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Taylor-Salmon E, Hill V, Paul LM, Koch RT, Breban MI, Chaguza C, Sodeinde A, Warren JL, Bunch S, Cano N, Cone M, Eysoldt S, Garcia A, Gilles N, Hagy A, Heberlein L, Jaber R, Kassens E, Colarusso P, Davis A, Baudin S, Rico E, Mejía-Echeverri Á, Scott B, Stanek D, Zimler R, Muñoz-Jordán JL, Santiago GA, Adams LE, Paz-Bailey G, Spillane M, Katebi V, Paulino-Ramírez R, Mueses S, Peguero A, Sánchez N, Norman FF, Galán JC, Huits R, Hamer DH, Vogels CBF, Morrison A, Michael SF, Grubaugh ND. Travel surveillance uncovers dengue virus dynamics and introductions in the Caribbean. Nat Commun 2024; 15:3508. [PMID: 38664380 PMCID: PMC11045810 DOI: 10.1038/s41467-024-47774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Dengue is the most prevalent mosquito-borne viral disease in humans, and cases are continuing to rise globally. In particular, islands in the Caribbean have experienced more frequent outbreaks, and all four dengue virus (DENV) serotypes have been reported in the region, leading to hyperendemicity and increased rates of severe disease. However, there is significant variability regarding virus surveillance and reporting between islands, making it difficult to obtain an accurate understanding of the epidemiological patterns in the Caribbean. To investigate this, we used travel surveillance and genomic epidemiology to reconstruct outbreak dynamics, DENV serotype turnover, and patterns of spread within the region from 2009-2022. We uncovered two recent DENV-3 introductions from Asia, one of which resulted in a large outbreak in Cuba, which was previously under-reported. We also show that while outbreaks can be synchronized between islands, they are often caused by different serotypes. Our study highlights the importance of surveillance of infected travelers to provide a snapshot of local introductions and transmission in areas with limited local surveillance and suggests that the recent DENV-3 introductions may pose a major public health threat in the region.
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Affiliation(s)
- Emma Taylor-Salmon
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Verity Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Lauren M Paul
- Department of Biological Sciences, College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Robert T Koch
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Mallery I Breban
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Chrispin Chaguza
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Afeez Sodeinde
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Sylvia Bunch
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Natalia Cano
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Marshall Cone
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Sarah Eysoldt
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Alezaundra Garcia
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Nicadia Gilles
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Andrew Hagy
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Lea Heberlein
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Rayah Jaber
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Elizabeth Kassens
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, FL, USA
| | - Pamela Colarusso
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Jacksonville, FL, USA
| | - Amanda Davis
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Jacksonville, FL, USA
| | - Samantha Baudin
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | - Edhelene Rico
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | | | - Blake Scott
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, FL, USA
| | - Danielle Stanek
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, FL, USA
| | - Rebecca Zimler
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, FL, USA
| | - Jorge L Muñoz-Jordán
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A Santiago
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura E Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Melanie Spillane
- Office of Data, Analytics, and Technology, Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Bureau for Global Health, United States Agency for International Development, Arlington, VA, USA
| | - Volha Katebi
- Office of Data, Analytics, and Technology, Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Sayira Mueses
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Armando Peguero
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Nelissa Sánchez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, CIBER de Enfermedades Infecciosas, IRYCIS, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan-Carlos Galán
- Microbiology Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Center for Emerging Infectious Disease Policy and Research, Boston University, and National Emerging Infectious Disease Laboratory, Boston, MA, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Andrea Morrison
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, FL, USA.
| | - Scott F Michael
- Department of Biological Sciences, College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, FL, USA.
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
- Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA.
- Yale Institute for Global Health, Yale University, New Haven, CT, USA.
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
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Paraná VC, Feitosa CA, da Silva GCS, Gois LL, Santos LA. Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:173-191. [PMID: 38263345 DOI: 10.1111/tmi.13968] [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] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. METHODS PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. RESULTS Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. CONCLUSION These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.
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Affiliation(s)
- Victoria Cruz Paraná
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | | | | | - Luana Leandro Gois
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Department of Biointeraction Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciane Amorim Santos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Graduate Program in Health Sciences, College of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
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Kharwadkar S, Herath N. Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2521. [PMID: 38340071 DOI: 10.1002/rmv.2521] [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: 12/30/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Dengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, haemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalisation and mortality rates in dengue were 9.90% (95% CI 7.67-12.37) and 0.23% (95% CI 0.16-0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72-3.63) of reported cases and 23.23% (95% CI 13.58-34.53) of hospitalised patients. Complications associated with Zika virus included Guillain-Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71-16.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30-4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06-2.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreaks.
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Affiliation(s)
- Sahil Kharwadkar
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nipun Herath
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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4
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Hoffman SA, Maldonado YA. Emerging and re-emerging pediatric viral diseases: a continuing global challenge. Pediatr Res 2024; 95:480-487. [PMID: 37940663 PMCID: PMC10837080 DOI: 10.1038/s41390-023-02878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.
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Affiliation(s)
- Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne A Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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5
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Taylor-Salmon E, Hill V, Paul LM, Koch RT, Breban MI, Chaguza C, Sodeinde A, Warren JL, Bunch S, Cano N, Cone M, Eysoldt S, Garcia A, Gilles N, Hagy A, Heberlein L, Jaber R, Kassens E, Colarusso P, Davis A, Baudin S, Rico E, Mejía-Echeverri Á, Scott B, Stanek D, Zimler R, Muñoz-Jordán JL, Santiago GA, Adams LE, Paz-Bailey G, Spillane M, Katebi V, Paulino-Ramírez R, Mueses S, Peguero A, Sánchez N, Norman FF, Galán JC, Huits R, Hamer DH, Vogels CB, Morrison A, Michael SF, Grubaugh ND. Travel surveillance uncovers dengue virus dynamics and introductions in the Caribbean. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.11.23298412. [PMID: 37986857 PMCID: PMC10659465 DOI: 10.1101/2023.11.11.23298412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Dengue is the most prevalent mosquito-borne viral disease in humans, and cases are continuing to rise globally. In particular, islands in the Caribbean have experienced more frequent outbreaks, and all four dengue virus (DENV) serotypes have been reported in the region, leading to hyperendemicity and increased rates of severe disease. However, there is significant variability regarding virus surveillance and reporting between islands, making it difficult to obtain an accurate understanding of the epidemiological patterns in the Caribbean. To investigate this, we used travel surveillance and genomic epidemiology to reconstruct outbreak dynamics, DENV serotype turnover, and patterns of spread within the region from 2009-2022. We uncovered two recent DENV-3 introductions from Asia, one of which resulted in a large outbreak in Cuba, which was previously under-reported. We also show that while outbreaks can be synchronized between islands, they are often caused by different serotypes. Our study highlights the importance of surveillance of infected travelers to provide a snapshot of local introductions and transmission in areas with limited local surveillance and suggests that the recent DENV-3 introductions may pose a major public health threat in the region.
