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Lu HZ, Xie YZ, Gao C, Wang Y, Liu TT, Wu XZ, Dai F, Wang DQ, Deng SQ. Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012217. [PMID: 38820529 PMCID: PMC11168630 DOI: 10.1371/journal.pntd.0012217] [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: 12/11/2023] [Revised: 06/12/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Dengue fever (DF) and West Nile fever (WNF) have become endemic worldwide in the last two decades. Studies suggest that individuals with diabetes mellitus (DM) are at a higher risk of developing severe complications from these diseases. Identifying the factors associated with a severe clinical presentation is crucial, as prompt treatment is essential to prevent complications and fatalities. This article aims to summarize and assess the published evidence regarding the link between DM and the risk of severe clinical manifestations in cases of DF and WNF. METHODOLOGY/PRINCIPAL FINDINGS A systematic search was conducted using the PubMed and Web of Science databases. 27 studies (19 on DF, 8 on WNF) involving 342,873 laboratory-confirmed patients were included in the analysis. The analysis showed that a diagnosis of DM was associated with an increased risk for severe clinical presentations of both DF (OR 3.39; 95% CI: 2.46, 4.68) and WNF (OR 2.89; 95% CI: 1.89, 4.41). DM also significantly increased the risk of death from both diseases (DF: OR 1.95; 95% CI: 1.09, 3.52; WNF: OR 1.74; 95% CI: 1.40, 2.17). CONCLUSIONS/SIGNIFICANCE This study provides strong evidence supporting the association between DM and an increased risk of severe clinical manifestations in cases of DF and WNF. Diabetic individuals in DF or WNF endemic areas should be closely monitored when presenting with febrile symptoms due to their higher susceptibility to severe disease. Early detection and appropriate management strategies are crucial in reducing the morbidity and mortality rates associated with DF and WNF in diabetic patients. Tailored care and targeted public health interventions are needed to address this at-risk population. Further research is required to understand the underlying mechanisms and develop effective preventive and therapeutic approaches.
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Affiliation(s)
- Hong-Zheng Lu
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Yu-Zhuang Xie
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Chen Gao
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui China
| | - Ying Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Ting-Ting Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Xing-Zhe Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, China
| | - Sheng-Qun Deng
- Department of Pathogen Biology, Anhui Province Key Laboratory of Zoonoses, the Key Laboratory of Zoonoses of High Institutions in Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
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Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:16-33. [PMID: 38263966 PMCID: PMC10800775 DOI: 10.1016/j.jointm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 01/25/2024]
Abstract
Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
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Affiliation(s)
- Alexandre Mestre Tejo
- Intensive Care Unit, Department of Intensive Medicine of the Cancer Institute of the State of São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Transfusion Medicine and Cell Therapy Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Letícia Mattos Menezes
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Nguyen RN, Lam HT, Phan HV. Liver Impairment and Elevated Aminotransferase Levels Predict Severe Dengue in Vietnamese Children. Cureus 2023; 15:e47606. [PMID: 37886653 PMCID: PMC10597804 DOI: 10.7759/cureus.47606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The degree of liver impairment in children with dengue infection varies from mild to severe injury. Aminotransferase levels may be useful in predicting severe dengue. This study aimed to evaluate the degree of liver impairment and determine whether elevated aminotransferases could be used to discriminate between non-severe and severe dengue in Vietnamese children. METHODS This was a prospective cohort study of pediatric patients with confirmed dengue infection who were admitted to Can Tho Children's Hospital, Vietnam. The receiver operating characteristic (ROC) curve was used to discriminate the power of Aspartate transaminase (AST) or Alanine transaminase (ALT) to predict severe dengue. RESULTS Two hundred and thirty confirmed dengue patients were enrolled, including 70% (161) patients with non-severe dengue and 30% (69) with severe dengue. This study indicates that 73.9% of patients had abnormal AST (>40 U/L), and 34.8% of patients had abnormal ALT (>40 U/L). The incidence of dengue patients with hepatitis (AST or ALT ≥ 4×ULN) and severe hepatitis (AST or ALT ≥ 10×ULN) were 18.7% and 17.0%, respectively. At a cut-off point of 120 U/L, AST's AUROC, sensitivity, and specificity were 0.93 (95% CI: 0.90-0.96), 82.5%, and 87.3%, respectively. At a cut-off point of 80 U/L, ALT's AUROC, sensitivity, and specificity were 0.89 (95% CI: 0.84-0,93), 87.5%, and 85.2%, respectively, for predicting severe dengue. CONCLUSION Elevated aminotransferase levels were associated with severe dengue, and AST/ALT were good markers for predicting severe dengue in Vietnamese children.
