Dengue outbreak 2019: clinical and laboratory profiles of dengue virus infection in Dhaka city

Clinico-epidemiological profiling of dengue patients in a non-endemic region of Bangladesh

BACKGROUND

This study aimed to characterise the clinical and epidemiological profiles of dengue patients and their outcomes during an ongoing outbreak in a non-endemic region of Bangladesh.

METHODS

This prospective observational study analysed 805 confirmed dengue cases during August-December 2023. Data on demographic, clinical and laboratory profiles, as well as outcomes, were gathered using a structured questionnaire. Statistical analysis was conducted using SPSS 25.

RESULTS

The mean age of dengue patients was 31.5 (±12.2) y, with the majority being males (81.2%). All 805 patients experienced fever, 792 (98.4%) had headaches, 698 (86.7%) had myalgia, 601 (74.7%) had persistent vomiting and 598 (74.3%) had abdominal pain. Bleeding was observed in 191 (23.7%) patients and neurological symptoms were seen in 209 (25.9%) patients. Most patients (n=781, 97%) exhibited non-severe symptoms, while 3% (n=24) had severe symptoms. Among the 24 severe cases, four (16.7%) patients were reported to have encephalitis and one (4.2%) patient had meningoencephalitis. Moreover, 365 patients (45.3%) had travelled to an endemic region who were predominantly males (n=327, 89.6%). Most dengue patients recovered well with rapid fluid replacement therapy (n=754, 93.7%).

CONCLUSIONS

The 2023 dengue outbreak in a non-endemic area of Bangladesh primarily impacted males, young adults, with the majority presenting non-severe symptoms. Further studies are essential to validate and build upon these results.

Computational Analysis of the Accumulation of Mutations in Therapeutically Important RNA Viral Proteins During Pandemics with Special Emphasis on SARS-CoV-2

Single stranded RNA viruses are primary causative agents for pandemics, causing extensive morbidity and mortality worldwide. A pivotal question in pandemic preparedness and therapeutic intervention is what are the specific mutations which are more likely to emerge during such global health crises? This study aims to identify markers for mutations with the highest probability of emergence in these pandemics, focusing on the SARS-CoV-2 spike protein, an essential and therapeutically significant viral protein, starting from sequence information from the onset of the pandemic until July 2022. Quite consistently, we observed that emerged mutations tended to demonstrate a high genetic score, which reflects high similarity of the type of codon required for translation between an amino acid and to the mutated one. Further, this pattern is also observed in therapeutically significant proteins of other ssRNA pandemic viruses, including influenza (HA, NA), spike proteins of Ebola, envelope of Dengue and Chikungunya. We propose that the genetic score serves as an initial indicator, preceding the actual impact of the mutation on viral fitness. Finally, we developed a comprehensive computational pipeline to further explore and predict the subsequent effects of mutations on viral fitness. We believe that our pipeline can narrow down and predict future mutations in therapeutically important viral proteins during a pandemic.

Risk factors associated with dengue complications and death: A cohort study in Peru

BACKGROUND

Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru.

METHODOLOGY

This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors.

FINDINGS

The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11-45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1).

SIGNIFICANCE

Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

Knowledge, attitudes, and practices of health care professionals regarding dengue fever: need for training and provision of diagnostic equipment in Togo in 2022, a cross-sectional study

Background

Health statistics on dengue are virtually non-existent, despite the fact that the virus is circulating in Togo. This study aimed to assess the knowledge, attitudes, and practices (KAP) of health professionals in the Kara health region.

Methods

A cross-sectional study was conducted from March to June 2022 among healthcare professionals who had worked in the Kara region of northern Togo were selected using an exhaustive recruitment method. Data were collected by trained resident doctors with a face-to-face interview using a standardized, pretested questionnaire based on the WHO 2009 dengue guide. Three multivariate regression models were utilized to investigate factors associated with knowledge, attitudes and, and practices.

Results

A total of 464 respondents (37.1% female), median age 35 years, interquartile range (29-43 years) were included. Only (3.0%) of the participants had received training on dengue fever diagnosis, treatment and prevention in the last 3 years, and 10.3% had dengue rapid diagnostic tests available at their hospital. Half of the respondents (49.1%) had good knowledge of dengue fever, compared with 30.0% who had positive attitudes. Of a total of 256 professionals who had encountered a case of dengue fever in their practice, only 24 (9.4%) had appropriate practices for diagnosing and treating dengue fever. In multivariate analysis, the healthcare professionals who had taken part in ongoing training on dengue fever were more likely to have adequate dengue diagnosis and treatment practice aOR = 8.1; CI 95% = [1.7-36.0].

Conclusion

Strengthening healthcare professionals' dengue-related skills through ongoing training and the provision of dengue diagnostic tests could help improve early detection practices and management of dengue fever in Togo.

The Epidemiologic and Clinical Characteristics of the 2023 Dengue Outbreak in Bangladesh

The ongoing 2023 dengue outbreak is the worst ever case reported in Bangladesh. There is a lack of epidemiological studies on the outbreak. A 2-tailed t test was performed. Multivariable logistic regression analysis was conducted. We found about 277 801 cases and 1393 deaths from the 2023 dengue outbreak. About 52% of the cases were from outside of Dhaka. The male:female ratio was about 3:2. The highest frequency of cases was found among people aged 19-29 years (28.7%, 79 673 of 277 801; P = .001). The overall case fatality rate (CFR) was 0.5%. The highest CFR was found among children aged 0-10 years (12%). Fever (99%) was the most prevalent, followed by joint pain (86%). We found significantly higher odds of fatalities (adjusted odds ratio [aOR], 4.21; 95% CI, 3.93-4.74; P = .05), cases (aOR, 3.85; 95% CI, 3.25-4.12; P = .001) and hospitalizations (aOR, 3.26; 95% CI, 3.11-4.04; P = .006) during the 2023 outbreak compared with previous outbreaks during 2008-2022. This is one of the early reports of epidemiological and clinical characteristics of ongoing dengue outbreak.