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Affiliation(s)
- Emma Taylor-Salmon
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Verity Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Lauren M. Paul
- Department of Biological Sciences, College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Florida, United States of America
| | - Robert T. Koch
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Mallery I. Breban
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Chrispin Chaguza
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Afeez Sodeinde
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Sylvia Bunch
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Natalia Cano
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Marshall Cone
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Sarah Eysoldt
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Alezaundra Garcia
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Nicadia Gilles
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Andrew Hagy
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Lea Heberlein
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Rayah Jaber
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Elizabeth Kassens
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Tampa, Florida, United States of America
| | - Pamela Colarusso
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Jacksonville, Florida, United States of America
| | - Amanda Davis
- Bureau of Public Health Laboratories, Division of Disease Control and Health Protection, Florida Department of Health, Jacksonville, Florida, United States of America
| | - Samantha Baudin
- Florida Department of Health in Miami-Dade County, Miami, Florida, United States of America
| | - Edhelene Rico
- Florida Department of Health in Miami-Dade County, Miami, Florida, United States of America
| | - Álvaro Mejía-Echeverri
- Florida Department of Health in Miami-Dade County, Miami, Florida, United States of America
| | - Blake Scott
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Danielle Stanek
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Rebecca Zimler
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Jorge L. Muñoz-Jordán
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura E. Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Melanie Spillane
- Office of Data, Analytics, and Technology, Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Bureau for Global Health, United States Agency for International Development, Arlington, Virginia, United States of America
| | - Volha Katebi
- Office of Data, Analytics, and Technology, Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Sayira Mueses
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Armando Peguero
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Nelissa Sánchez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, UNIBE Research Hub, Santo Domingo, Dominican Republic
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, CIBER de Enfermedades Infecciosas, IRYCIS, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan-Carlos Galán
- Microbiology Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Center for Emerging Infectious Disease Policy and Research, Boston University, and National Emerging Infectious Disease Laboratory, Boston, Massachusetts, United States of America
| | - Chantal B.F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
| | - Andrea Morrison
- Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Scott F. Michael
- Department of Biological Sciences, College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Florida, United States of America
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America
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Pérez-Guerra CL, Rosado-Santiago C, Ramos SA, Marrero KM, González-Zeno G, Miranda-Bermúdez J, Ortíz-Ortíz M, Rivera-Amill V, Waterman S, Paz-Bailey G, Sánchez-González L. Community perceptions on challenges and solutions to implement an Aedes aegypti control project in Ponce, Puerto Rico (USA). PLoS One 2023; 18:e0284430. [PMID: 37068074 PMCID: PMC10109480 DOI: 10.1371/journal.pone.0284430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
This study characterizes community perceptions on a large-scale project seeking to reduce the population of Aedes aegypti mosquitoes and prevent arboviral disease transmission in Ponce, Puerto Rico; and to leverage on these perceptions to make modifications to ensure effective project implementation. In 2017-2018 the team conducted informal interviews, focus groups, and in-depth interviews with leaders and residents of the communities, focusing on challenges and potential solutions to the project implementation. Possible challenges to the project implementation included the lack of geographic consistency between clusters defined by researchers and the participants' description of the communities' geographic boundaries. Few children living in the communities could affect the ability of the project to adequately measure arboviral disease incidence. Also, population attrition due to out-migration, and lack of community leaders and communication channels after Hurricane Maria could affect participation in project activities. Lack of trust on strangers was an important challenge due to criminal activity involving violence and drug use in some community areas. Solutions to the identified challenges included identifying emerging leaders and implementing community meetings to promote project activities. The information that community members provided helped us to understand the natural disasters' impact on population attrition in these communities with a disproportionate impact in younger groups, resulting in an aging population. We identified lack of community organization and leadership and increasing number of abandoned houses that could turn into Aedes aegypti breeding sites. The formative work helped to better define the geographic areas that the study would cover, evaluate the acceptability of innovative vector control methods, and identify communication methods used by residents. With this information, challenges and potential solutions in recruiting participants were anticipated, and the community engagement and communications plans were developed. We recommend selecting clusters before research, because opinions towards mosquito control technologies could vary in added clusters.
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Affiliation(s)
- Carmen L. Pérez-Guerra
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Coral Rosado-Santiago
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Sue A. Ramos
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Karla M. Marrero
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Gladys González-Zeno
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Julieanne Miranda-Bermúdez
- Puerto Rico Science, Technology and Research Trust, Puerto Rico Vector Control Unit, San Juan, Puerto Rico, United States of America
| | - Marianyoly Ortíz-Ortíz
- Puerto Rico Science, Technology and Research Trust, Puerto Rico Vector Control Unit, San Juan, Puerto Rico, United States of America
| | - Vanessa Rivera-Amill
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Stephen Waterman
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Gabriela Paz-Bailey
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
| | - Liliana Sánchez-González
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico, United States of America
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Sriprapun M, Rattanamahaphoom J, Sriburin P, Chatchen S, Limkittikul K, Sirivichayakul C. The expression of circulating hsa-miR-126-3p in dengue-infected Thai pediatric patients. Pathog Glob Health 2023; 117:76-84. [PMID: 35708203 PMCID: PMC9848246 DOI: 10.1080/20477724.2022.2088465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Circulating hsa-miRNA-126 (CmiR-126) has been reported to involve in the pathogenesis of many infectious diseases including dengue virus infection. However, no prior study has been conducted to describe more details in dengue-infected pediatric patients. This study aimed to describe CmiR-126-3p in dengue-infected pediatric patients during the febrile and convalescent phases. Additionally, the correlations between CmiR-126-3p and other relevant clinical laboratory factors were investigated. Sixty paired-serum specimens collected during febrile and convalescent phases were retrieved from patients with dengue fever (DF) (n = 30) and dengue hemorrhagic fever (DHF) (n = 30). Thirty paired-serum specimens collected from non-dengue acute febrile illness patients (AFI) were included as the control group. CmiR-126-3p was determined using reverse transcription quantitative real-time polymerase-chain reaction (RT-qPCR). Relative miRNA expression was calculated as 2-ΔCt using CmiR-16-5p for data normalization. CmiR-126-3p expression during febrile and convalescent phases in dengue-infected patients was significantly lower than AFI (p < 0.05). However, miRNA levels were not different (p > 0.05) compared between DF and DHF and between primary and secondary infection. CmiR-126-3p levels in DF in the convalescent were significantly higher than in the febrile phase (p = 0.025). No association between CmiR-126-3p and hematocrit, WBC level, platelet count, WBC differential count or dengue viral load was observed (p > 0.05). The data suggest that hsa-miR-126-3p involved in pathogenesis of dengue infection and may be a promising early and late biomarker for DENV infection. However, hsa-miR-126-3p alone cannot be used as a predictor for dengue severity.
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Affiliation(s)
- Methee Sriprapun
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Jittraporn Rattanamahaphoom
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,TROPMED Dengue Diagnostic Center (TDC), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pimolpachr Sriburin
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,TROPMED Dengue Diagnostic Center (TDC), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supawat Chatchen
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,TROPMED Dengue Diagnostic Center (TDC), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kriengsak Limkittikul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,TROPMED Dengue Diagnostic Center (TDC), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,TROPMED Dengue Diagnostic Center (TDC), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,CONTACT Chukiat Sirivichayakul Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandThis article has been corrected with minor changes. These changes do not impact the academic content of the article
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Soomar SM, Issani A, Moin G, Dhalla Z, Adnan A, Soomar SM. The Serological Confirmation and Outcome of the Pediatric Dengue Patients Presenting to Emergency Department: A Cross-Sectional Study. Glob Pediatr Health 2022; 9:2333794X221138434. [PMID: 36601355 PMCID: PMC9806414 DOI: 10.1177/2333794x221138434] [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: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background In the emergency department, it is very uncommon perform a differential diagnosis to serologically differentiate between dengue, dengue hemorrhagic fever, and dengue shock syndrome. Prompt differential diagnosis and treatment is essential with the presentation of dengue. This study aims to determine the serological confirmation and outcome of the dengue epidemic in the pediatric population presenting to the ED in a tertiary care hospital. Methods A single-center cross-sectional study was conducted. All pediatric patients aged less than 18 years presented to ED with clinical features suggestive of DF, DFF, and DSS while also doing the serological confirmation for the dengue were enrolled in the study. Data was collected on demographics, clinical characteristics, diagnosis, and outcomes of 324 pediatric patients. Multivariable binary logistic regression was applied for the analysis. Results Out of 324 patients, 191 (59.13%) underwent NS1 testing and 132 (40.87%) did the IgM test. Most participants were in the age range of 13 to 18 years in both groups. Fever was the most common complaint in both groups 191 (100%) and 132 (100%). In each group, around one-third of the participants complained about body aches 69 (36.13%) and 44 (33.33%). The patient having a history of traveling within the past 14 days created a 1.51 (95% CI: 1.27-2.25) times higher odds of contracting dengue fever as compared to no history of travel. Conclusion The serologic confirmation of dengue in the ED helps in both the adequate and timely treatment as well as patient disposition and ultimately saves lives.