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Affiliation(s)
- Rang N Nguyen
- Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, VNM
| | - Hue T Lam
- Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, VNM
| | - Hung V Phan
- Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, VNM
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Low GKK, Jiee SF, Masilamani R, Shanmuganathan S, Rai P, Manda M, Omosumwen OF, Kagize J, Gavino AI, Azahar A, Jabbar MA. Routine blood parameters of dengue infected children and adults. A meta-analysis. Pathog Glob Health 2023; 117:565-589. [PMID: 36593636 PMCID: PMC10392251 DOI: 10.1080/20477724.2022.2161864] [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: 01/04/2023] Open
Abstract
The World Health Organization (WHO) has revised dengue case classification in 2009 to better reflect the severity of the disease. However, there was no comprehensive meta-analysis of pooled routine blood parameters according to the age or the categories of the 2009 WHO classification. This study aimed to meta-analyze the routine blood parameters of dengue infected children and adults. Electronic search was performed with eligible articles included for review. Meta-analysis was conducted for six blood parameters stratified into children, adults and all ages, which were further grouped into the three 2009 WHO case classifications (dengue without warning signs, DwoWS; dengue with warning signs, DwWS; severe dengue, SD), non-severe dengue (non-SD) and 'All' cases. A total of 55 articles were included in the meta-analysis. Fifteen studies were conducted in the children's age category, 31 studies in the adult category and nine studies in all ages. The four selected pooled blood parameters for children were white blood cell (WBC) (×103/L) with 5.11 (SD), 5.64 (DwWS), 5.52 (DwoWS) and 4.68 (Non-SD) hematocrit (HCT) (%) with 36.78 (SD), 40.70 (DwWS), 35.00 (DwoWS) and 29.78 (Non-SD) platelet (PLT) (×103/µL) with 78.66 (SD), 108.01 (DwWS), 153.47 (DwoWS) and 108.29 (non-SD); and aspartate aminotransferase (AST) (/µL) with 248.88 (SD), 170.83 (DwWS), 83.24 (DwoWS) and 102.99 (non-SD). For adult, WBC were 4.96 (SD), 6.44 (DwWS), 7.74 (DwoWS) and 3.61 (non-SD); HCT were 39.50 (SD), 39.00 (DwWS), 37.45 (DwoWS) and 41.68 (non-SD); PLT were 49.62 (SD), 96.60 (DwWS), 114.37 (DwoWS) and 71.13 (non-SD); and AST were 399.50 (SD), 141.01 (DwWS), 96.19 (DwoWS) and 118.13 (non-SD). These blood parameters could not differentiate between each dengue severity according to the WHO 2009 classification, SD, DwoWS, DwWS and non-SD, because the timing of blood drawing was not known and there was an overlapping confidence interval among the clinical classification. Hence, these pooled blood parameter values could not be used to guide clinicians in management and did not correlate with severity as in previous scientific literatures and guidelines.
