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1.
Pak J Pharm Sci ; 32(4): 1545-1554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31608873

RESUMO

Malaria, dengue and chikungunya are the most rampant mosquito-borne infections predominantly in Pakistan. They pose a serious threat and cause a havoc for the victims owing to the life threatening signs and symptoms marked with elevated morbidity and mortality rate. It seems hard to discriminate due to common indications, consequently, deserves appropriate diagnosis prior elevated toll of death. Present article encompasses depth insights about their prevalence, diagnosis and clinical manifestation if erupt in the pandemic. However, host-vector-host cycle is the root cause of transmission and diverse mosquito species confer dissimilar infections. Indeed these infections are seasonal but other factors like flood, open irrigation channels, immense agricultural land, rich fauna and water reservoirs can't be overlooked. Dire need was felt to acknowledge and aware the public about local transmission, vector control, entomologic, research resources, diagnosis and advancement in healthcare system to alleviate them absolutely in future.


Assuntos
Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Dengue/diagnóstico , Dengue/epidemiologia , Malária/tratamento farmacológico , Malária/epidemiologia , Antimaláricos/uso terapêutico , Febre de Chikungunya/tratamento farmacológico , Dengue/complicações , Dengue/tratamento farmacológico , Humanos , Malária/diagnóstico , Paquistão/epidemiologia , Prevalência , Fatores Socioeconômicos
2.
Mymensingh Med J ; 28(3): 708-711, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391450

RESUMO

We are going to report a case study of dengue fever (DF) affecting myocardium and explore the literature. A gentleman of 28 years old experienced DF which was complicated by acute myocarditis, acute kidney injury and hepatitis in the Emergency Department of Apollo Hospitals, Dhaka, Bangladesh on 5th August 2017. Clinically it was considered as an acute coronary syndrome due to depressed ST segment in chest leads ECG, extreme bradycardia but normal serum troponin-I level. He had to undergo temporary pacemaker insertion for symptomatic bradycardia and later on, he was monitored closely. Fortunately, he recovered; pacemaker was removed on day 8 of his admission without any further complication. After 3 days, patient recovered with symptomatic treatment. In different publications, various manifestations of cardiac complications occurred, from self-limiting tachy-brady arrhythmia to severe damage of the myocardium, causing reduced blood pressure and pulmonary edema. To reduce morbidity and mortality, physicians should suspect for cardiac complications in patients with dengue fever and should manage these complications.


Assuntos
Dengue , Miocardite , Adulto , Bangladesh , Dengue/complicações , Eletrocardiografia , Humanos , Masculino , Miocardite/diagnóstico por imagem , Miocardite/virologia
3.
PLoS Pathog ; 15(8): e1007766, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31369649

RESUMO

Zika virus (ZIKV) and dengue virus (DENV) are genetically and antigenically related flaviviruses that now co-circulate in much of the tropical and subtropical world. The rapid emergence of ZIKV in the Americas in 2015 and 2016, and its recent associations with Guillain-Barré syndrome, birth defects, and fetal loss have led to the hypothesis that DENV infection induces cross-reactive antibodies that influence the severity of secondary ZIKV infections. It has also been proposed that pre-existing ZIKV immunity could affect DENV pathogenesis. We examined outcomes of secondary ZIKV infections in three rhesus and fifteen cynomolgus macaques, as well as secondary DENV-2 infections in three additional rhesus macaques up to a year post-primary ZIKV infection. Although cross-binding antibodies were detected prior to secondary infection for all animals and cross-neutralizing antibodies were detected for some animals, previous DENV or ZIKV infection had no apparent effect on the clinical course of heterotypic secondary infections in these animals. All animals had asymptomatic infections and, when compared to controls, did not have significantly perturbed hematological parameters. Rhesus macaques infected with DENV-2 approximately one year after primary ZIKV infection had higher vRNA loads in plasma when compared with serum vRNA loads from ZIKV-naive animals infected with DENV-2, but a differential effect of sample type could not be ruled out. In cynomolgus macaques, the serotype of primary DENV infection did not affect the outcome of secondary ZIKV infection.


