1
|
Salgado DM, Rivera GM, Pinto WA, Rodríguez J, Acosta G, Castañeda DM, Vega R, Perdomo-Celis F, Bosch I, Narváez CF. Unique Immune Blood Markers Between Severe Dengue and Sepsis in Children. Pediatr Infect Dis J 2023; 42:792-800. [PMID: 37463399 DOI: 10.1097/inf.0000000000003990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Pediatric dengue and sepsis share clinical and pathophysiologic aspects. Multiple inflammatory and regulatory cytokines, decoy receptors and vascular permeability factors have been implicated in the pathogenesis of both diseases. The differential pattern and dynamic of these soluble factors, and the relationship with clinical severity between pediatric dengue and sepsis could offer new diagnosis and therapeutic strategies. METHODS We evaluated the concentration levels of 11 soluble factors with proinflammatory, regulatory and vascular permeability involvement, in plasma from children with dengue or sepsis, both clinically ranging from mild to severe, in the early, late and convalescence phases of the disease. RESULTS During early acute infection, children with sepsis exhibited specific higher concentration levels of IL-6, vascular endothelial growth factor (VEGF), and its soluble decoy receptor II (sVEGFR2) and lower concentration levels of IL-10 and the soluble tumor necrosis factor receptor 2 (sTNFR2), in comparison with children with severe dengue. In addition, the circulating amounts of soluble ST2, and VEGF/sVEGFR2 were widely associated with clinical and laboratory indicators of dengue severity, whereas secondary dengue virus infections were characterized by an enhanced cytokine response, relative to primary infections. In severe forms of dengue, or sepsis, the kinetics and the cytokines response during the late and convalescence phases of the disease also differentiate. CONCLUSIONS Dengue virus infection and septic processes in children are characterized by cytokine responses of a specific magnitude, pattern and kinetics, which are implicated in the pathophysiology and clinical outcome of these diseases.
Collapse
Affiliation(s)
- Doris M Salgado
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - Gina M Rivera
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - William A Pinto
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - Jairo Rodríguez
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - Gladys Acosta
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - Diana M Castañeda
- División de Inmunología, Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Rocío Vega
- From the Departamento de Pediatría, Universidad Surcolombiana, E.S.E. Hospital Universitario de Neiva, Neiva, Huila, Colombia
| | - Federico Perdomo-Celis
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Irene Bosch
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Carlos F Narváez
- División de Inmunología, Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| |
Collapse
|
2
|
Chokephaibulkit K, Chien YW, AbuBakar S, Pattanapanyasat K, Perng GC. Use of Animal Models in Studying Roles of Antibodies and Their Secretion Cells in Dengue Vaccine Development. Viruses 2020; 12:E1261. [PMID: 33167518 PMCID: PMC7694450 DOI: 10.3390/v12111261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
The cardinal feature of adaptive immunity is its ability to form memory responses that can be rapidly recalled to contain pathogens upon reencountering. Conferring a robust memory immune response to an infection is a key feature for a successful vaccination program. The plasmablasts are cells that not only can secret non-neutralizing antibodies but also can secrete the specific antibodies essential to neutralize and inactivate the invading pathogens. Dengue has been recognized as one of the most important vector-borne human viral diseases globally. Currently, supportive care with vigilant monitoring is the standard practice since there is as yet no approved therapeutic modality to treat dengue. Even though the approved vaccine has become available, its low efficacy with the potential to cause harm is the major hurdle to promote the widespread usage of the vaccine. Despite the decades of research on dengue, the major challenge in dengue vaccine development is the absence of suitable experimental animal models that reflect the pathological features and clinical symptoms, as seen in humans. Dengue is transmitted by the bite of mosquitoes carrying infectious dengue virus (DENV), which has four distinct serotypes. Recently, cases resulting from unconventional transmission routes, such as blood transfusion, organs as well as stem cells and bone marrow transplantations, and mother-to-infant vertical transmission, have been reported, suggesting an alternate route of DENV transmission exists in nature. This review discusses issues and challenges needing to be resolved to develop an effective dengue vaccine. Development of a robust and reliable dengue animal model that can reflect not only dynamic human clinical symptoms but also can answer around why preexisting neutralizing antibodies do not confer protection upon re-infection and immune protection marker for dengue vaccine efficacy evaluation.
