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Demirhan S, Escobar Lee K, Herold BC. Visual Hallucinations and Headache in a Returning Adolescent Traveler. Clin Pediatr (Phila) 2024; 63:1329-1332. [PMID: 38767296 DOI: 10.1177/00099228241254607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Salih Demirhan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Children Hospital at Montefiore and Albert Einstein College of Medicine, New York, NY, USA
| | - Kiriam Escobar Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Children Hospital at Montefiore and Albert Einstein College of Medicine, New York, NY, USA
| | - Betsy C Herold
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Children Hospital at Montefiore and Albert Einstein College of Medicine, New York, NY, USA
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2
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Kayesh MEH, Nazneen H, Kohara M, Tsukiyama-Kohara K. An effective pan-serotype dengue vaccine and enhanced control strategies could help in reducing the severe dengue burden in Bangladesh-A perspective. Front Microbiol 2024; 15:1423044. [PMID: 39228383 PMCID: PMC11368799 DOI: 10.3389/fmicb.2024.1423044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024] Open
Abstract
Dengue is an important vector-borne disease occurring globally. Dengue virus (DENV) infection can result in a potentially life-threatening disease. To date, no DENV-specific antiviral treatment is available. Moreover, an equally effective pan-serotype dengue virus vaccine is not available. Recently, two DENV vaccines, Dengvaxia and Qdenga, were licensed for limited use. However, none of them have been approved in Bangladesh. DENV is transmitted by Aedes mosquitoes, and global warming caused by climate change favoring Aedes breeding plays an important role in increasing DENV infections in Bangladesh. Dengue is a serious public health concern in Bangladesh. In the year 2023, Bangladesh witnessed its largest dengue outbreak, with the highest number of dengue cases (n = 321,179) and dengue-related deaths (n = 1,705) in a single epidemic year. There is an increased risk of severe dengue in individuals with preexisting DENV-specific immunoglobulin G if the individuals become infected with different DENV serotypes. To date, vector control has remained the mainstay for controlling dengue; therefore, an immediate, strengthened, and effective vector control program is critical and should be regularly performed for controlling dengue outbreaks in Bangladesh. In addition, the use of DENV vaccine in curbing dengue epidemics in Bangladesh requires more consideration and judgment by the respective authority of Bangladesh. This review provides perspectives on the control and prevention of dengue outbreaks. We also discuss the challenges of DENV vaccine use to reduce dengue epidemics infection in Bangladesh.
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Affiliation(s)
- Mohammad Enamul Hoque Kayesh
- Department of Microbiology and Public Health, Faculty of Animal Science and Veterinary Medicine, Patuakhali Science and Technology University, Barishal, Bangladesh
| | - Humayra Nazneen
- Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kyoko Tsukiyama-Kohara
- Joint Faculty of Veterinary Medicine, Transboundary Animal Diseases Centre, Kagoshima University, Kagoshima, Japan
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3
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Cherie TJJ, Choong CSH, Abid MB, Weber MW, Yap ES, Seneviratne SL, Abeysuriya V, de Mel S. Immuno-Haematologic Aspects of Dengue Infection: Biologic Insights and Clinical Implications. Viruses 2024; 16:1090. [PMID: 39066252 PMCID: PMC11281699 DOI: 10.3390/v16071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Dengue infection is caused by the dengue virus (DENV) and is transmitted to humans by infected female Aedes aegypti and Aedes albopictus mosquitoes. There are nearly 100 million new dengue cases yearly in more than 120 countries, with a five-fold increase in incidence over the past four decades. While many patients experience a mild illness, a subset suffer from severe disease, which can be fatal. Dysregulated immune responses are central to the pathogenesis of dengue, and haematologic manifestations are a prominent feature of severe disease. While thrombocytopaenia and coagulopathy are major causes of bleeding in severe dengue, leucocyte abnormalities are emerging as important markers of prognosis. In this review, we provide our perspective on the clinical aspects and pathophysiology of haematologic manifestations in dengue. We also discuss the key gaps in our current practice and areas to be addressed by future research.