Assuntos
Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Coinfecção/virologia , Vírus da Dengue/imunologia , Dengue/virologia , Infecção por Zika virus/virologia , Zika virus/imunologia , Animais , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Coinfecção/sangue , Coinfecção/complicações , Reações Cruzadas , Dengue/sangue , Dengue/complicações , Feminino , Macaca mulatta , Masculino , Infecção por Zika virus/sangue , Infecção por Zika virus/complicações
4.
Mikrobiyol Bul ; 53(3): 348-353, 2019 Jul.
Artigo em Turco | MEDLINE | ID: mdl-31414637

RESUMO

The frequency of travel-related infections in the world has increased due to the easily and widespread use of travel facilities in the 21st century. Vector-borne diseases are an important part of infectious diseases. Dengue fever is one of the travel-related infections that has been reported increasingly in recent years through the development of diagnostic methods. The aim of this report was to present two Dengue fever cases originating from travel. There was a story of mosquito bite during a trip to Sri Lanka travel in our first case. The patient was 30 years old and maculopapular rash appeared on the fifth day of contact. Three days after the onset of the rash, she has admitted to our clinic, complaining with fever and chills. Increased leukopenia and muscle enzymes were detected in the laboratory analysis. Real-time reverse transcriptase polimerase chain reaction (RT-PCR) was positive in the serum sample. The patient was followed up with supportive care and discharged by improvement. The second case, a 24-year-old male, had a story of mosquito bite during his trip to Malaysia. After the patient complained of fever, chills, fever, nausea, vomiting and muscle pain, the Dengue virus (DENV) NS1 antigen test performed in this country was found to be positive. In the second case, there was no maculopapular rash and laboratory analysis showed an increase in leukopenia, thrombocytopenia and muscle enzymes. RT-PCR positivity was detected in the serum sample. The patient was followed up with supportive treatment and discharged with cure. DENV infections are caused by DENV which is common in the tropical areas of the world. There are four DENV-1, DENV-2, DENV-3 and DENV-4 serotypes. DENV infections can present different clinical manifestations such as asymptomatic disease, viral syndrome, Dengue haemorrhagic fever, and Dengue shock syndrome. Dengue fever is often accompanied by arthritis, maculopapular rash and high fever. Our cases were defined as Dengue fever according to this definition. In the diagnosis of the disease, it is necessary first to be suspicious of the disease and the travel history must be questioned. In the definitive diagnosis, virus isolation, antigen, nucleic acid detection and serological tests are used. The virus can be isolated from blood, serum, urine and tissues. In the first five days after beginning of the symptoms associated with DENV infections, serum RT-PCR and Dengue NS1 antigen test may be positive.


Assuntos
Vírus da Dengue , Dengue , Doença Relacionada a Viagens , Adulto , Dengue/complicações , Dengue/diagnóstico , Dengue/patologia , Dengue/virologia , Vírus da Dengue/classificação , Exantema/etiologia , Feminino , Humanos , Malásia , Masculino , Sri Lanka , Resultado do Tratamento , Adulto Jovem
5.
J Med Case Rep ; 13(1): 271, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31462315

