know the clinical and laboratory characteristics of a patient of less than one-year-old whose dengue shock syndrome was initially interpreted as a case of severe sepsis. Case presentation: 8-months-old female patient with fever and diarrhea that was checked in more than one hospital and the mother refuses to hospitalize her. In the fifth day of being ill appeared exanthem, and having fever she presented cyanosis and other signs of tisular hypoperfusion, being initially diagnosed a sepsis shock. She responded satisfactorily to the replacement of crystalloid fluids intravenously administered initially and she was sent to a pediatric intensive care unit where she continued receiving rehydration treatment and antibiotic therapy was started. Subsequently, sepsis was ruled out due to the case´s evolutions and the clinical and microbiological laboratory´s results, as well as a serology positive to dengue fever. Conclusions: Dengue shock syndrome in an infant can present without its typical clinical manifestations and for its diagnosis is essential to consider the epidemiological history(AU)


Asunto(s)
Humanos , Femenino , Lactante , Choque/complicaciones , Dengue Grave/complicaciones , Sepsis/diagnóstico , Dengue Grave/diagnóstico , Diarrea Infantil/diagnóstico
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