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Affiliation(s)
| | | | | | - Zeyanna Dhalla
- Aga Khan University, Karachi,
Pakistan
- The College of William and Mary,
Williamsburg, VA, United States
| | - Ahmer Adnan
- Aga Khan University, Karachi,
Pakistan
- Life Care Hospital, Karachi,
Pakistan
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Islam S, Khan MAS, Badal MFA, Khan MZI, Gozal D, Hasan MJ. Clinical and hematological profiles of children with dengue residing in a non-endemic zone of Bangladesh. PLoS Negl Trop Dis 2022; 16:e0010847. [PMID: 36215330 PMCID: PMC9584401 DOI: 10.1371/journal.pntd.0010847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 10/20/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The clinical and hematological parameters of children with dengue during an outbreak in a non-endemic region have not been well described. To delineate the clinical profile of pediatric cases from a tertiary care center located in a non-endemic zone (Tangail district) in Bangladesh was the objective of the study. METHODS A cross-sectional observational study was conducted in the Department of Pediatrics of a 250-bed general hospital in Tangail, Bangladesh, between June 2019 to September 2019. Data collection was done using a pre-structured case record form. All patients underwent detailed history taking, physical examination, and hematological profiling. A total of 123 confirmed dengue cases were analyzed. RESULTS The average age of patients was 7.3±4.1 (SD) years, with nearly two-thirds being male (61.8%) and the majority living in rural areas (76.4%). Fever (100%), body ache (57.7%), headache (56.9%), and rash (55.3%) were the four common clinical manifestations. NS1 antigen and anti-dengue IgM antibody tests were positive in 86% (102 out of 119) and 37.7% (20 out of 53) of cases, respectively. Thrombocytopenia was present in 42% of cases. The majority of the cases had dengue fever (73.2%), and the remaining cases were either dengue hemorrhagic fever or dengue shock syndrome (26.8%). Clinical and hematological parameters varied with the type of dengue. Particularly, rash (p = <0.001), bleeding manifestation (p = <0.001), vomiting (p = 0.012), hypotension (p = 0.018), pleural effusion (p = 0.018), ascites (p = 0.018), hepatomegaly (p = <0.001) and low platelet count (<150 x 103cells/μL) (p = 0.038) were significantly more common among dengue hemorrhagic fever or dengue shock syndrome cases. CONCLUSIONS The present study documented the clinical features of dengue in a pediatric group of patients from a non-endemic zone of Bangladesh. This vulnerable patient group requires earlier identification and keen attention during management.
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Affiliation(s)
- Saiful Islam
- 250 Bedded General Hospital, Tangail, Bangladesh
| | | | | | | | - David Gozal
- University of Missouri School of Medicine, Columbia, Missouri, United States of America
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Wang R, Wang X, Zhang L, Feng G, Liu M, Zeng Y, Xie Z. The epidemiology and disease burden of children hospitalized for viral infections within the family Flaviviridae in China: A national cross-sectional study. PLoS Negl Trop Dis 2022; 16:e0010562. [PMID: 35788743 PMCID: PMC9286261 DOI: 10.1371/journal.pntd.0010562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/15/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Viruses of the family Flaviviridae, including Japanese encephalitis virus (JEV), dengue virus (DENV), yellow fever virus (YFV) and hepatitis C virus (HCV), are widely distributed worldwide. JEV, DENV and YFV belong to the genus Flavivirus, whereas HCV belongs to the genus Hepacivirus. Children’s symptoms are usually severe. As a result, rates of hospitalization due to infection with these viruses are high. The epidemiology and disease burden of hospitalized children have rarely been described in detail to date. The objective of this study was to report the general epidemiological characteristics, clinical phenotype, length of stay (LOS), burden of disease, and potential risk factors for hospitalized children infected with JEV, DENV, YFV, or HCV in Chinese pediatric hospitals. Methodology A cross-sectional study of epidemiology and disease burden of children hospitalized for Flaviviridae virus infections between December 2015 and December 2020 in China was performed. Face sheets of discharge medical records (FSMRs) were collected from 27 tertiary children’s hospitals in the Futang Research Center of Pediatric Development and aggregated into FUTang Update medical REcords (FUTURE). Information on sociodemographic variables, clinical phenotype, and LOS as well as economic burden was included in FSMRs and compared using appropriate statistical tests. Findings The study described 490 children aged 0–15 years hospitalized for infections with Flaviviridae viruses. Japanese encephalitis (JE) cases are the highest, accounting for 92.65% of the total hospitalization cases caused by Flaviviridae virus infection. The incidence of JE peaked from July to October with a profile of a high proportion of severe cases (68.06%) and low mortality (0.44%). Rural children had a significantly higher incidence than urban children (91.63%). Most hospitalized dengue cases were reported in 2019 when dengue outbreaks occurred in many provinces of China, although only 14 dengue cases were collected during the study period. Yellow fever (YF) is still an imported disease in China. The hospitalizations for children with hepatitis C (HC) were not high, and mild chronic HC was the main clinical phenotype of patients. Among the four viral infections, JE had the highest disease burden (LOS and expenditure) for hospitalized children. Conclusion First, the present study reveals that JE remains the most serious disease due to Flaviviridae virus infection and threatens children’s health in China. Many pediatric patients have severe illnesses, but their mortality rate is lower, suggesting that existing treatment is effective. Both JEV vaccination and infection control of rural children should represent a focus of study. Second, although the dual risks of indigenous epidemics and imports of DENV still exist, the prevalence of DENV in children is generally manageable. Third, YFV currently shows no evidence of an epidemic in China. Finally, the proportion of children with chronic hepatitis C (CHC) is relatively large among hospitalized children diagnosed with HCV. Thus, early and effective intervention should be offered to children infected with HCV to ease the burden of CHC on public health. We performed a general epidemiological and disease burden assessment of 490 hospitalized children infected with any virus from the family Flaviviridae [Japanese encephalitis virus (JEV), dengue virus (DENV), yellow fever virus (YFV) and hepatitis C virus (HCV)] from December 2015 to December 2020 with confirmed clinical presentation and laboratory results. Our study found that hospitalization for Japanese encephalitis (JE) predominated in children who lived in rural areas, and the infection was rate was considerably higher in summer and autumn (July–October) compared with other months. In addition, children hospitalized with JE have the largest share of disease burden. However, the overall low rate of hospitalization and mortality of children shows that China’s JE prevention and control policies remain effective. However, the prevention, control and surveillance of JEV in rural areas should not be neglected. Dengue and yellow fever have not yet caused serious public health concerns among children in China, but the spatial and temporal distributions of viral infection must be assessed to be alert to the indigenous spread of imported cases. CHC is a refractory phenotype of HCV infection in children; thus, early screening and intervention are encouraged given the insidious appearance of symptoms in the early stages after HCV infection. These findings can help to understand the epidemic status of viruses classified in the family Flaviviridae in children and the disease burden of hospitalized children, which is conducive to precise prevention and control, optimization of the allocation of resources, and the formulation of more reasonable and effective policies.