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Affiliation(s)
- Tan Jiao Jie Cherie
- Department of Medicine, National University Health System, Singapore 119228, Singapore;
| | - Clarice Shi Hui Choong
- Department of Haematology Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Singapore;
| | - Muhammad Bilal Abid
- Division of Haematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.B.A.); (M.W.W.)
| | - Matthew W. Weber
- Division of Haematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.B.A.); (M.W.W.)
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore;
| | - Suranjith L. Seneviratne
- Institute of Immunity and Transplantation, Royal Free Hospital and University College London, London NW3 2PP, UK
- Nawaloka Hospital Research and Educational Foundation, Nawaloka Hospitals PLC, Colombo 00200, Sri Lanka
| | - Visula Abeysuriya
- Department of Immunology, Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 00300, Sri Lanka;
| | - Sanjay de Mel
- Department of Haematology Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Singapore;
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4
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Nasir A, Samad A, Ajmal A, Li P, Islam M, Ullah S, Shah M, Bai Q. Identification of novel and potential inhibitors against the dengue virus NS2B/NS3 protease using virtual screening and biomolecular simulations. Int J Biol Macromol 2024; 272:132855. [PMID: 38834129 DOI: 10.1016/j.ijbiomac.2024.132855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024]
Abstract
Approximately 3.9 billion individuals are vulnerable to dengue infection, a prevalent cause of tropical diseases worldwide. Currently, no drugs are available for preventing or treating Flavivirus diseases, including Dengue, West Nile, and the more recent Zika virus. The highly conserved Flavivirus NS2B-NS3 protease, crucial for viral replication, is a promising therapeutic target. This study employed in-silico methodologies to identify novel and potentially effective anti-dengue small molecules. A pharmacophore model was constructed using an experimentally validated NS2B-NS3 inhibitor, with the Gunner Henry score confirming the model's validity. The Natural Product Activity and Species Source (NPASS) database was screened using the validated pharmacophore model, yielding a total of 60 hits against the NS2B-NS3 protease. Furthermore, the docking finding reveals that our newly identified compounds from the NPASS database have enhanced binding affinities and established significant interactions with allosteric residues of the target protein. MD simulation and post-MD analysis further validated this finding. The free binding energy was computed in terms of MM-GBSA analysis, with the total binding energy for compound 1 (-57.3 ± 2.8 and - 52.9 ± 1.9 replica 1 and 2) indicating a stronger binding affinity for the target protein. Overall, this computational study identified these compounds as potential hit molecules, and these findings can open up a new avenue to explore and develop inhibitors against Dengue virus infection.
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Affiliation(s)
- Abdul Nasir
- Medical Research Center, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Abdus Samad
- Department of Biochemistry, Abdul Wali Khan University, Mardan, KPK, Pakistan
| | - Amar Ajmal
- Department of Biochemistry, Abdul Wali Khan University, Mardan, KPK, Pakistan
| | - Ping Li
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan, China
| | - Muhammad Islam
- Department of Biochemistry, Abdul Wali Khan University, Mardan, KPK, Pakistan
| | - Sami Ullah
- Department of Biochemistry, Abdul Wali Khan University, Mardan, KPK, Pakistan
| | - Masaud Shah
- Department of Physiology, Ajou University, South Korea.