RESUMO

BACKGROUND: Dengue fever is a mosquito-borne illness prevalent mainly in the tropics. It is feared for causing the dengue hemorrhagic spectrum of the disease leading to significant morbidity and mortality. Its rarer manifestations are categorized as the expanded dengue syndrome, and though being recognized, they are not fully appreciated and understood. The involvement of the eye in dengue fever is one such phenomenon. CASE PRESENTATION: A 27-year-old South-Asian woman presented on day 2 of dengue fever, without capillary leakage, for further management. Despite developing hepatitis, she had an otherwise uncomplicated progression of the illness because she did not develop capillary leakage. On day 8 of the illness, she had the lowest platelet count and developed bilateral blurred vision. Examination revealed that only gross movements were detected in the left eye, and the right eye had a visual acuity of 6/9. She was diagnosed with foveolitis in the right eye and central serous chorioretinopathy in the left eye, along with hemorrhages in both eyes. These were confirmed by funduscopy, fluorescein angiography, optical coherence tomography, and macular scans. She received systemic and intravitreal steroids and was assessed regularly. After 6 months of observation, her visual acuity was 6/6 in the right eye and 6/9 in the left eye, which remained the same thereafter. DISCUSSION: The exact mechanism of eye involvement in dengue viral infection is poorly understood. Multiple causes have been suspected and include viral factors, immune mediation, capillary leakage, stress, and hemorrhage. Eye involvement is classically seen at the lowest platelet count and when the count begins to rise. Though symptoms are nonpathognomonic, blurring of vision is the commonest complaint, but the range of presentation is extensive and variable. Ophthalmological assessment and funduscopy are very useful in addition to advanced assessments. There is no clear consensus on management; suggestions range from conservative care to aggressive steroid therapy with immune modulation and even ophthalmological intervention. Recovery can be full or partial with a variable time scale. CONCLUSION: The extensive spectrum of possible visual symptoms should prompt the clinician to suspect any visual complaint as potential dengue eye involvement. Guided studies and screening are needed to better understand the true incidence of eye involvement in dengue fever.


Assuntos
Coriorretinopatia Serosa Central/virologia , Dengue/complicações , Retinite/virologia , Adulto , Hemorragia Ocular/virologia , Feminino , Humanos
6.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466966

RESUMO

We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.


Assuntos
Anemia Hemolítica/etiologia , Dengue/complicações , Dengue/tratamento farmacológico , Adulto , Teste de Coombs/métodos , Dengue/sangue , Dengue/imunologia , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Hemólise , Humanos , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Contagem de Reticulócitos , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Resultado do Tratamento
7.
Acta Trop ; 199: 105134, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31415737

RESUMO

The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.


Assuntos
Dengue/complicações , Dengue Grave/etiologia , Lesão Renal Aguda/etiologia , Adolescente , Criança , Pré-Escolar , Vírus da Dengue/imunologia , Humanos , Lactente , Pancreatite/etiologia , Síndrome de Reye/etiologia , Ruptura Esplênica/etiologia , Acidente Vascular Cerebral/etiologia
8.
Rev. neurol. (Ed. impr.) ; 69(3): 113-122, 1 ago., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184024

RESUMO

Introducción. El dengue es una infección arboviral causada por el virus del dengue. Se revisan las complicaciones neurológicas asociadas a dicha infección. Desarrollo. El carácter neurotropo del virus del dengue se ha confirmado en estudios epidemiológicos, series de casos y estudios histopatológicos. El rango de complicaciones neurológicas es del 5,6-14,6%, y son más frecuentes en los serotipos 1 y 3. La encefalopatía es el síndrome neurológico más común (0,5-6%); su prevalencia es mayor en los niños y los adolescentes. La detección del antígeno viral en el tejido cerebral y la presencia de pleocitosis o ARN en el líquido cefalorraquídeo son evidencia del carácter neurotropo del virus del dengue, que se manifiesta en forma de encefalitis. Los síndromes neurológicos durante la fase de convalecencia (encefalomielitis aguda diseminada, cerebelitis, opsoclonía-mioclonía, mononeuritis, polirradiculoneuritis y plexitis) parecen ser inmunomediados. La mielitis puede suceder durante la infección aguda por el virus del dengue y por un mecanismo inmunomediado en la fase de convalecencia. Mialgias, miositis, rabdomiólisis y parálisis hipopotasémica son ejemplos de disfunción muscular asociada al virus del dengue. La incidencia de ictus es del 0,26%, y puede ser isquémico o hemorrágico. Las complicaciones oftalmológicas incluyen maculopatía, hemorragia retiniana, neuropatía óptica y vitritis. Conclusiones. El espectro de complicaciones neurológicas por el virus del dengue es amplio. No existen datos fiables sobre su incidencia real porque la mayor parte de los estudios publicados son series o casos aislados


Introduction. Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed. Development. The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, polyradiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis. Conclusions. The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases


Assuntos
Humanos , Dengue/complicações , Doenças do Sistema Nervoso Central/virologia , Doenças Neuromusculares/virologia , Doenças Vasculares/virologia
9.
Acta Trop ; 197: 105064, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31220435