Clinical profile and early severity predictors of dengue fever: Current trends for the deadliest dengue infection in Bangladesh in 2022

Objectives

In 2022, Bangladesh had the highest dengue-related fatality (281). This study evaluated clinical profiles to detect early changes to predict dengue fever severity.

Methods

This prospective observational study was performed in four government hospitals from June to November 2022 in Dhaka. Febrile patients admitted within 4th day of illness were recruited if they had a confirmed dengue viral infection either by by positive dengue nonstructural protein antigen or anti-dengue immunoglobulin (Ig)M antibody.

Results

We divided 308 patients with confirmed dengue into two groups: 232 (74.3%) in nonsevere dengue and 76 (24.7%) in severe dengue. Men were 205 (66.6%), and the most affected age group was 21-30 years (47.7%). Patients with severe dengue reported a higher number of nausea 80.3%, coughs 57.9%, abdominal pain 56.6%, persistent vomitting 53.9%, dyspnea 35.5%, diarrhea 28.9%, and skin rash at 27.6%. In addition, the disease's febrile phase (≤4 days) showed thrombocytopenia (odds ratio [OR] 6.409, 95% CI 2.855-14.386, p <0.001), hemoconcentration (OR 3.428, 95% CI 1.030-11.405, p 0.045), and hypotension (OR 5.896, 95% CI 1.203-28.897, p 0.029) were associated severe disease.

Conclusions

Hypotension, thrombocytopenia, and hemoconcentration during the febrile phase might indicate progression towards severe disease.

Dengue hemorrhagic fever: a growing global menace

Dengue virus is an arthropod-borne virus, transmitted by Aedes aegypti among humans. In this review, we discussed the epidemiology of dengue hemorrhagic fever (DHF) as well as the disease's natural history, cycles of transmission, clinical diagnosis, aetiology, prevention, therapy, and management. A systematic literature search was done by databases such as PubMed and Google Scholar using search terms, 'dengue fever', 'symptoms and causes of dengue fever', 'dengue virus transmission', and 'strategies to control dengue'. We reviewed relevant literature to identify hazards related to DHF and the most recent recommendations for its management and prevention. Clinical signs and symptoms of dengue infection range from mild dengue fever (DF) to potentially lethal conditions like DHF or dengue shock syndrome (DSS). Acute-onset high fever, muscle and joint pain, myalgia, a rash on the skin, hemorrhagic episodes, and circulatory shock are among the most common symptoms. An early diagnosis is vital to lower mortality. As dengue virus infections are self-limiting, but in tropical and subtropical areas, dengue infection has become a public health concern. Hence, developing and executing long-term control policies that can reduce the global burden of DHF is a major issue for public health specialists everywhere.

Recent Dengue Infection in Bangladesh: A Seasonal Endemic Progressing to Year-long Serious Health Concern

Dengue represents one of the most dangerous mosquito-borne viral diseases. Although the disease has been prevalent around the globe over the centuries, recent outbreaks of dengue have devasted the healthcare delivery system of many countries. Being a global infection, dengue virus (DENV) is endemically present mainly in Latin America and Caribbean countries as well as countries in South Asia. The recent outbreak of DENV infection has indicated an exceptional outbreak of DENV in some countries in South Asia. There has been a serious endemic of DENV during 2019. After a heterogeneous pause, another severe outbreak of DENV was reported in some Asian countries in 2023. Among the Asian countries, Bangladesh has reported an acute upsurge of DENV infection in 2023 with record numbers of fatalities. However, this pattern of DENV has not been detected in neighbors of Bangladesh, such as India or other countries in Southeast Asia. This provides an emergent task of dissecting the present DENV infection in Bangladesh from different angles to get insights for future containment of the DENV infection, not only in Bangladesh but also in other DENV endemic areas or DENV-native areas.

How to cite this article

Akbar SMF, Khan S, Mahtab M, et al. Recent Dengue Infection in Bangladesh: A Seasonal Endemic Progressing to Year-long Serious Health Concern. Euroasian J Hepato-Gastroenterol 2023;13(2):145-151.

An autonomous cycle of data analysis tasks for the clinical management of dengue

Dengue is the most widespread vector-borne disease worldwide. Timely diagnosis and treatment of dengue is the main objective of medical professionals to decrease mortality rates. In this paper, we propose an autonomous cycle that integrates data analysis tasks to support decision-making in the clinical management of dengue. Particularly, the autonomous cycle supports dengue diagnosis and treatment. The proposed system was built using machine learning techniques for classification tasks (artificial neural networks and support vector machines) and evolutionary techniques (a genetic algorithm) for prescription tasks (treatment). The system was quantitatively evaluated using dengue-patient datasets reported by healthcare institutions. Our system was compared with previous works using qualitative criteria. The proposed system has the ability to classify a patient's clinical picture and recommend the best treatment option. In particular, the classification of dengue was done with 98% accuracy and a genetic algorithm recommends treatment options for particular patients. Finally, our system is flexible and easily adaptable, which will allow the addition of new tasks for dengue analysis.