| | - Qian Bai
- Medical Research Center, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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5
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Cloherty APM, Rader AG, Patel KS, Eisden TJTHD, van Piggelen S, Schreurs RRCE, Ribeiro CMS. Dengue virus exploits autophagy vesicles and secretory pathways to promote transmission by human dendritic cells. Front Immunol 2024; 15:1260439. [PMID: 38863700 PMCID: PMC11165123 DOI: 10.3389/fimmu.2024.1260439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/19/2024] [Indexed: 06/13/2024] Open
Abstract
Dengue virus (DENV), transmitted by infected mosquitoes, is a major public health concern, with approximately half the world's population at risk for infection. Recent decades have increasing incidence of dengue-associated disease alongside growing frequency of outbreaks. Although promising progress has been made in anti-DENV immunizations, post-infection treatment remains limited to non-specific supportive treatments. Development of antiviral therapeutics is thus required to limit DENV dissemination in humans and to help control the severity of outbreaks. Dendritic cells (DCs) are amongst the first cells to encounter DENV upon injection into the human skin mucosa, and thereafter promote systemic viral dissemination to additional human target cells. Autophagy is a vesicle trafficking pathway involving the formation of cytosolic autophagosomes, and recent reports have highlighted the extensive manipulation of autophagy by flaviviruses, including DENV, for viral replication. However, the temporal profiling and function of autophagy activity in DENV infection and transmission by human primary DCs remains poorly understood. Herein, we demonstrate that mechanisms of autophagosome formation and extracellular vesicle (EV) release have a pro-viral role in DC-mediated DENV transmission. We show that DENV exploits early-stage canonical autophagy to establish infection in primary human DCs. DENV replication enhanced autophagosome formation in primary human DCs, and intrinsically-heightened autophagosome biogenesis correlated with relatively higher rates of DC susceptibility to DENV. Furthermore, our data suggest that viral replication intermediates co-localize with autophagosomes, while productive DENV infection introduces a block at the late degradative stages of autophagy in infected DCs but not in uninfected bystander cells. Notably, we identify for the first time that approximately one-fourth of DC-derived CD9/CD81/CD63+ EVs co-express canonical autophagy marker LC3, and demonstrate that DC-derived EV populations are an alternative, cell-free mechanism by which DCs promote DENV transmission to additional target sites. Taken together, our study highlights intersections between autophagy and secretory pathways during viral infection, and puts forward autophagosome accumulation and viral RNA-laden EVs as host determinants of DC-mediated DENV infection in humans. Host-directed therapeutics targeting autophagy and exocytosis pathways thus have potential to enhance DC-driven resistance to DENV acquisition and thereby limit viral dissemination by initial human target cells following mosquito-to-human transmission of DENV.
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Affiliation(s)
- Alexandra P. M. Cloherty
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
| | - Anusca G. Rader
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Kharishma S. Patel
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
| | - Tracy-Jane T. H. D. Eisden
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sterre van Piggelen
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
| | - Renée R. C. E. Schreurs
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Carla M. S. Ribeiro
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
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Abdullah M, Choudry MA, Sheikh SA, Shoaib F, Jamil M. Dengue encephalopathy concurrent with secondary pulmonary tuberculosis in an elderly male with multiple comorbidities. IDCases 2024; 36:e01993. [PMID: 38912257 PMCID: PMC11190485 DOI: 10.1016/j.idcr.2024.e01993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Dengue fever (DF) and tuberculosis (TB) present significant global health challenges, often with overlapping clinical features, especially when complicated by conditions like dengue encephalopathy. We present a case study involving an 84-year-old male with a complex medical history, encompassing pulmonary tuberculosis reactivation, who subsequently developed dengue encephalitis. This underscores the complexity of managing such cases in the geriatric population. Dengue encephalitis, once considered non-neurotropic, is increasingly recognized, necessitating consideration as a potential differential diagnosis in patients with neurological symptoms, particularly in endemic regions. Our patient exhibited typical DF symptoms alongside manifestations of encephalopathy. Concurrently, secondary TB reactivation was observed, emphasizing the intricate interplay between these diseases. Additionally, lower respiratory tract infection (LRTI) further complicated the clinical picture. Timely recognition and comprehensive management are crucial, as demonstrated in our case, where prompt reporting and conservative measures led to a favorable outcome.