Collapse
Affiliation(s)
- Kulkanya Chokephaibulkit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur 50603, Malaysia;
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Kovit Pattanapanyasat
- Center of Research Excellence for Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Guey Chuen Perng
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| |
Collapse
|
3
|
Bhalala U, Bansal A, Chugh K. Advances in Pediatric Critical Care Research in India. Front Pediatr 2018; 6:150. [PMID: 29892595 PMCID: PMC5985403 DOI: 10.3389/fped.2018.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
Over last 2 decades, there has been a significant progress made in the field of pediatric critical care in India. There has been complementary and parallel growth in the pediatric critical care services in India and the number of pediatric critical care providers who are either formally trained in India or who have returned to India after their formal training abroad. The pediatric critical care community in India has recognized obvious differences in profiles of critical illnesses and patients between Indian subcontinent and the West. Therefore there is a growing interest in generating scientific evidence through local research which would be applicable to critically ill children in Indian subcontinent. This article focuses on advances in pediatric critical care research in India and its future directions.
Collapse
Affiliation(s)
- Utpal Bhalala
- Baylor College of Medicine at The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Arun Bansal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | |
Collapse
|
4
|
Kher V, Srisawat N, Noiri E, Benghanem Gharbi M, Shetty MS, Yang L, Bagga A, Chakravarthi R, Mehta R. Prevention and Therapy of Acute Kidney Injury in the Developing World. Kidney Int Rep 2017. [PMCID: PMC5720672 DOI: 10.1016/j.ekir.2017.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Timely recognition of patients at risk or with possible acute kidney injury (AKI) is essential for early intervention to minimize further damage and improve outcome. Initial management of patients with suspected and persistent AKI should include thorough clinical assessment of all patients with AKI to identify reversible factors, including fluid volume status, potential nephrotoxins, and an assessment of the underlying health of the kidney. Based on these assessments, early interventions to provide appropriate and adequate fluid resuscitation while avoiding fluid overload, removal of nephrotoxins, and adjustment of drug doses according to the level of kidney function derangement are important. The judicious use of diuretics for fluid overload and/or in cardiac decompensated patients and introduction of early enteral nutritional support need to be considered to improve outcomes in AKI. Although these basic principles are well recognized, their application in clinical practice in low resource settings is often limited due to lack of education, availability of resources, and lack of trained personnel, which limits access to care. We report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on strategies to evaluate patients with suspected AKI and initiate measures for prevention and management to improve outcomes, particularly in low resource settings. These recomendations provide a framework for caregivers, who are often primary care physicians, nurses, and other allied healthcare personnel, to manage patients with AKI in resource poor countries.
Collapse
|
5
|
|
6
|
Thanachartwet V, Wattanathum A, Sahassananda D, Wacharasint P, Chamnanchanunt S, Khine Kyaw E, Jittmittraphap A, Naksomphun M, Surabotsophon M, Desakorn V. Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study. PLoS One 2016; 11:e0156135. [PMID: 27196051 PMCID: PMC4873173 DOI: 10.1371/journal.pone.0156135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/10/2016] [Indexed: 12/02/2022] Open
Abstract
Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC) parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5%) experienced dengue shock and 145 (89.5%) did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045) and the pulse pressure was significantly lower between days 4 and 7 (P<0.05). The stroke volume index and cardiac index were significantly decreased between days 4 and 15 and between days 5 and 8 after fever onset (P<0.05), respectively. A significant proportion of patients with dengue shock had an IVC diameter <1.5 cm and IVC collapsibility index >50% between days 4 and 5 (P<0.05). Hypovolemic shock was observed in 9 (52.9%) patients and cardiogenic shock in 8 (47.1%), with a median (interquartile range) time to shock onset of 6.0 (5.0–6.5) days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock.