RESUMO

Guillain-Barre syndrome (GBS) is one of the main neurologic manifestations of arboviruses, especially Zika virus infection. As known, the prevalence of these diseases is high, so the risk of having an increase on GBS is relevant. The study purposes making a comparative survey between the involvement of dengue, Zika and chikungunya infections in the development of the GBS in Brazil, as well as search in literature resemblances and distinctions between beforehand reported cases. It was performed an electronic search in online databases, with articles published between the years of 2004-2018. A total of 729 articles about the proposed search were found, and 10 were selected according to inclusion and exclusion criteria. The medium age found in Brazilian studies was 429. The time lapse for the neurological symptoms manifest was 6,5-11 days. Facial palsy, paresthesia and member weakness were the main symptoms related. Pediatric cases are rare. There are many studies that implicated the association of GBS and arboviruses and point it to one of the main neurological manifestation of these infections. More research and consistent data are needed to clarify unanswered questions and guide public health measures.


Assuntos
Febre de Chikungunya/complicações , Dengue/complicações , Síndrome de Guillain-Barré/etiologia , Infecção por Zika virus/complicações , Feminino , Humanos , Masculino , Inquéritos e Questionários
10.
PLoS Negl Trop Dis ; 13(6): e0007438, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31226110

RESUMO

BACKGROUND: Dengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics. METHODS: A retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015. RESULTS: There were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case. CONCLUSION: The use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Dengue/complicações , Uso de Medicamentos/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Adolescente , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Feminino , Hospitais Privados , Hospitais de Ensino , Humanos , Indonésia , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
11.
BMJ Case Rep ; 12(6)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31253660

RESUMO

Transient splenial lesion(TSL) is seen in a variety of conditions and is detectable only on MRI of the brain. Dengue fever (DF) is a common viral infection encountered in the tropics. The affected patients may face neurological complications like encephalopathy and intracranial haemorrhage, or even ischaemic stroke. Non-cirrhotic hyperammonaemia is a rare scenario; and its occurrence in DF is unknown. The patient being described had DF and developed dysarthria. His MRI brain showed splenial hyperintensity. Further evaluation revealed non-cirrhotic hyperammonaemia. To the best of our knowledge, TSL due to non-cirrhotic hyperammonaemia in DF is an unreported scenario.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/virologia , Dengue/complicações , Dengue/diagnóstico , Hiperamonemia/etiologia , Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Diagnóstico Diferencial , Ácido Fólico/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Lactulose/uso terapêutico , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico
12.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164382

RESUMO

Dengue fever is known for its life-threatening complications of bleeding and capillary leak syndrome. We report an unusual complication of dengue fever causing panophthalmitis, leading to rapidly progressive painful visual loss within days. Later on, the patient developed secondary bacterial infection of the eyeball and developed multiple brain abscesses due to spread of infection from the eyeball. Culture from pus swab of the right eye grew Staphylococcus epidermidis. The patient was promptly treated with broad spectrum antibiotics and after stabilisation, evisceration of the affected eye was done. Supportive therapy in the form of mechanical ventilation in view of poor sensorium, platelet transfusions for thrombocytopenia and guided fluid therapy was also provided. After multiple challenges in the management of the patient, fortunately, the patient survived but we failed to save his right eye. Therefore, it is necessary to carefully examine all vital organs at an early stage to prevent unfortunate outcome.


Assuntos
Dengue/diagnóstico , Panoftalmite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus epidermidis/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Dengue/complicações , Dengue/diagnóstico por imagem , Dengue/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Panoftalmite/complicações , Panoftalmite/diagnóstico por imagem , Panoftalmite/tratamento farmacológico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/tratamento farmacológico , Baixa Visão/etiologia
14.
Drug Discov Ther ; 13(2): 101-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080200