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Affiliation(s)
| | | | | | - Faryal Shoaib
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Manahil Jamil
- Department of Physiology, Shifa College of Medicine, H-8/4, Islamabad, Pakistan
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Jamil Z, Khalid S, Khan HMMH, Waheed I, Ehsan A, Alissa M, Muhammad K, Munawar N, Waheed Y. Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Novel Score in Early Detection of Complicated Dengue Fever. J Multidiscip Healthc 2024; 17:2321-2330. [PMID: 38770172 PMCID: PMC11104365 DOI: 10.2147/jmdh.s459929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The occurrence of dengue fever presents a considerable burden for public health care in developing countries. This study aims to validate APRI as predictor score for severity of dengue fever so that catastrophic events could be prevented, and early triage can save lives. Methods The retrospective cross-sectional study was done on dengue positive patients from August to November 2023. APRI score was calculated for every patient at the time of admission. The primary end-point was non-complicated disease (Simple dengue fever) vs complicated disease (dengue hemorrhagic fever and dengue shock syndrome). ROC curve was used to identify the role of APRI in prediction of dengue complication. Youden index was used to find the cut-off value of APRI along with sensitivity, specificity, positive and negative likelihood ratios. To further evaluate the role of APRI score, patients were divided into two groups, patients with APRI score greater and lesser than cut-off value. The qualitative variables among two groups were compared by chi-square testing. The predictors of complicated dengue were first determined by univariate regression analysis and then confirmed by multivariate regression analysis. Results The mean APRI score of 135 patients was 20.06 ± 6.31. AUC for APRI score was 0.93 (p < 0.0001) indicating that APRI score calculated at the time of admission is an excellent marker in determining the complicated dengue. The cut-off value for APRI score was 9.04 (sensitivity 84.91%, specificity 89.02%, p < 0.0001). The patients with APRI <9.04 mostly developed simple dengue fever (54.1%) vs DHF (4.4%) and DSS (1.5%), while patients with APRI >9.04 had more DHF (20.7%) and DSS (12.6%) vs simple dengue fever (6.7%). None of the patient died with APRI <9.04 while the mortality rate was 3.7% in patients with APRI >9.04. Conclusion The APRI score, calculated at the time of admission, is an excellent marker in determining the severe dengue.
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Affiliation(s)
- Zubia Jamil
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
| | - Samreen Khalid
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
| | | | - Ikram Waheed
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, 43600, Pakistan
| | - Amna Ehsan
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, 43600, Pakistan
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Khalid Muhammad
- Department of Biology, College of Science, UAE University, Al Ain, 15551, United Arab Emirates
| | - Nayla Munawar
- Department of Chemistry, College of Science, UAE University, Al Ain, 15551, United Arab Emirates
| | - Yasir Waheed
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, 1401, Lebanon
- MEU Research Unit, Middle East University, Amman, 11831, Jordan
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8
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Macha NO, Komarasamy TV, Harun S, Adnan NAA, Hassan SS, Balasubramaniam VRMT. Cross Talk between MicroRNAs and Dengue Virus. Am J Trop Med Hyg 2024; 110:856-867. [PMID: 38579704 PMCID: PMC11066346 DOI: 10.4269/ajtmh.23-0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/19/2023] [Indexed: 04/07/2024] Open
Abstract
Dengue fever (DF) is an endemic infectious tropical disease and is rapidly becoming a global problem. Dengue fever is caused by one of the four dengue virus (DENV) serotypes and is spread by the female Aedes mosquito. Clinical manifestations of DF may range from asymptomatic to life-threatening severe illness with conditions of hemorrhagic fever and shock. Early and precise diagnosis is vital to avoid mortality from DF. A different approach is required to combat DF because of the challenges with the vaccines currently available, which are nonspecific; each is capable of causing cross-reaction and disease-enhancing antibody responses against the residual serotypes. MicroRNAs (miRNAs) are known to be implicated in DENV infection and are postulated to be involved in most of the host responses. Thus, they might be a suitable target for new strategies against the disease. The involvement of miRNAs in cellular activities and pathways during viral infections has been explored under numerous conditions. Interestingly, miRNAs have also been shown to be involved in viral replication. In this review, we summarize the role of known miRNAs, specifically the role of miRNA Let-7c (miR-Let-7c), miR-133a, miR-30e, and miR-146a, in the regulation of DENV replication and their possible effects on the initial immune reaction.
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Affiliation(s)
- Nur Omar Macha
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Thamil Vaani Komarasamy
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Sarahani Harun
- Institute of Systems Biology Malaysia, National University of Malaysia, Selangor, Malaysia
| | - Nur Amelia Azreen Adnan
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Sharifah Syed Hassan
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Vinod R. M. T. Balasubramaniam
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
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Vidanapathirana M. Dengue haemorrhagic fever in chronic kidney disease and heart failure: challenges in fluid management. Trop Med Health 2024; 52:33. [PMID: 38659069 PMCID: PMC11040987 DOI: 10.1186/s41182-024-00600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Dengue haemorrhagic fever (DHF) is recognized to have high mortality in patients with chronic kidney disease (CKD) and heart failure (HF). They are at high risk of shock during the ascending limb of the critical phase of DHF, fluid overload during convalescence and bleeding throughout the entire illness. Physiological changes and medications used in CKD/HF make the diagnosis and monitoring of DHF difficult. Treatment with standard fluid regimens also poses a challenge due to the propensity for fluid overload. As a result, standard dengue guidelines do not provide recommendations on fluid management regimens in DHF with CKD/HF. This article provides a narrative review on the existing evidence for management of DHF in patients with volume-changed states such as HF, CKD and nephrotic/ nephritic syndromes. It will explore the relevant diagnostic and therapeutic dilemmas, acknowledge the challenges for developing guidelines and recommend strategies to improve fluid management in these groups of patients.