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Affiliation(s)
- Gary KK Low
- Research Operations, Nepean Hospital, Kingswood, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sam Froze Jiee
- Sarawak State Health Department, Ministry of Health Malaysia, Sri Aman District Health Office, Sri Aman, Sarawak, Malaysia
| | - Retneswari Masilamani
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Selvanaayagam Shanmuganathan
- Quality Unit, Hospital Kulim, Kulim, Kedah, Malaysia
- Menzies Centre Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Pramila Rai
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Mitali Manda
- Hammondcare Neringah Hospital, Wahroonga,New South Wales, Australia
| | - Osamudiamen Favour Omosumwen
- Department of Addiction and Community Health Professional, Faculty of Health and Social Science, Sundance College Edmonton, Edmonton, Alberta, Canada
| | - Jackob Kagize
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Alex I. Gavino
- Centre for Health Futures, Torrens University Australia, Sydney, New South Wales, Australia
- Public Health Department, Torrens University Australia, Sydney, New South Wales, Australia
| | - Aizad Azahar
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohammed Abdulrazzaq Jabbar
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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Kalluru PKR, Mamilla M, Valisekka SS, Mandyam S, Calderon Martinez E, Posani S, Sharma S, Gopavaram RR, Gargi B, Gaddam A, Reddy S. Aminotransferases in Relation to the Severity of Dengue: A Systematic Review. Cureus 2023; 15:e39436. [PMID: 37234451 PMCID: PMC10208548 DOI: 10.7759/cureus.39436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
A systematic review was conducted to investigate the relationship between aminotransferases and the severity of dengue infection, which is a prevalent and significant infection in tropical and subtropical regions. Aminotransferases are enzymes that are often elevated in dengue due to the liver's physiological and immunological response to the infection. This review focused on analyzing various studies that examined the correlation between aminotransferase levels and the severity of dengue. Extensive literature searches were performed using ("dengue*" OR "dengue fever*" OR "dengue haemorrhagic fever*" OR "dengue shock syndrome*") AND ("alanine aminotransferase*" OR "aspartate aminotransferase*") on PubMed. The selected articles were thoroughly reviewed, encompassing epidemiology, pathogenesis, and clinical manifestations of dengue. The consistent findings across the studies indicated that aminotransferases can serve as predictive markers for dengue severity. Therefore, early assessment of liver enzyme levels is crucial in dengue cases, and elevated levels should be closely monitored to prevent adverse outcomes.
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Affiliation(s)
| | - Mahesh Mamilla
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | - Sai Sudha Valisekka
- Internal Medicine, University of Minnesota School of Medicine, Minneapolis, USA
| | | | | | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kothagudem, IND
| | - Shriya Sharma
- Internal Medicine, Dnipropetrovsk State Medical Academy, Dnipro, UKR
| | | | - Borgharkar Gargi
- Public Health, University of Alabama at Birmingham School of Medicine, Brimingham, USA
| | - Anvitha Gaddam
- Internal Medicine, Siddhartha Medical College, Vijayawada, IND
| | - Sushritha Reddy
- Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, IND
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Bujang MA. An Elaboration on Sample Size Planning for Performing a One-Sample Sensitivity and Specificity Analysis by Basing on Calculations on a Specified 95% Confidence Interval Width. Diagnostics (Basel) 2023; 13:diagnostics13081390. [PMID: 37189491 DOI: 10.3390/diagnostics13081390] [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: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023] Open
Abstract
Sample size calculation based on a specified width of 95% confidence interval will offer researchers the freedom to set the level of accuracy of the statistics that they aim to achieve for a particular study. This paper provides a description of the general conceptual context for performing sensitivity and specificity analysis. Subsequently, sample size tables for sensitivity and specificity analysis based on a specified 95% confidence interval width is then provided. Such recommendations for sample size planning are provided based on two different scenarios: one for a diagnostic purpose and another for a screening purpose. Further discussion on all the other relevant considerations for the determination of a minimum sample size requirement and on how to draft the sample size statement for performing sensitivity and specificity analysis are also provided.