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Affiliation(s)
- Ran Wang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xinyu Wang
- Big Data Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Linlin Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Mengjia Liu
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- * E-mail:
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Richter RP, Payne GA, Ambalavanan N, Gaggar A, Richter JR. The endothelial glycocalyx in critical illness: A pediatric perspective. Matrix Biol Plus 2022; 14:100106. [PMID: 35392182 PMCID: PMC8981764 DOI: 10.1016/j.mbplus.2022.100106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/18/2022] Open
Abstract
The vascular endothelium is the interface between circulating blood and end organs and thus has a critical role in preserving organ function. The endothelium is lined by a glycan-rich glycocalyx that uniquely contributes to endothelial function through its regulation of leukocyte and platelet interactions with the vessel wall, vascular permeability, coagulation, and vasoreactivity. Degradation of the endothelial glycocalyx can thus promote vascular dysfunction, inflammation propagation, and organ injury. The endothelial glycocalyx and its role in vascular pathophysiology has gained increasing attention over the last decade. While studies characterizing vascular glycocalyx injury and its downstream consequences in a host of adult human diseases and in animal models has burgeoned, studies evaluating glycocalyx damage in pediatric diseases are relatively few. As children have unique physiology that differs from adults, significant knowledge gaps remain in our understanding of the causes and effects of endothelial glycocalyx disintegrity in pediatric critical illness. In this narrative literature overview, we offer a unique perspective on the role of the endothelial glycocalyx in pediatric critical illness, drawing from adult and preclinical data in addition to pediatric clinical experience to elucidate how marked derangement of the endothelial surface layer may contribute to aberrant vascular biology in children. By calling attention to this nascent field, we hope to increase research efforts to address important knowledge gaps in pediatric vascular biology that may inform the development of novel therapeutic strategies.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- CD, cell differentiation marker
- COVID-19, coronavirus disease 2019
- CPB, cardiopulmonary bypass
- CT, component therapy
- Children
- Critical illness
- DENV NS1, dengue virus nonstructural protein 1
- DM, diabetes mellitus
- ECLS, extracorporeal life support
- ECMO, extracorporeal membrane oxygenation
- EG, endothelial glycocalyx
- Endothelial glycocalyx
- FFP, fresh frozen plasma
- GAG, glycosaminoglycan
- GPC, glypican
- HPSE, heparanase
- HSV, herpes simplex virus
- IV, intravenous
- MIS-C, multisystem inflammatory syndrome in children
- MMP, matrix metalloproteinase
- Pragmatic, Randomized Optimal Platelet and Plasma Ratios
- RHAMM, receptor for hyaluronan-mediated motility
- S protein, spike protein
- SAFE, Saline versus Albumin Fluid Evaluation
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SDC, syndecan
- SDF, sidestream darkfield
- SIRT1, sirtuin 1
- TBI, traumatic brain injury
- TBSA, total body surface area
- TMPRSS2, transmembrane protease serine 2
- Th2, type 2 helper T cell
- VSMC, vascular smooth muscle cell
- Vascular biology
- WB+CT, whole blood and component therapy
- eNOS, endothelial nitric oxide synthase
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Affiliation(s)
- Robert P. Richter
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Program in Protease and Matrix Biology, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory A. Payne
- Program in Protease and Matrix Biology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namasivayam Ambalavanan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
- Translational Research in Normal and Disordered Development Program, University of Alabama, Birmingham, AL, USA
| | - Amit Gaggar
- Program in Protease and Matrix Biology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jillian R. Richter
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
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Hiestand J, Relly C, De Crom-Beer S, Fehr J, Kotsias-Konopelska S. [Baby on board - recommendations for pediatric travel consultation]. Dtsch Med Wochenschr 2022; 147:767-780. [PMID: 35672024 DOI: 10.1055/a-1737-7921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traveling with babies and children is challenging for parents and the doctor providing travel medicine advice. Especially pediatric VFR (visiting friends and relatives) travelers have a higher risk for infectious diseases due to lower risk perception and higher exposure. Being well prepared helps in exploring the world while staying healthy. Topics to be discussed in pediatric travel consultation are travel vaccinations, mosquito repellents, malaria prophylaxis, thorough sun protection, rehydration for gastroentritis, avoidance of rabies exposure, an agetailored travel pharmacy and more. We provide a guide to the most important topics for pediatric travel consultations.
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Chen Y, Li N, Lourenço J, Wang L, Cazelles B, Dong L, Li B, Liu Y, Jit M, Bosse NI, Abbott S, Velayudhan R, Wilder-Smith A, Tian H, Brady OJ. Measuring the effects of COVID-19-related disruption on dengue transmission in southeast Asia and Latin America: a statistical modelling study. THE LANCET. INFECTIOUS DISEASES 2022; 22:657-667. [PMID: 35247320 PMCID: PMC8890758 DOI: 10.1016/s1473-3099(22)00025-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic has resulted in unprecedented disruption to society, which indirectly affects infectious disease dynamics. We aimed to assess the effects of COVID-19-related disruption on dengue, a major expanding acute public health threat, in southeast Asia and Latin America. METHODS We assembled data on monthly dengue incidence from WHO weekly reports, climatic data from ERA5, and population variables from WorldPop for 23 countries between January, 2014 and December, 2019 and fit a Bayesian regression model to explain and predict seasonal and multi-year dengue cycles. We compared model predictions with reported dengue data January to December, 2020, and assessed if deviations from projected incidence since March, 2020 are associated with specific public health and social measures (from the Oxford Coronavirus Government Response Tracer database) or human movement behaviours (as measured by Google mobility reports). FINDINGS We found a consistent, prolonged decline in dengue incidence across many dengue-endemic regions that began in March, 2020 (2·28 million cases in 2020 vs 4·08 million cases in 2019; a 44·1% decrease). We found a strong association between COVID-19-related disruption (as measured independently by public health and social measures and human movement behaviours) and reduced dengue risk, even after taking into account other drivers of dengue cycles including climatic and host immunity (relative risk 0·01-0·17, p<0·01). Measures related to the closure of schools and reduced time spent in non-residential areas had the strongest evidence of association with reduced dengue risk, but high collinearity between covariates made specific attribution challenging. Overall, we estimate that 0·72 million (95% CI 0·12-1·47) fewer dengue cases occurred in 2020 potentially attributable to COVID-19-related disruption. INTERPRETATION In most countries, COVID-19-related disruption led to historically low dengue incidence in 2020. Continuous monitoring of dengue incidence as COVID-19-related restrictions are relaxed will be important and could give new insights into transmission processes and intervention options. FUNDING National Key Research and Development Program of China and the Medical Research Council.
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Affiliation(s)
- Yuyang Chen
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
| | - Naizhe Li
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China; MOE Key Laboratory for Biodiversity Science and Ecological Engineering, College of Life Sciences, Beijing Normal University, Beijing, China
| | - José Lourenço
- Biosystems and Integrative Sciences Institute, University of Lisbon, Lisbon, Portugal
| | - Lin Wang
- Department of Genetics, University of Cambridge, Cambridge, UK; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France
| | - Bernard Cazelles
- Institut de Biologie de l'École Normale Supérieure UMR8197, Eco-Evolutionary Mathematics, École Normale Supérieure, Paris, France; Unité Mixte Internationnale 209, Mathematical and Computational Modeling of Complex Systems, Sorbonne Université, Paris, France
| | - Lu Dong
- MOE Key Laboratory for Biodiversity Science and Ecological Engineering, College of Life Sciences, Beijing Normal University, Beijing, China
| | - Bingying Li
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nikos I Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Huaiyu Tian
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China.
| | - Oliver J Brady
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Sena MA, da Silva Castanha PM, Giles Guimarães AB, Oliveira PADS, da Silva MAL, Cordeiro MT, Moura P, Braga C, Vasconcelos LRS. Mannose-binding lectin levels and MBL2 gene polymorphisms are associated to dengue infection in Brazilian children at the early ages. Int J Infect Dis 2022; 117:212-219. [PMID: 35150914 DOI: 10.1016/j.ijid.2022.02.012] [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: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The mannose-binding lectin (MBL) plays an important role in innate immunity. Genetically determined variations in serum levels of MBL may influence the susceptibility and clinical outcome of dengue infection in early life. METHODS We investigated MBL2 gene polymorphisms and serum levels of MBL (total and functional) in children with asymptomatic (n=17) and symptomatic (n=29), primary dengue infections, and age-matched uninfected children (n=84) enrolled in a Brazilian dengue birth cohort. Polymorphisms of the MBL2 gene were assessed by RT-PCR, while ELISA were used to quantify serum levels of MBL. RESULTS We found that the X allele and YX genotype in the MBL2 were more frequent in dengue cases than controls. Likewise, the LXPA haplotype was exclusively found in dengue cases, thus probably related to dengue infection in our setting. Moreover, we found a higher frequency of the O allele and AO genotype in control group. Serum levels of total and functional MBL were higher in dengue naïve infants than dengue cases. CONCLUSIONS MBL2 variants related to lower production of serum MBL were associated to dengue infection in infants, while intermediate to high levels of total and functional serum MBL were associated with protection. These findings highlight the role of MBL2 variants and serum levels of MBL in the susceptibility to dengue disease at early ages.