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See KC. Dengue-Associated Hemophagocytic Lymphohistiocytosis: A Narrative Review of Its Identification and Treatment. Pathogens 2024; 13:332. [PMID: 38668287 PMCID: PMC11053942 DOI: 10.3390/pathogens13040332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
Dengue's lack of specific treatments beyond supportive care prompts a focus on uncovering additional pathophysiological factors. Dengue-associated hemophagocytic lymphohistiocytosis (HLH), characterized by dysregulated macrophage activation and cytokine storm, remains underexplored despite its potential to worsen disease severity and mortality. While rare, dengue-associated HLH disproportionately affects severe cases, significantly impacting mortality rates. To mitigate high mortality, early identification and familiarity with dengue-associated HLH are imperative for prompt treatment by clinicians. This narrative review therefore aims to examine the current clinical and therapeutic knowledge on dengue-associated HLH, and act as a resource for clinicians to improve their management of HLH associated with severe dengue. Dengue-associated HLH should be considered for all cases of severe dengue and may be suspected based on the presence of prolonged or recurrent fever for >7 days, or anemia without intravascular hemolysis or massive bleeding. Diagnosis relies on fulfilling at least five of the eight HLH-2004 criteria. Treatment predominantly involves short courses (3-4 days) of high-dose steroids (e.g., dexamethasone 10 mg/m2), with additional therapies considered in more severe presentations. Notably, outcomes can be favorable with steroid therapy alone.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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11
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Srisawat N, Gubler DJ, Pangestu T, Limothai U, Thisyakorn U, Ismail Z, Goh D, Capeding MR, Bravo L, Yoksan S, Tantawichien T, Hadinegoro SR, Rafiq K, Picot VS, Ooi EE. Proceedings of the 6th Asia Dengue Summit, June 2023. PLoS Negl Trop Dis 2024; 18:e0012060. [PMID: 38551892 PMCID: PMC10980189 DOI: 10.1371/journal.pntd.0012060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Abstract
The 6th Asia Dengue Summit (ADS) themed "Road Map to Zero Dengue Death" was held in Thailand from 15th-16th June 2023. The summit was hosted by Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand in conjunction with Queen Saovabha Memorial Institute, The Thai Red Cross Society; Faculty of Tropical Medicine, Mahidol University; and the Ministry of Public Health. The 6th ADS was convened by Asia Dengue Voice and Action (ADVA); Global Dengue and Aedes Transmitted Diseases Consortium (GDAC); Southeast Asian Ministers of Education Tropical Medicine and Public Health Network (SEAMEO TROPMED); Fondation Mérieux (FMx) and the International Society for Neglected Tropical Diseases (ISNTD). Dengue experts from academia and research, and representatives from the Ministries of Health, Regional and Global World Health Organization (WHO) and International Vaccine Institute (IVI) participated in the three-day summit. With more than 51 speakers and 451 delegates from over 24 countries, 10 symposiums, and 2 full days, the 6th ADS highlighted the growing threat of dengue and its antigenic evolution, flagged the urgent need to overcome vaccine hesitancy and misinformation crisis, and focused on dengue control policies, newer diagnostics, therapeutics and vaccines, travel-associated dengue, and strategies to improve community involvement.