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Affiliation(s)
- Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Kuching 93586, Malaysia
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Iqtadar S, Khan A, Mumtaz SU, Livingstone S, Chaudhry MNA, Raza N, Zahra M, Abaidullah S. Vitamin D Deficiency (VDD) and Susceptibility towards Severe Dengue Fever-A Prospective Cross-Sectional Study of Hospitalized Dengue Fever Patients from Lahore, Pakistan. Trop Med Infect Dis 2023; 8:tropicalmed8010043. [PMID: 36668950 PMCID: PMC9866117 DOI: 10.3390/tropicalmed8010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
Dengue is a mosquito-borne flaviviral serious febrile illness, most common in the tropical and subtropical regions including Pakistan. Vitamin D is a strong immunomodulator affecting both the innate and adaptive immune responses and plays a pivotal role in pathogen-defense mechanisms. There has been considerable interest in the possible role of vitamin D in dengue viral (DENV) infection. In the present prospective cross-sectional study, we assessed a possible association between serum vitamin D deficiency (VDD) and susceptibility towards severe dengue fever (DF) illness. Serum vitamin D levels were measured at the time of hospitalization in 97 patients diagnosed with dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) at Mayo Hospital, King Edward Medical University, Lahore, PK, from 16 November 2021 to 15 January 2022. In terms of disease severity, 37 (38.1%) patients were DF, 52 (53.6%) were DHF grade 1 and 2, and 8 (8.2%) were DSS. The results revealed that most patients (75 (77.3%)) were vitamin-D-deficient (i.e., serum level < 20 ng/mL), including 27 (73.0%) in DF, 41 (78.8%) in DHF grade 1 and 2, and 7 (87.5%) in DSS. The degree of VDD was somewhat higher in DSS patients as compared to DF and DHF grade 1 and 2 patients. Overall, serum vitamin D levels ranged from 4.2 to 109.7 ng/mL, and the median (IQR) was in the VDD range, i.e., 12.2 (9.1, 17.8) ng/mL. Our results suggest that there may be a possible association between VDD and susceptibility towards severe dengue illness. Hence, maintaining sufficient vitamin D levels in the body either through diet or supplementation may help provide adequate immune protection against severe dengue fever illness. Further research is warranted.
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Affiliation(s)
- Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Amjad Khan
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford OX3 9DU, UK
- Correspondence:
| | - Sami Ullah Mumtaz
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Shona Livingstone
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | | | - Nauman Raza
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Mehreen Zahra
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Sajid Abaidullah
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
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Teo A, Chia PY, Ramireddi GK, Khoo SKM, Yeo TW. Clinical and prognostic relevance of sST2 in adults with dengue-associated cardiac impairment and severe dengue. PLoS Negl Trop Dis 2022; 16:e0010864. [PMID: 36228040 PMCID: PMC9595566 DOI: 10.1371/journal.pntd.0010864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/25/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dengue can be complicated by severe outcomes including cardiac impairment, and the lack of reliable prognostic biomarkers poses a challenge in managing febrile dengue patients. Here, we investigated the functionality of soluble suppressor of tumorigenicity (sST2) as a predictive marker of severe dengue and its association in dengue-associated cardiac impairment. METHODS Plasma samples, aged >16 years, collected from 36 dengue fever, 43 dengue with warning signs, 11 severe dengue (collected at febrile, critical and recovery phases) and 30 controls were assayed for plasma levels of sST2, troponin T and N-terminal (NT)-pro hormone brain natriuretic peptide (NT-proBNP) by ELISA. Cardiac parameters: stroke index (SI), cardiac index (CI) and Granov-Goor Index (GGI) were measured with a bioimpedance device during the different phases for dengue subjects and once for the controls. PRINCIPAL FINDINGS In the febrile, critical and early recovery phases, sST2 levels were significantly elevated in dengue participants and sST2 levels increased with increasing disease severity (P < 0.01 for all). sST2 concentrations were negatively correlated with SI (r = -0.48; P < 0.001, r = -0.55; P < 0.001), CI (r = -0.26; P = 0.02, r = -0.6: P < 0.001) and GGI (r = -0.44; P < 0.001, r = -0.57; P < 0.001) in the critical and early recovery phases. In contrast, sST2 levels in the febrile and critical phases, were positive correlated to troponin T (r = 0.44, P < 0.001; r = 0.22, P = 0.03, respectively) and NT-proBNP (r = 0.21, P = 0.03; r = 0.35, P < 0.001). ROC analysis demonstrated sST2 as a good biomarker of severe dengue in the critical phase, AUROC 0.79, P < 0.001. CONCLUSION/SIGNIFICANCE sST2 levels were elevated in patients with dengue especially in cases of severe dengue. Furthermore, increased sST2 levels were associated with cardiac indicators suggesting lower cardiac performance. While further research is needed to demonstrate its clinical utility, sST2 may be a useful prognostic biomarker of severe dengue.