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Affiliation(s)
- Marília A Sena
- Aggeu Magalhães Institute - Oswaldo Cruz Foundation/FIOCRUZ, Recife, Brazil.
| | - Priscila Mayrelle da Silva Castanha
- Infectious Diseases and Microbiology Department, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Faculty of Medical Science, University of Pernambuco/UPE, Recife, Brazil
| | | | | | | | | | - Patricia Moura
- Faculty of Medical Science, University of Pernambuco/UPE, Recife, Brazil; Laboratory of Immunobiology and Pathology, University of Pernambuco/UPE, Recife, Brazil
| | - Cynthia Braga
- Aggeu Magalhães Institute - Oswaldo Cruz Foundation/FIOCRUZ, Recife, Brazil
| | - Luydson Richardson Silva Vasconcelos
- Aggeu Magalhães Institute - Oswaldo Cruz Foundation/FIOCRUZ, Recife, Brazil; Faculty of Medical Science, University of Pernambuco/UPE, Recife, Brazil; Laboratory of Immunobiology and Pathology, University of Pernambuco/UPE, Recife, Brazil
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15
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Cell strain-derived induced pluripotent stem cell as a genetically controlled approach to investigate age-related host response to flaviviral infection. J Virol 2021; 96:e0173721. [PMID: 34851147 PMCID: PMC8826815 DOI: 10.1128/jvi.01737-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The expansion of the geographical footprint of dengue viruses (DENVs) and their mosquito vectors have affected more than half of the global population, including older adults who appear to show elevated risk of severe dengue. Despite this epidemiological trend, how ageing contributes to increase dengue pathogenesis is poorly understood. A limitation has been the lack of useful in vitro experimental approaches; cell lines commonly used for infection studies are immortal and hence do not age. Cell strains, such as WI-38 and MRC-5 with diploid genomes, do age with in vitro passaging but these cell strains were isolated decades ago and are now mostly highly passaged. Herein, we show that reprogramming of cell strains with finite lifespan into induced pluripotent stem cells (iPSCs), followed by conversion back into terminally differentiated cells, can be an approach to derive genetically identical cells at different stages of ageing. The iPSC-derived differentiated cells were susceptible to wild-type DENV infection and produced greater levels of type-I interferon expression with increase passaging, despite similar levels of infection. In contrast, infection with the attenuated DENV-2 PDK53 and YF17D-204 strains showed reduced and increased levels of infection with increasing passages; the latter could be clinically pertinent as YF17D-204 vaccination in older adults is associated with increased risk of severe adverse outcome. The differences in infection susceptibility and host response collectively suggest the potential of iPSC-derived cell strains as a genetically controlled approach to understand how ageing impacts viral pathogenesis. Importance Ageing has been a risk factor for poor clinical outcome in several infectious diseases, including dengue. However, age-dependent responses to dengue and other flaviviral infection or vaccination have remained incompletely understood due partly to lack of suitable laboratory tools. We thus developed an in vitro approach to examine age-related changes in host response to flaviviral infection. Notably, this approach uses cell strains with diploid rather than aneuploidic genomes, which are unstable. Conversion of these cells into iPSCs ensure sustainability of this resource and reprogramming back into terminally differentiated cells would, even with limited number of passages, produce cells at different stages of ageing for infection studies. Our findings suggest that this in vitro system has the potential to serve as a genetically-controlled approach to define the age-related response to flavivirus infection.
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Khan MAS, Al Mosabbir A, Raheem E, Ahmed A, Rouf RR, Hasan M, Alam FB, Hannan N, Yesmin S, Amin R, Ahsan N, Anwar S, Afroza S, Hossain MS. Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh. BMC Pediatr 2021; 21:478. [PMID: 34715835 PMCID: PMC8555185 DOI: 10.1186/s12887-021-02947-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019. METHODS We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data. RESULTS Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75-0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06-6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48-17.31, p = 0.01) were significant predictors of severity. CONCLUSIONS Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.
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Affiliation(s)
- Md Abdullah Saeed Khan
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Abdullah Al Mosabbir
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Enayetur Raheem
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Ahsan Ahmed
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Rashawan Raziur Rouf
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Mahmudul Hasan
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Fawzia Bente Alam
- Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Nahida Hannan
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | | | - Robed Amin
- Department of Medicine, Dhaka Medical College & Hospital, Dhaka, Bangladesh
| | - Nazmul Ahsan
- Department of Medicine, Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh
| | - Sayeeda Anwar
- Department of Paediatrics, Dhaka Medical College & Hospital, Dhaka, Bangladesh
| | - Syeda Afroza
- Department of Paediatrics, MH Samorita Hospital and Medical College, Dhaka, Bangladesh
| | - Mohammad Sorowar Hossain
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh.
- School of Environment and Life Sciences, Independent University, Dhaka, Bangladesh.
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Pathak B, Chakravarty A, Krishnan A. High viral load positively correlates with thrombocytopenia and elevated haematocrit in dengue infected paediatric patients. J Infect Public Health 2021; 14:1701-1707. [PMID: 34655984 DOI: 10.1016/j.jiph.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue fever is one of the major viral diseases worldwide transmitted by mosquitoes. Depending on the severity of disease it can range from mild fever to severe fatal cases. Rapid decline of platelet levels is one of indicators of clinical worsening. The role of viral factors in dengue pathogenesis and correlation with clinical and laboratory parameters remain unclear. METHODS Between September 2017 to December 2018, 102 dengue confirmed paediatric cases were analysed for various viral and host parameters. Based on symptoms, they were classified into dengue without warning signs (DOS), dengue with warning signs (DWS) and severe dengue (SD) as per 2009 WHO classification. Quantitative analysis of NS1, IgM and IgG in were done by ELISA. IgM/IgG ratio revealed primary or secondary dengue infection. Serotyping of virus in serum was done by nested multiplex RT-PCR. Viral load (VL) was determined by quantitative real time polymerase chain reaction. Association between VL and NS1 in patient sera with clinical and laboratory parameters was statistically analysed. RESULTS It was found that disease severity (as per 2009 WHO classification) significantly associated with secondary dengue infection. DENV3 was found to be the only serotype detected. The present study reports neither NS1 nor VL significantly associated with disease severity or type of infection (primary or secondary). However, VL positively correlated with haematocrit (p < 0.05). Viral load above 106 copies/mL was found in 61% of patients. Further, high viral load (>106 copies/mL) negatively correlated with platelet levels (p < 0.05). CONCLUSION Thus, viral load could be an important predictive parameter in dengue related severe symptoms like thrombocytopenia and elevated hematocrit when it goes above a certain threshold (>106 copies/ mL).
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Affiliation(s)
- Bharti Pathak
- Department of Molecular Medicine, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi 110062, India
| | - Aparna Chakravarty
- Department of Paediatrics, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Anuja Krishnan
- Department of Molecular Medicine, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi 110062, India.