RESUMO

Acute febrile illness (AFI) is one of the commonest indications for hospitalization and can present with varying severity including single or multiple organ dysfunction syndrome (MODS). During monsoon season, there is a spurt of AFI often caused by vector borne diseases leading to substantial morbidity and mortality. Our aim was to determine distribution of etiological causes, differential organ involvement and predictors of mortality in critically ill patients with AFI. It was a hospital based observational study which included patients with AFI with dysfunction of at least one organ system. The study was conducted over 4 months during monsoon season. Admitted patients were included who had been subjected to a standard battery of tests and managed with standard hospital based management protocol. 145 patients were included and etiology of fever was ascertained in 81.4% of patients with the most common single infection being chikungunya (20.7%) followed by dengue (20%) fever. Thrombocytopenia and deranged liver biochemistry each were seen in nearly 75% of the patients. Renal (50.3%) and nervous system (46.2%) dysfunction were the predominant organ failures. 49 patients died (33.8%) which correlated with predicted mortality by APACHE (acute physiological assessment and chronic health evaluation) II score. Independent predictors for mortality were older age (> 55 years) (p = 0.01), acidemia (p = 0.01), altered sensorium (p = 0.02) and coagulopathy (p = 0.048). Sub-group analysis revealed that amongst patients with MODS, hypotension could help differentiate between bacterial and non-bacterial causes (p = 0.01). Critically ill patients with AFI suffer from significant morbidity and mortality. Features like the presence of hypotension in MODS may differentiate between a bacterial cause vis-à-vis viral or protozoal etiology.


Assuntos
Febre de Chikungunya/epidemiologia , Estado Terminal/mortalidade , Dengue/epidemiologia , Hipotensão/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , APACHE , Adolescente , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/transmissão , Criança , Dengue/complicações , Dengue/transmissão , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/classificação , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Prospectivos , Fatores de Risco , Estações do Ano , Centros de Atenção Terciária , Adulto Jovem
15.
J Med Case Rep ; 13(1): 120, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31043165

RESUMO

BACKGROUND: Although dengue viral infections have emerged as one of the most important mosquito-borne diseases, neurological manifestations of dengue infections are uncommon. Guillain-Barré syndrome and Miller Fisher syndrome have been reported to occur as immune-mediated complications following dengue infection. We report the case of a patient who developed Miller Fisher syndrome during the acute phase of dengue fever suggesting that Miller Fisher syndrome may arise as a result of direct neurotropism of the dengue virus. CASE PRESENTATION: A 70-year-old Sri Lankan man with well-controlled diabetes mellitus and hypertension presented with fever of 3 days' duration, drooping of eyelids, dysarthria, and unsteady gait. He developed bilateral asymmetric partial ptosis, complete external ophthalmoplegia, bilateral palatal palsy, unilateral tongue weakness, ataxia, and areflexia from the second day of illness. He did not have limb weakness. He had evidence of acute dengue infection including progressive thrombocytopenia and leukopenia, positive dengue non-structural protein 1 antigen, dengue immunoglobulin M antibodies, and polymerase chain reaction detection of dengue virus genome in serum. Magnetic resonance imaging of his brain and cerebrospinal fluid analysis were normal. Polymerase chain reaction for dengue virus and immunoglobulin M antibodies in cerebrospinal fluid were negative. Nerve conduction studies showed axonal neuropathy. Antibodies (immunoglobulin G, immunoglobulin M, and immunoglobulin A) against GQ1b and GT1a were negative. He was treated with intravenously administered immunoglobulins and a recommended fluid regimen for dengue fever. He made a complete recovery from dengue fever in 7 days and Miller Fisher syndrome in 20 days. CONCLUSIONS: This case report highlights the rare occurrence of Miller Fisher syndrome during the acute phase of dengue fever. Neurological manifestations may occur as a consequence of direct neurotropism of dengue virus.