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Affiliation(s)
- Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Medicine, The Doherty Institute, University of Melbourne, Melbourne, Australia
- National Centre for Infectious Diseases, Singapore, Singapore
- * E-mail: (AT); (YTW)
| | - Po Ying Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- * E-mail: (AT); (YTW)
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Ng WY, Atan R, Mohd Yunos N, bin Md Kamal AH, Roslan MH, Quah KY, Teh KX, Zaid M, Kassim M, Mariapun J, Ngim CF, Dhanoa A, Yeo TW. A double whammy: The association between comorbidities and severe dengue among adult patients—A matched case-control study. PLoS One 2022; 17:e0273071. [PMID: 36126060 PMCID: PMC9488767 DOI: 10.1371/journal.pone.0273071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Dengue infection is the most prevalent mosquito-borne viral infection globally. Concurrently, there has also been an upsurge of non-communicable comorbidities. We aimed to investigate the association between these comorbidities and the development of severe dengue. Methods We performed a retrospective, case-control study involving 117 cases with severe dengue and 351 controls with non-severe dengue; matched according to gender, age (+/- 5 years old), and admission date (+/- 2 weeks). We analyzed the data using conditional odds ratio (cOR) and adjusted conditional odds ratio (AcOR) using univariate and multivariable conditional logistic regression respectively. Results Six main comorbidities namely obesity, diabetes mellitus, hypertension, hyperlipidemia, chronic pulmonary disease, and ischemic heart disease were observed among cases and controls. Multivariable conditional logistic regression model found only hypertension to be independently associated with the development of severe dengue (ACOR 2.46; 95% CI:1.09–5.53). Among symptoms at presentation, lethargy, vomiting, bleeding manifestations, and abdominal pain were associated with increased odds of severe dengue, although the associations were not statistically significant. Headache (ACOR: 0:32; 95% CI: 0.21–0.51) and skin rash (ACOR: 0.42; 95% CI: 0.22–0.81) were associated with significantly lower odds of severe dengue. Severe dengue patients were also found to have significantly higher white cell count, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase on admission, while platelet and albumin were significantly lower compared to non-severe dengue patients. Conclusions Our study found a significant association between hypertension and the development of severe dengue in adult patients. For clinical practice, this finding suggests that dengue patients with underlying hypertension warrant closer clinical monitoring for deterioration. The association between significant derangement in various laboratory parameters and severe dengue as shown in this study is in keeping with previous reports. While further substantiation by larger prospective studies will be desirable, this association may serve to inform the dengue triaging process.