Collapse
Affiliation(s)
- Vipa Thanachartwet
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- * E-mail:
| | - Anan Wattanathum
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand
| | - Duangjai Sahassananda
- Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Petch Wacharasint
- Critical Care Division, Department of Anesthesiology, Phramongkutklao Hospital, Bangkok 10400, Thailand
| | - Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Ei Khine Kyaw
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Akanitt Jittmittraphap
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Mali Naksomphun
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Manoon Surabotsophon
- Pulmonary and Critical Care Division, Department of Medicine, Ramkhamhaeng Hospital, Bangkok 10240, Thailand
| | - Varunee Desakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
7
|
What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts. CURRENT PEDIATRICS REPORTS 2013. [DOI: 10.1007/s40124-012-0007-z] [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: 10/27/2022]
|
8
|
Yacoub S, Griffiths A, Chau TTH, Simmons CP, Wills B, Hien TT, Henein M, Farrar J. Cardiac function in Vietnamese patients with different dengue severity grades. Crit Care Med 2012; 40:477-83. [PMID: 21946658 PMCID: PMC4140416 DOI: 10.1097/ccm.0b013e318232d966] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dengue continues to cause significant global morbidity and mortality. Severe disease is characterized by cardiovascular compromise from capillary leakage. Cardiac involvement in dengue has also been reported but has not been adequately studied. SETTING Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. SUBJECTS AND DESIGN Seventy-nine patients aged 8-6 yrs with different dengue severity grades were studied using echocardiography including tissue Doppler imaging. The patients were split into severity grades: dengue, dengue with warning signs, and severe dengue. Changes in cardiac functional parameters and hemodynamic indices were monitored over the hospital stay. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patients with severe dengue had worse cardiac function compared with dengue in the form of left ventricular systolic dysfunction with increased left myocardial performance index (0.58 [0.26-0.80] vs. 0.38 [0.22-0.70], p = .006). Septal myocardial systolic velocities were reduced (6.4 [4.8-10] vs. 8.1 [6-13] cm/s, p = .01) as well as right ventricular systolic (11.4 [7.5-17] vs. 13.5 [10-17] cm/s, p = .016) and diastolic velocities (13 [8-23] vs. 17 [12-25] cm/s, p = .0026). In the severe group, these parameters improved from hospital admission to discharge; septal myocardial systolic velocities to 8.8 (7-11) cm/s (p = .002), right ventricular myocardial systolic velocities to 15.0 (11.8-23) cm/s, (p = .003), and diastolic velocity to 21 (11-25) cm/s (p = .002). Patients with cardiac impairment were more likely to have significant pleural effusions. CONCLUSIONS Patients with severe dengue have evidence of systolic and diastolic cardiac impairment with septal and right ventricular wall being predominantly affected.