Assuntos
Dengue/diagnóstico , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome de Miller Fisher/diagnóstico , Oftalmoplegia/diagnóstico , Idoso , Artralgia/etiologia , Artralgia/virologia , Dengue/complicações , Dengue/fisiopatologia , Diplopia/virologia , Febre/virologia , Humanos , Masculino , Síndrome de Miller Fisher/etiologia , Síndrome de Miller Fisher/fisiopatologia , Debilidade Muscular/virologia , Oftalmoplegia/etiologia , Oftalmoplegia/virologia , Resultado do Tratamento
17.
BMC Infect Dis ; 19(1): 385, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060498

RESUMO

BACKGROUND: Dengue fever is a common infection with increasing numbers of patients affected. Muscle haematomas are a rare complication of dengue fever. In most cases haematomas resolve spontaneously. CASE PRESENTATION: We report a case of spontaneous psoas muscle haematoma, formed during the critical phase of dengue haemorrhagic fever. A 28-year-old gentleman presented with features of severe dengue and was admitted to the Dengue High Dependency Unit. He was treated with intravenous fluid therapy and supportive measures, and gradually improved initially. However, as the critical phase ended, he suddenly developed pain in the left groin and inguinal region and physical examination was normal. Ultrasound scan revealed a left psoas haematoma. As the patient deteriorated haemodynamically blood was transfused. He recovered without further complication and was discharged home. CONCLUSIONS: Dengue fever is a common tropical infection. Recognizing serious complications such as psoas haematoma presenting as simple complaints such as back pain and inguinal pain are important to prevent mortality.


Assuntos
Transfusão de Sangue , Dengue/diagnóstico , Hematoma/diagnóstico , Adulto , Anticorpos Antivirais/sangue , Dengue/complicações , Dengue/terapia , Vírus da Dengue/imunologia , Vírus da Dengue/isolamento & purificação , Hidratação , Hematoma/complicações , Hematoma/diagnóstico por imagem , Humanos , Masculino , Ultrassonografia
18.
Saudi J Kidney Dis Transpl ; 30(2): 394-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031376

RESUMO

Dengue-related renal manifestations such as proteinuria, hematuria in the absence of thrombocytopenia, rhabdomyolysis, and acute kidney injury (AKI) are not uncommon. There is relatively sparse data on the renal manifestations of dengue viral infection (DVI). Hence, a retrospective study was conducted to investigate the incidence, characteristics, and clinical outcome of DVI with renal manifestations. A total of 2416 patients were admitted to our hospital with the diagnosis of dengue fever during the study period from 2012 to 2015. Data were collected from the electronic medical records and were analyzed retrospectively. The disease severity was classified according to the World Health Organization criteria. The renal manifestations were divided into AKI and non-AKI groups using AKI Network (AKIN) criteria. Proteinuria was defined as urinary protein >1+ (30 mg/dL) by dipstick test. A total of 218 patients were found to have proteinuria (9.56%). Most of the patients [135 (58.44%) with renal manifestations] were aged between 15 and 30 years. Comorbid conditions including diabetes mellitus, hypertension, and ischemic heart disease were seen in 10 (4.31%), 11 (4.76%), and six (2.59%) patients, respectively. Nephrotic-range proteinuria was seen in five patients (2.16%). AKI was seen in 82 patients (3.4%); 58 (70.73%) had AKIN-I, 19 (23.17%) had AKIN-II, and five patients (6.09%) had AKIN-III. Death occurred in 11 patients (39.28%) with AKI. The incidence of renal manifestations (proteinuria, hematuria, and AKI) is high at 9.59% among patients with dengue, and those with AKI had significant morbidity, mortality, longer hospital stay, and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase health-care burden that underscores the need for clinician's alertness to this highly morbid and potentially fatal complication for optimal prevention and management.


Assuntos
Lesão Renal Aguda/epidemiologia , Dengue/complicações , Diabetes Mellitus/epidemiologia , Hematúria/epidemiologia , Hipertensão/epidemiologia , Proteinúria/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hematúria/virologia , Humanos , Incidência , Índia/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Proteinúria/virologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
19.
Ophthalmol Retina ; 3(2): 170-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31014768