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Affiliation(s)
- Nattachai Srisawat
- Tropical Medicine Cluster, Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thailand
| | - Duane J. Gubler
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Tikki Pangestu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Umaporn Limothai
- Tropical Medicine Cluster, Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thailand
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University and Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zulkifli Ismail
- Department of Pediatrics, KPJ Selangor Specialist Hospital, Malaysia
| | - Daniel Goh
- Division of Paediatric Pulmonary Medicine and Sleep, Khoo Teck Puat National University Children’s Medical Institute, National University Hospital, Singapore
| | | | - Lulu Bravo
- University of the Philippines Manila, Manila, the Philippines
| | - Sutee Yoksan
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Bangkok, Thailand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine and Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Sri Rezeki Hadinegoro
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kamran Rafiq
- International Society of Neglected Tropical Diseases, London, United Kingdom
| | | | - Eng Eong Ooi
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
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12
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Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:16-33. [PMID: 38263966 PMCID: PMC10800775 DOI: 10.1016/j.jointm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 01/25/2024]
Abstract
Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
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Affiliation(s)
- Alexandre Mestre Tejo
- Intensive Care Unit, Department of Intensive Medicine of the Cancer Institute of the State of São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Transfusion Medicine and Cell Therapy Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Letícia Mattos Menezes
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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13
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Zuckerman NS, Schwartz E, Pandey P, Erster O, Halpern O, Bucris E, Morad-Eliyahu H, Wax M, Lustig Y. Dengue Types 1 and 3 Identified in Travelers Returning from Kathmandu, Nepal, during the October 2022 Outbreak Are Related to Strains Recently Identified in India. Viruses 2023; 15:2334. [PMID: 38140575 PMCID: PMC10921925 DOI: 10.3390/v15122334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Phylogenetic analysis of dengue serotypes 1 and 3, which were diagnosed in travelers and Nepalese infected in Kathmandu during the October 2022 outbreak, revealed that both serotypes were clustered closest to the sequences sampled in India. This suggests both serotypes may have originated in India.
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Affiliation(s)
- Neta S. Zuckerman
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer 52621, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kathmandu 44600, Nepal;
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Osnat Halpern
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Efrat Bucris
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Hagar Morad-Eliyahu
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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14
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Alghsham RS, Shariq A, Rasheed Z. Dengue: A global health concern. Int J Health Sci (Qassim) 2023; 17:1-2. [PMID: 37416844 PMCID: PMC10321461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Affiliation(s)
- Ruqaih S. Alghsham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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15
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Kalluru PKR, Mamilla M, Valisekka SS, Mandyam S, Calderon Martinez E, Posani S, Sharma S, Gopavaram RR, Gargi B, Gaddam A, Reddy S. Aminotransferases in Relation to the Severity of Dengue: A Systematic Review. Cureus 2023; 15:e39436. [PMID: 37234451 PMCID: PMC10208548 DOI: 10.7759/cureus.39436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
A systematic review was conducted to investigate the relationship between aminotransferases and the severity of dengue infection, which is a prevalent and significant infection in tropical and subtropical regions. Aminotransferases are enzymes that are often elevated in dengue due to the liver's physiological and immunological response to the infection. This review focused on analyzing various studies that examined the correlation between aminotransferase levels and the severity of dengue. Extensive literature searches were performed using ("dengue*" OR "dengue fever*" OR "dengue haemorrhagic fever*" OR "dengue shock syndrome*") AND ("alanine aminotransferase*" OR "aspartate aminotransferase*") on PubMed. The selected articles were thoroughly reviewed, encompassing epidemiology, pathogenesis, and clinical manifestations of dengue. The consistent findings across the studies indicated that aminotransferases can serve as predictive markers for dengue severity. Therefore, early assessment of liver enzyme levels is crucial in dengue cases, and elevated levels should be closely monitored to prevent adverse outcomes.
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Affiliation(s)
| | - Mahesh Mamilla
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | - Sai Sudha Valisekka
- Internal Medicine, University of Minnesota School of Medicine, Minneapolis, USA
| | | | | | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kothagudem, IND
| | - Shriya Sharma
- Internal Medicine, Dnipropetrovsk State Medical Academy, Dnipro, UKR
| | | | - Borgharkar Gargi
- Public Health, University of Alabama at Birmingham School of Medicine, Brimingham, USA
| | - Anvitha Gaddam
- Internal Medicine, Siddhartha Medical College, Vijayawada, IND
| | - Sushritha Reddy
- Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, IND
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