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Choudhary B, Jayappa M, Gupta P, Singh K, Choudhary Y. A Clinical Audit of Adherence to Guidelines During Emergency Management of Pediatric Dengue Patients. Indian J Pediatr 2021; 88:717. [PMID: 33907917 DOI: 10.1007/s12098-021-03781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Bharat Choudhary
- Department of Trauma and Emergency (Pediatrics), All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Manjesh Jayappa
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priya Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Yachana Choudhary
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Leowattana W, Leowattana T. Dengue hemorrhagic fever and cardiac involvement. World J Meta-Anal 2021; 9:286-296. [DOI: 10.13105/wjma.v9.i3.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/30/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Dengue viral infection (DVI) is one of the world’s most significant viral infections spreading. Most of the patients have been asymptomatic, with relatively benign clinical manifestations and outcomes. However, a small number of patients have progressed to severe dengue diseases, including hemorrhage, multi-organ impairment, and increased vascular leakage causing hypovolemic shock, which can cause cardiovascular collapse and death. Numerous lines of evidence have demonstrated that DVI could also cause cardiac dysfunction, arrhythmias, and severe myocarditis. The treatment for dengue hemorrhagic fever (DHF) patients remains symptomatic and supportive, with close monitoring of hemodynamic status. The contributory role of cardiac dysfunction in DHF patients has potentially critical implications on the management. This review will address the current knowledge of cardiac involvement in DHF patients and the management strategy to reduce the fatality outcome.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
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Tan KW, Tan B, Thein TL, Leo YS, Lye DC, Dickens BL, Wong JGX, Cook AR. Dynamic dengue haemorrhagic fever calculators as clinical decision support tools in adult dengue. Trans R Soc Trop Med Hyg 2021; 114:7-15. [PMID: 31943116 DOI: 10.1093/trstmh/trz099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/21/2019] [Accepted: 08/15/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The objective of this study was to develop multiple prediction tools that calculate the risk of developing dengue haemorrhagic fever. METHODS Training data consisted of 1771 individuals from 2006-2008 admitted with dengue fever whereby 304 developed dengue haemorrhagic fever during hospitalisation. Least absolute shrinkage and selection operator regression was used to construct three types of calculators, static admission calculators and dynamic calculators that predict the risk of developing dengue haemorrhagic fever for a subsequent day (DAily Risk Tomorrow [DART]) or for any future point after a specific day since fever onset (DAily Risk Ever [DARE]). RESULTS From 119 admission covariates, 35 were in at least one of the calculators, which reported area under the curve (AUC) values of at least 0.72. Addition of person-time data for DART improved AUC to 0.76. DARE calculators displayed a large increase in AUC to 0.79 past day 7 with the inclusion of a strong predictor, maximum temperature on day 6 since onset, indicative of a saddleback fever. CONCLUSIONS All calculators performed well when validated with 2005 data. Addition of daily variables further improved the accuracy. These calculators can be used in tandem to assess the risk of dengue haemorrhagic fever upon admission and updated daily to obtain more precise risk estimates.
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Affiliation(s)
- Ken Wei Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549
| | - Ben Tan
- Ministry of Education, 1 North Buona Vista Drive, Singapore 138675
| | - Tun L Thein
- National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442
| | - Yee-Sin Leo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549.,National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442.,Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore 636921
| | - David C Lye
- National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442.,Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore 636921
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549
| | | | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549
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Byrne AB, García AG, Brahamian JM, Mauri A, Ferretti A, Polack FP, Talarico LB. A murine model of dengue virus infection in suckling C57BL/6 and BALB/c mice. Animal Model Exp Med 2021; 4:16-26. [PMID: 33738433 PMCID: PMC7954830 DOI: 10.1002/ame2.12145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Dengue is a significant public health concern across tropical and subtropical regions worldwide, principally causing disease in children. Very young children are at increased risk of severe manifestations of dengue infection. The mechanism of dengue disease in this population is not fully understood. In this study, we present a murine model of dengue virus primary infection in suckling C57BL/6 and BALB/c mice in order to investigate disease pathogenesis. Three-day-old C57BL/6 mice intraperitoneally infected with DENV-2 NGC were more susceptible to infection than BALB/c mice, showing increased liver enzymes, extended viremia, dissemination to organs and histological alterations in liver and small intestine. Furthermore, the immune response in DENV-infected C57BL/6 mice exhibited a marked Th1 bias compared to BALB/c mice. These findings highlight the possibility of establishing an immunocompetent mouse model of DENV-2 infection in suckling mice that reproduces certain signs of disease observed in humans and that could be used to further study age-related mechanisms of dengue pathogenesis.
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Affiliation(s)
- Alana B. Byrne
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Laboratorio de Investigaciones Infectológicas y Biología MolecularInfectologíaDepartamento de MedicinaHospital de Niños Ricardo GutiérrezBuenos AiresArgentina
| | - Ayelén G. García
- Fundación INFANTBuenos AiresArgentina
- Present address:
Instituto Nacional de Enfermedades Infecciosas (INEI) ‐ Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr Carlos Malbrán”Buenos AiresArgentina
| | - Jorge M. Brahamian
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Departamento de Química Biológica‐IQUIBICEN (CONICET‐UBA)Facultad de Ciencias Exactas y NaturalesUniversidad de Buenos AiresBuenos AiresArgentina
| | | | | | | | - Laura B. Talarico
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Laboratorio de Investigaciones Infectológicas y Biología MolecularInfectologíaDepartamento de MedicinaHospital de Niños Ricardo GutiérrezBuenos AiresArgentina
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Nandwani S, Bhakhri BK, Singh N, Rai R, Singh DK. Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis. Rev Soc Bras Med Trop 2021; 54:e05192020. [PMID: 33533817 PMCID: PMC7849329 DOI: 10.1590/0037-8682-0519-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.
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Affiliation(s)
- Sumi Nandwani
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Microbiology, Noida, Uttar Pradesh, India
| | - Bhanu Kiran Bhakhri
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
| | - Nupur Singh
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
| | - Ruchi Rai
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Neonatology, Noida, Uttar Pradesh, India
| | - Dharmender Kumar Singh
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
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Minodier P, Imbert P. Conduite à tenir devant un enfant fébrile au retour de voyage ☆. JOURNAL DE PEDIATRIE ET DE PUERICULTURE 2020; 33:118-145. [PMID: 32341631 PMCID: PMC7184019 DOI: 10.1016/j.jpp.2020.04.002] [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] [Indexed: 11/28/2022]
Abstract
Les pathologies le plus fréquentes au retour de voyage à l’étranger sont les infections gastro-intestinales, les maladies fébriles et les problèmes dermatologiques. L’évaluation d’un enfant fébrile de retour de voyage est clinique : vérification des antécédents et des vaccinations, recherche d’autres cas au contact, signes fonctionnels et physiques, caractéristiques du voyage. Un bilan paraclinique de débrouillage complète souvent l’évaluation pour une orientation syndromique. Si les causes de fièvre sont surtout cosmopolites, la gravité des pathologies exotiques doit les faire rechercher en priorité. Le paludisme doit être évoqué devant toute fièvre en provenance d’Afrique subsaharienne. Le diagnostic repose sur l’association d’un frottis sanguin et d’un test sensible (goutte épaisse, polymerase chain reaction [PCR]) ou d’un test de diagnostic rapide (pour Plasmodium [P ]. falciparum ). Les critères clinicobiologiques de gravité sont essentiels pour orienter et traiter le patient. En cas d’accès non compliqué à P. falciparum , le traitement repose sur une thérapie combinée à base d’artémisinine (ACT), artéméther-luméfantrine ou arténimol-pipéraquine. Les accès graves sont traités par l’artésunate intraveineux, puis un ACT oral. Dengue, chikungunya et infection à virus Zika ont des caractéristiques cliniques communes (association fièvre-éruption-arthralgies, traitement symptomatique). En cas de dengue, il faut surveiller l’apparition de signes d’alerte qui pourraient faire craindre une évolution péjorative. Le chikungunya est grave en cas de transmission per partum, avec un risque d’encéphalite néonatale. Chez l’enfant, le Zika est a- ou peu symptomatique. Mais en cas d’infection pendant une grossesse, le risque est celui d’une embryofœtopathie. Le diagnostic de ces arboviroses repose sur la PCR à la phase aiguë et la sérologie secondairement. La symptomatologie de la typhoïde est peu spécifique, justifiant la pratique d’hémocultures systématiques devant une fièvre du retour. Son traitement repose sur les céphalosporines de troisième génération ou la ciprofloxacine, mais les résistances augmentent. Au total, la diversité des étiologies d’une fièvre de retour et la gravité potentielle des infections importées imposent une réflexion sur le parcours de soins de ces patients, en particulier vis-à-vis du risque de fièvre hémorragique.
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Affiliation(s)
- P. Minodier
- Accueil des urgences pédiatriques, Hôpital Nord, Chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - P. Imbert
- Centre de vaccinations internationales, Hôpital d’instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Post-infectious functional gastrointestinal disorders in children after a non-severe dengue episode without warning signs. ACTA ACUST UNITED AC 2019; 39:93-100. [PMID: 31529837 DOI: 10.7705/biomedica.v39i4.4281] [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: 01/14/2018] [Indexed: 11/21/2022]
Abstract
Introduction: The pathogenesis of functional gastrointestinal disorders involves infectious agents such as viruses.