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Affiliation(s)
- Wei Yao Ng
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- Mackay Base Hospital, Mackay Hospital and Health Services, West Mackay, Queensland, Australia
| | - Rafidah Atan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor’azim Mohd Yunos
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Adam Harrish bin Md Kamal
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Mohd Hariz Roslan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Kai Yuan Quah
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- Mackay Base Hospital, Mackay Hospital and Health Services, West Mackay, Queensland, Australia
| | - Kai Xuan Teh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Masliza Zaid
- Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Mahazir Kassim
- Department of Anesthesiology and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Jeevitha Mariapun
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Amreeta Dhanoa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University and Imperial College, Singapore, Singapore
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10
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Lue AM, Richards-Dawson MAEH, Gordon-Strachan GM, Kodilinye SM, Dunkley-Thompson JAT, James-Powell TD, Pryce CA, Mears CD, Anzinger JJ, Webster-Kerr K, Christie CDC. Severity and Outcomes of Dengue in Hospitalized Jamaican Children in 2018-2019 During an Epidemic Surge in the Americas. Front Med (Lausanne) 2022; 9:889998. [PMID: 35801209 PMCID: PMC9254731 DOI: 10.3389/fmed.2022.889998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Objective In 2019, dengue was among the "top-ten threats to global health," with 3.1 million cases reported from the Americas, the highest ever. Simultaneously, Jamaica reported its largest dengue outbreak in 40 years, following Chikungunya and Zika virus epidemics, in 2014 and 2016-2017, respectively. We describe dengue in children admitted to five hospitals in Jamaica during August 2018 through September 2019. Methods Hospitalized children and adolescents aged 0 to 15 years with dengue were managed using PAHO/WHO criteria. Data were extracted from questionnaires, entered into a dataset on Microsoft Excel version 2016, exported to SPSS version 20 and analyzed. Groups were compared using Student's t-test for normally distributed parametric data. Chi-square analysis, or Fisher's exact test was used for categorical variables. A p-value < 0.05 was considered statistically significant. Results There were 339 children, 245 (72.3%) aged 1-10 years, males:females 1:1. Classification was "dengue without warning signs" 53 (15.3%), "dengue with warning signs" 218 (64.3%) and "severe dengue" 68 (20%). Co-morbidities were reported in 88 (26%). Hemoglobin SC disease was associated with severe dengue with hemorrhage (p = 0.005). Organ-system involvement occurred in 334 (98.5%) including gastrointestinal 317 (93.5%), hematologic 311 (91.7%) and musculoskeletal 180 (53.1%). Thirty-nine (11.5%) had 5-7 organ-systems involved. Metabolomics emphasized increased hepatic transaminases 245 (72.3%), lactate dehydrogenase 164 (48.4%) and creatine phosphokinase 84 (24.8%) approaching the high thousands (121,560 u/L), both were markers for severe disease (p < 0.002). Thirteen (3.8%) received intensive care. Dengue was laboratory-confirmed in 220 (78.9%): NS1 antigen-positive (218); RT-PCR-positive (23), with an overlap of NS1 antigen and RT-PCR positive (21); DENV-3 serotype (20). Seventeen (5%) died, 16 (94.1%) had severe dengue and 11 (64.7%) succumbed within 24 to 48 h of admission despite resuscitation and transfusion of blood products. Conclusion Severe dengue with increased attributable mortality occurred in hospitalized children after Jamaica's maiden Zika epidemic.