Collapse
Affiliation(s)
- Sophie Yacoub
- Department of Infection and Immunity, Imperial College, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
OBJECTIVES To provide a comprehensive review of dengue, with an emphasis on clinical syndromes, classification, diagnosis, and management, and to outline relevant aspects of epidemiology, immunopathogenesis, and prevention strategies. Dengue, a leading cause of childhood mortality in Asia and South America, is the most rapidly spreading and important arboviral disease in the world and has a geographic distribution of > 100 countries. DATA SOURCE Boolean searches were carried out by using PubMed from 1975 to March 2009 and the Cochrane Database of Systematic Reviews from 1993 to March 2009 to identify potentially relevant articles by key search terms such as: "dengue"; "dengue fever"; "dengue hemorrhagic fever"; "dengue shock syndrome"; "severe dengue" and "immunopathogenesis," pathogenesis," "classification," "complications," and "management." In addition, authoritative seminal and up-to-date reviews by experts were used. STUDY SELECTION Original research and up-to-date reviews and authoritative reviews consensus statements relevant to diagnosis and therapy were selected. DATA EXTRACTION AND SYNTHESIS We considered the most relevant articles that would be important and of interest to the critical care practitioner as well as authoritative consensus statements from the World Health Organization and the Centers for Disease Control and Prevention. Dengue viral infections are caused by one of four single-stranded ribonucleic acid viruses of the family Flaviviridae and are transmitted by their mosquito vector, Aedes aegypti. The clinical syndromes caused by dengue viral infections occur along a continuum; most cases are asymptomatic and few present with severe forms characterized by shock. Management is predominantly supportive and includes methods to judiciously resolve shock and control bleeding while at the same time preventing fluid overload. CONCLUSIONS Dengue is no longer confined to the tropics and is a global disease. Treatment is supportive. Outcomes can be optimized by early recognition and cautious titrated fluid replacement, especially in resource-limited environments.
Collapse
|
10
|
|
11
|
Gurugama P, Garg P, Perera J, Wijewickrama A, Seneviratne SL. Dengue viral infections. Indian J Dermatol 2010; 55:68-78. [PMID: 20418983 PMCID: PMC2856379 DOI: 10.4103/0019-5154.60357] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dengue viral infections are one of the most important mosquito-borne diseases in the world. Presently dengue is endemic in 112 countries in the world. It has been estimated that almost 100 million cases of dengue fever and half a million cases of dengue hemorrhagic fever (DHF) occur worldwide. An increasing proportion of DHF is in children less than 15 years of age, especially in South East and South Asia. The unique structure of the dengue virus and the pathophysiologic responses of the host, different serotypes, and favorable conditions for vector breeding have led to the virulence and spread of the infections. The manifestations of dengue infections are protean from being asymptomatic to undifferentiated fever, severe dengue infections, and unusual complications. Early recognition and prompt initiation of appropriate supportive treatment are often delayed resulting in unnecessarily high morbidity and mortality. Attempts are underway for the development of a vaccine for preventing the burden of this neglected disease. This review outlines the epidemiology, clinical features, pathophysiologic mechanisms, management, and control of dengue infections.
Collapse
Affiliation(s)
| | - Pankaj Garg
- From the Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jennifer Perera
- From the Department of Microbiology, University of Colombo, Colombo, Sri Lanka
| | | | - Suranjith L Seneviratne
- From the Department of Clinical Immunology, St. Mary's Hospital and Imperial College, London, UK.
| |
Collapse
|
12
|
Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 2008; 13:1328-40. [PMID: 18803612 DOI: 10.1111/j.1365-3156.2008.02151.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Clinicians in resource-poor countries need to identify patients with dengue using readily-available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue-endemic populations. METHOD Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. RESULTS Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case-control studies. Seven studies assessed all ages, four assessed children only, and four assessed adults only. Patients with dengue had significantly lower platelet, white blood cell (WBC) and neutrophil counts, and a higher frequency of petechiae than OFI patients. Higher frequencies of myalgia, rash, haemorrhagic signs, lethargy/prostration, and arthralgia/joint pain and higher haematocrits were reported in adult patients with dengue but not in children. Most multivariable models included platelet count, WBC, rash, and signs of liver damage; however, none had high statistical validity and none considered changes in clinical features over the course of illness. CONCLUSIONS Several individual clinical and laboratory variables distinguish dengue from OFI; however, some variables may be dependent on age. No published multivariable model has been validated. Study design, populations, diagnostic criteria, and data collection methods differed widely across studies, and the majority of studies did not identify specific aetiologies of OFIs. More prospective studies are needed to construct a valid and generalizable algorithm to guide the differential diagnosis of dengue in endemic countries.
Collapse
Affiliation(s)
- James A Potts
- University of Massachusetts Medical School, Worcester, MA 01655, USA
| | | |
Collapse
|