Objective: To study the development of functional gastrointestinal disorders 3, 6, 9 and 12 months after an episode of non-severe dengue without warning signs in children.
Materials and methods: We conducted a cohort study in 73 children diagnosed with non-severe dengue without warning signs at Hospital Universitario del Valle “Evaristo García” and 62 healthy children from Cali, Colombia. Using the Questionnaire for Pediatric Gastrointestinal Symptoms Rome III (QPGS-III) in Spanish we identified functional gastrointestinal disorders 3, 6, 9, and 12 months after non-severe dengue without warning signs. Measurements of central tendency, relative risk, chi square, and Fisher’s exact test were performed, with p<0.05 being significant.
Results: We included 135 children who were 10.7±1.9 years old; 51.1% of them were male and 19.3% had a functional gastrointestinal disorder (9.6% of them had abdominal pain related to functional gastrointestinal disorders). There was a greater risk to present a functional gastrointestinal disorder and related abdominal pain in children after non-severe dengue without warning signs at 3, 6, 9, and 12 months of follow-up, but without significant differences.
Conclusion: Our study suggests that non-severe dengue without warning signs does not increase the risk of functional gastrointestinal disorders and related abdominal pain for up to 12 months of follow-up.
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Minodier P, Imbert P. Conducta práctica ante un niño febril al regresar de un viaje. EMC. PEDIATRIA 2019; 54:1-22. [PMID: 32308527 PMCID: PMC7159023 DOI: 10.1016/s1245-1789(19)42593-6] [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] [Indexed: 10/27/2022]
Abstract
Las enfermedades más frecuentes al regresar de un viaje al extranjero son las infecciones gastrointestinales, las enfermedades febriles y los problemas dermatológicos. La evaluación de un niño febril al regreso de un viaje es clínica: verificación de los antecedentes y las vacunaciones, búsqueda de otros casos en contacto, signos funcionales y físicos, y características del viaje. Unas pruebas complementarias de rutina completan a menudo la evaluación para una orientación sindrómica. Si bien las causas de fiebre son, sobre todo, cosmopolitas, la gravedad de la enfermedad exótica obliga a buscarlas prioritariamente. El paludismo debe sospecharse ante una fiebre procedente de África subsahariana. El diagnóstico se basa en la asociación de un frotis sanguíneo y una prueba sensible (gota gruesa, reacción en cadena de la polimerasa [PCR]) o una prueba de diagnóstico rápido (para Plasmodium falciparum ). Los criterios clínico-biológicos de gravedad son esenciales para orientar y tratar al paciente. En caso de acceso no complicado por P. falciparum, el tratamiento se basa en un tratamiento combinado a base de artemisinina (ACT), arteméter-lumefantrina o artenimol-piperaquina. Los accesos graves se tratan con artesunato intravenoso, seguido de ACT oral. Dengue, chikungunya e infección por virus Zika tienen características clínicas comunes (fiebre-erupción-artralgias, tratamiento sintomático). En caso de dengue, conviene controlar la aparición de signos de alerta, que podrían hacer temer una evolución negativa. El chikungunya es grave en caso de transmisión en el parto, con un riesgo de encefalitis neonatal. En el niño, el Zika es asintomático o poco sintomático. Pero, en caso de infección durante el embarazo, el riesgo es el de una embriofetopatía. El diagnóstico de estas arbovirosis se basa en la PCR en la fase aguda y en la serología secundariamente. La sintomatología de la fiebre tifoidea es poco específica, lo cual justifica la práctica de hemocultivos sistemáticos ante una fiebre tras un viaje. Su tratamiento se basa en las cefalosporinas de tercera generación o el ciprofloxacino, pero las resistencias aumentan. En suma, la diversidad de las etiologías de una fiebre al regreso de un viaje y la potencial gravedad de las infecciones importadas imponen una reflexión sobre el proceso de tratamiento de estos pacientes, en especial en lo referente al riesgo de fiebre hemorrágica.
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Affiliation(s)
- P Minodier
- Accueil des urgences pédiatriques, Hôpital Nord, Chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - P Imbert
- Centre de vaccinations internationales, Hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Dengue and Chikungunya Infections in Children : Guest Editor: Bhim S. Pandhi. Indian J Pediatr 2019; 86:287-295. [PMID: 30511272 DOI: 10.1007/s12098-018-2794-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/15/2022]
Abstract
Dengue and Chikungunya are two important mosquito-borne acute febrile illnesses in children. With increased urbanization and newer strains of chikungunya virus with improved transmission with Aedes albopictus, the at-risk population for these infections has greatly increased. Dengue fever has been classified by WHO as dengue with/ without warning signs and severe dengue. Severe dengue is associated with hemorrhagic manifestations, hypovolemia and hypotension secondary to third space loss due to capillary leak or severe end organ dysfunction. NS1 antigen detection and dengue polymerase chain reaction, [polymerase chain reaction (PCR during first 5 d)] and IgM for dengue (6th day of fever onwards) are commonly utilized diagnostic tests. Appropriate fluid therapy with timely tapering of intravenous fluid rate with hematocrit, treatment of hemorrhagic manifestations and clinical monitoring are the mainstay of dengue treatment. Chikungunya has less severe course with shorter febrile phase with prominent and persistent joint symptoms. PCR and IgM against chikungunya are appropriate investigations. Treatment is supportive for chikungunya infection with appropriate joint pain relief.
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Velasco-Benítez CA, Ortíz-Rivera CJ. ¿El antecedente de dengue está asociado a la presencia de Desórdenes Gastrointestinales Funcionales en Niños? INFECTIO 2019. [DOI: 10.22354/in.v23i2.773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introducción: La patogénesis de los desórdenes gastrointestinales funcionales (DGFs) es multifactorial.Objetivo: Investigar la prevalencia de DGFs luego del antecedente de dengue.Materiales y métodos: Estudio de prevalencia en niños entre 8-18 años de edad. Se tomaron variables sociodemográficas, clínicas y el antecedente del último año de dengue diagnosticado en urgencias. Se aplicó el Cuestionario para Síntomas Gastrointestinales Pediátricos Roma III en Español para DGFs. El análisis estadístico incluyó el cálculo del OR, con IC95% y Fisher a dos colas, con una p<0.05 significativo.Resultados: Fueron incluidos 4023 niños con edad 11,9±2,3 años y 50,1% masculinos. La prevalencia para presentar al menos 1 DGFs fue 23.0% y del antecedente de haber presentado dengue en el último año del 7,5%; habiendo predominio en escolares entre 8-12 años de edad (OR=1,56 IC95%=1,20-2,04 p=0,0006) y con al menos 1 DGFs (OR=1,98 IC95%=1,53-2,56 p<0,0001). En los niños que por antecedente presentaron dengue en el último año, hubo diferencias significativas cuando tenían padres separados/divorciados.Conclusión: En este grupo de niños, los DGFs son frecuentes, presentándose mayor oportunidad de tener algún DGFs en los escolares entre los 8-12 años de edad cuando se tiene el antecedente de dengue diagnosticado en un servicio de urgencias.
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Freeman MC, Coyne CB, Green M, Williams JV, Silva LA. Emerging arboviruses and implications for pediatric transplantation: A review. Pediatr Transplant 2019; 23:e13303. [PMID: 30338634 DOI: 10.1111/petr.13303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection. In this review, we discuss the current state of knowledge for these viruses as well as repercussions of infection in the solid organ and HSCT population, with a focus, when possible, on pediatric patients.
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Affiliation(s)
- Megan Culler Freeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolyn B Coyne
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Green
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V Williams
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurie A Silva
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Harville EW. Paediatric Zika - Beyond Pregnant Women. Paediatr Perinat Epidemiol 2017; 31:546-548. [PMID: 28806481 DOI: 10.1111/ppe.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emily W Harville
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, Louisiana, LA
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Li GH, Ning ZJ, Liu YM, Li XH. Neurological Manifestations of Dengue Infection. Front Cell Infect Microbiol 2017; 7:449. [PMID: 29119088 PMCID: PMC5660970 DOI: 10.3389/fcimb.2017.00449] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.