RESUMO

PURPOSE: Dengue maculopathy can present with a unique constellation of features resulting in significant central visual morbidity. We aim to describe various findings of dengue-induced inflammatory, ischemic foveolitis, and outer maculopathy (DIII-FOM) and assess the serial changes in vitreous inflammation, retinal structure, and vascularity using swept-source OCT (SS-OCT) and OCT angiography (OCTA). DESIGN: Retrospective case series. PARTICIPANTS: A total of 32 eyes (16 patients; 7 male) with dengue fever (positive serology for NS1 antigen) were enrolled in the study. METHODS: In this study, serial assessments of ocular findings and imaging using fundus photography, SS-OCT, and SS-OCTA were performed. All the patients received 0.5 to 1 mg/kg/day oral prednisolone that was tapered over 4 to 6 weeks. MAIN OUTCOME MEASURES: Outcome measures included functional change, that is, improvement in best-corrected visual acuity (BCVA), structural changes in the vitreous and retinal layers on SS-OCT, and retinal perfusion on OCTA. RESULTS: The mean age of the patients was 29.17±10.91 years. Swept-source OCT showed vitreous cells (32 eyes; 100%), disruption of outer retinal layers (foveolitis) (24 eyes; 75%), and conical foveal elevation (22 eyes; 68.75%). After initiation of systemic corticosteroids, all the eyes showed resolution of vitreous cells and improvement in the integrity of retinal layers. Mean BCVA improved from an initial 0.80±0.33 logarithm of the minimum angle of resolution (logMAR) to 0.23±0.36 logMAR. Retinal plexus flow deficit (superficial plexus: 0.10±0.12 mm2; deep plexus: 0.29±0.13 mm2) persisted in all eyes and correlated well with initial BCVA (P < 0.05). CONCLUSIONS: The pathophysiology of dengue maculopathy involves both ischemic and inflammatory components. Early institution of corticosteroid therapy may help in resolution of the inflammation-driven vitreoretinal alterations, but ischemia of the deep retinal plexuses may persist and may be the cause of permanent structural and functional changes.


Assuntos
Dengue/complicações , Fóvea Central/patologia , Macula Lutea/patologia , Doenças Retinianas/patologia , Adolescente , Adulto , Feminino , Fóvea Central/irrigação sanguínea , Humanos , Isquemia , Masculino , Doenças Retinianas/etiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto Jovem
20.
PLoS One ; 14(4): e0215143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31009479

RESUMO

BACKGROUND: In Nigeria, recent reports suggest that dengue viruses could be a major cause of acute fevers. We sought to make a cross-sectional estimate of the prevalence of current and previous dengue infections in patients presenting with fever to healthcare centres in Cross River State Nigeria. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional health facility survey recruited persons with temperature ≥38°C. Dengue virus immunoglobulin M (IgM)/immunoglobulin G (IgG) antibody testing using Onsite Duo dengue Ag-IgG/IgM lateral flow immunoassay cassettes was done. Samples which tested positive were further confirmed using the RecombiLISA dengue IgM and IgG enzyme linked immunosorbent assay kits and classified into primary and secondary dengue infection. Malaria testing was carried out using microscopy. Between 4 January 2017 and 24 August 2017 a total of 420 participants were sampled across 11 health centres. The mean age was 34 (range = 1-99), 63% were female, 49% reported sleeping under a treated mosquito net in the past week and 44% reported taking an antimalarial prior to seeking care. The mean number of days fever was present prior to seeking care was 8, and many of the participants presented with symptoms indicative of respiratory or urinary tract infections. Testing indicated that 6% (95% CI: 2, 13; n = 24) had either a primary or secondary dengue infection with or without co-existing malaria, while 4% (95% CI: 2, 9; n = 16) had either a primary or secondary dengue infection without co-existing malaria. 52% (95% CI: 46, 58; n = 218) had a malaria infection with or without any dengue infection, and 50% (95% CI: 44, 57; n = 210) had a malaria infection without any dengue infection. CONCLUSION: Our study confirms the presence of dengue at not insignificant levels in patients attending health centres with fever in this south eastern province of Nigeria. These data highlight the danger of the common presumption in this setting that fever is due to malaria. Surveillance for dengue is vital in this setting.


Assuntos
Vírus da Dengue/imunologia , Dengue/complicações , Febre/diagnóstico , Febre/etiologia , Instalações de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Criança , Pré-Escolar , Estudos Transversais , Dengue/epidemiologia , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Feminino , Febre/sangue , Humanos , Imunoglobulina M/imunologia , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
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