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Affiliation(s)
- Guo-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Zhi-Jie Ning
- Jinan Infectious Diseases Hospital, Jinan, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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Incidence and risk factors for Dengue virus (DENV) infection in the first 2 years of life in a Brazilian prospective birth cohort. Epidemiol Infect 2017; 145:2971-2979. [PMID: 28918772 DOI: 10.1017/s095026881700214x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study assessed the incidence and risk factors for dengue virus (DENV) infection among children in a prospective birth cohort conducted in the city of Recife, a hyperendemic dengue area in Northeast Brazil. Healthy pregnant women (n = 415) residing in Recife who agreed to have their children followed were enrolled. Children were followed during their first 24 months of age (May/2011-June/2014), before the 2015 Zika virus outbreak. DENV infection was detected by reverse-transcriptase polymerase chain reaction and/or serology (anti-DENV IgM/IgG). The incidence rates per 1000 person-years (py) and its association with risk factors by age bands (0-12, >12-30 months) were estimated through Poisson regression models. Forty-nine dengue infections were detected; none progressed to severe forms. The incidence rates were 107·6/1000py (95% CI 76·8-150·6) and 93·3/1000py (95% CI 56·1-154·4) in the first and second years of age, respectively. Male children (risk ratios (RR) = 2·33; 95% CI 1·09-4·98) and those born to DENV-naïve mothers (RR = 2·42; 95% CI 1·01-5·80) were at greater risk of infection in the first year of age. In the second year, children born to Caucasian/Asian descent skin colour mothers had a threefold higher risk of infection (RR = 3·34; 95% CI: 1·08-10·33). These data show the high exposure of children to DENV infection in our setting and highlight the role of biological factors in this population's susceptibility to infection.
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Wang L, Zhou P, Fu X, Zheng Y, Huang S, Fang B, Zhang G, Jia K, Li S. Yellow fever virus: Increasing imported cases in China. J Infect 2016; 73:377-80. [PMID: 27422700 DOI: 10.1016/j.jinf.2016.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Lifang Wang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China
| | - Pei Zhou
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China
| | - Xingliang Fu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, 510642, People's Republic of China
| | - Yun Zheng
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China
| | - San Huang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China
| | - Bo Fang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, 510642, People's Republic of China
| | - Guihong Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, 510642, People's Republic of China
| | - Kun Jia
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China.
| | - Shoujun Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Key Laboratory of Prevention and Control for Severe Clinical Animal Diseases, Guangzhou, Guangdong Province, 510642, People's Republic of China; Guangdong Provincial Engineering Research Center of Pet, Guangzhou, Guangdong Province, 510642, People's Republic of China.
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Cavalcanti LPDG, Braga DNDM, Pompeu MMDL, Lima AAB, Silva LMAD, Aguiar MG, Castiglioni M, Araújo FMDC, Malta DL, Queiroz A. Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil. Rev Soc Bras Med Trop 2016; 48:658-64. [PMID: 26676489 DOI: 10.1590/0037-8682-0287-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/11/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.
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Affiliation(s)
| | | | | | | | | | | | - Mariana Castiglioni
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Ceará, Brazil
| | | | | | - Anastácio Queiroz
- Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Torrentes-Carvalho A, Hottz ED, Marinho CF, da Silva JBC, de Oliveira Pinto LM, Fialho LG, Bozza FA, Cunha RV, Damasco PV, Kubelka CF, de Azeredo EL. Characterization of clinical and immunological features in patients coinfected with dengue virus and HIV. Clin Immunol 2016; 164:95-105. [DOI: 10.1016/j.clim.2016.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/02/2016] [Accepted: 01/14/2016] [Indexed: 12/20/2022]
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Abstract
"Infectious diseases of poverty" (IDoP) describes infectious diseases that are more prevalent among poor and vulnerable populations, namely human immunodeficiency virus (HIV) infection, tuberculosis (TB), malaria, and neglected tropical diseases (NTDs). In 2013, 190,000 children died of HIV-related causes and there were 550,000 cases and 80,000 TB deaths in children. Children under age 5 account for 78% of malaria deaths annually. NTDs remain a public health challenge in low- and middle-income countries. This article provides an overview of the major IDoP that affect children. Clinicians must be familiar with the epidemiology and clinical manifestations to ensure prompt diagnosis and treatment.
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Affiliation(s)
- Caitlin Hansen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Elijah Paintsil
- Department of Pediatrics, Yale University School of Medicine, 464 Congress Ave, New Haven, CT 06520, USA; Department of Pharmacology, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520, USA; Department of Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520, USA.
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Poddighe D, Bonomelli I, Giardinetti S, Nedbal M, Bruni P. Paediatric Dengue Fever diagnosed through parents' epidemiologic report and preventive strategy during the acute phase of infection. J Travel Med 2016; 23:tav013. [PMID: 26782129 DOI: 10.1093/jtm/tav013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/12/2022]
Abstract
In Europe, Dengue Fever is one of the most frequent imported diseases and also autochthonous cases occurred in areas where the insect vector is present. Here, we describe a child returning from Philippines and diagnosed with Dengue Fever, through the information provided by parents about an ongoing outbreak in their municipality. An appropriate clinical management in the hospital was established to monitor the occurrence of complications and to cancel the risk of dengue virus transmission in the acute phase of infection.
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Affiliation(s)
- Dimitri Poddighe
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Irene Bonomelli
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Silvia Giardinetti
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Marco Nedbal
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Paola Bruni
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
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Cavalcanti LPDG, Braga DNDM, da Silva LMA, Aguiar MG, Castiglioni M, Silva-Junior JU, Araújo FMDC, Pereira RADC, Malta DL, Pompeu MMDL. Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool. Am J Trop Med Hyg 2015; 94:187-92. [PMID: 26598561 DOI: 10.4269/ajtmh.15-0392] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/07/2015] [Indexed: 01/09/2023] Open
Abstract
Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date.
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Affiliation(s)
- Luciano Pamplona de Góes Cavalcanti
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Deborah Nunes de Melo Braga
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Lívia Maria Alexandre da Silva
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Marina Gondim Aguiar
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Mariana Castiglioni
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - José Udevanier Silva-Junior
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Fernanda Montenegro de Carvalho Araújo
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Renata Allana da Costa Pereira
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Danielle Lima Malta
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Margarida Maria de Lima Pompeu
- Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil
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Wakimoto MD, Camacho LAB, Guaraldo L, Damasceno LS, Brasil P. Dengue in children: a systematic review of clinical and laboratory factors associated with severity. Expert Rev Anti Infect Ther 2015; 13:1441-56. [PMID: 26536064 DOI: 10.1586/14787210.2015.1100534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Dengue is a potentially life-threatening illness, and children are at higher risk of severity. This review aimed to systematize the identified clinical and laboratory parameters associated with severe dengue in children, as monitoring these signs and fluid-replacement therapy are actually the cornerstones of dengue treatment. Of the 527 studies initially reviewed, 21 were selected as follows: three cohort studies, three case-control studies, 14 cross-sectional studies and one not defined. Eighteen studies were carried out in Asia and three in the Americas. Hepatomegaly, lethargy, abdominal pain, bleeding, hemoconcentration and thrombocytopenia, all referenced as warning signs in the WHO 2009 Guidelines, were the clinical and laboratory parameters independently associated with severity in more than one study. The recognition of these known warning signs associated to severe dengue disease underlines the usefulness of the WHO 2009 classification.
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Affiliation(s)
- Mayumi Duarte Wakimoto
- a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900
| | - Luiz Antonio Bastos Camacho
- b Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900
| | - Lusiele Guaraldo
- a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900
| | - Luana Santana Damasceno
- a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900
| | - Patrícia Brasil
- a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900
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Wang L, Yang G, Jia L, Zhu J, Xie J, Li P, Qiu S, Hao R, Wu Z, Pu W, Sun Y, Li Z, Song H. Epidemiologic characteristics of dengue in China (2010–2014). J Infect 2015; 71:397-9. [DOI: 10.1016/j.jinf.2015.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/17/2015] [Accepted: 04/18/2015] [Indexed: 11/15/2022]
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