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Affiliation(s)
- Aileen May Lue
- Bustamante Hospital for Children, Kingston, Jamaica
- Pediatric Residency Program, University of the West Indies, Kingston, Jamaica
| | | | - Georgiana Marie Gordon-Strachan
- Caribbean Institute of Health Research, University of the West Indies, Kingston, Jamaica
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
| | - Syed Matthew Kodilinye
- Department of Child and Adolescent Health, University Hospital of the West Indies, Kingston, Jamaica
| | | | | | | | | | - Joshua James Anzinger
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- Department of Microbiology, University of the West Indies, Kingston, Jamaica
- Global Virus Network, Baltimore, MD, United States
| | - Karen Webster-Kerr
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- National Epidemiology Unit, Ministry of Health and Wellness, Kingston, Jamaica
| | - Celia Dana Claire Christie
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- Department of Child and Adolescent Health, University Hospital of the West Indies, Kingston, Jamaica
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
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Huy BV, Toàn NV. Prognostic indicators associated with progresses of severe dengue. PLoS One 2022; 17:e0262096. [PMID: 34986174 PMCID: PMC8730386 DOI: 10.1371/journal.pone.0262096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background Dengue usually progress abnormally, especially in the critical phase. The main causes of death were shock, severe bleeding and organ failure. The aim of our study was to evaluate prognostic indicators of severe dengue according to the phases of the disease progression. Methods A cross-sectional study was conducted from July to December 2017 at the National Hospital for Tropical Diseases and the Hospital for Tropical Diseases of Ho Chi Minh City. 326 patients, aged 6 years and over, including 99/326 patients with severe dengue and 227/326 patients with non-severe dengue, hospitalized in the first 3 days of illness, confirmed Dengue virus by the RT-PCR assay have been registered for the study. Clinical manifestations were monitored daily. The hematocrit, white blood cells, platelet, serum albumin, ALT, AST, bilirubin, prothrombin time (PT%, PTs), fibrinogen, aPTT, INR and creatinine were evaluated at two times: febrile phase and critical phase. Results Independent factors associated with severe dengue were identified on multivariate logistic regression models. During the first 3 days of the disease, the prognostic indicators were platelet count ≤ 100 G/L (OR = 2.2; 95%CI: 1.2–3.9), or serum albumin < 35 g/L (OR = 3.3; 95%CI: 1.8–6.1). From day 4–6, the indicator were AST > 400 U/L (OR = 3.0; 95%CI: 1.1–7.9), ALT > 400 U/L (OR = 6.6; 95%CI: 1.7–24.6), albumin < 35 g/L (OR = 3.0; 95%CI: 1.5–5.9), and bilirubin total >17 μmol/L (OR = 4.6; 95%CI: 2.0–10.4). Conclusion To predict the risk of patients with severe dengue, prognostic laboratory indicators should be indicated consistent with the progression of the disease. During the first 3 days of illness, prognostic indicators should be platelet count, or serum albumin. From the 4th - 6th day of illness, prognostic indicators should be AST, ALT, albumin, or bilirubin total.
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Affiliation(s)
- Bùi Vũ Huy
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam.,Department of Pediatrics, National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Ngô Văn Toàn
- Department of Environmental Health, Hanoi Medical University, Hanoi, Vietnam
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12
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Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:123. [PMID: 34627388 PMCID: PMC8501593 DOI: 10.1186/s40249-021-00908-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue.
Methods A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (ORs) for patients’ demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model.
Results We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [OR = 1.96; 95% confidence interval (CI): 1.22–3.13], secondary infection (OR = 3.23; 95% CI: 2.28–4.57), and patients with pre-existing diabetes (OR = 2.88; 95% CI: 1.72–4.81) and renal disease (OR = 4.54; 95% CI: 1.55–13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (OR = 5.13; 95% CI: 1.61–16.34), abdominal pain (OR = 2.00; 95% CI: 1.49–2.68), lethargy (OR = 2.73; 95% CI: 1.05–7.10), vomiting (OR = 1.80; 95% CI: 1.43–2.26), hepatomegaly (OR = 5.92; 95% CI: 3.29–10.66), ascites (OR = 6.30; 95% CI: 3.75–10.60), pleural effusion (OR = 5.72; 95% CI: 3.24–10.10) and melena (OR = 4.05; 95% CI: 1.64–10.00). Conclusions Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00908-2.
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Affiliation(s)
- Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia. .,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Curtin University, Perth, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ripon K Adhikary
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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Thach TQ, Eisa HG, Hmeda AB, Faraj H, Thuan TM, Abdelrahman MM, Awadallah MG, Ha NX, Noeske M, Abdul Aziz JM, Nam NH, Nile ME, Dumre SP, Huy NT, Hirayama K. Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009808. [PMID: 34610027 PMCID: PMC8519480 DOI: 10.1371/journal.pntd.0009808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 10/15/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. METHODOLOGY We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). PRINCIPAL FINDINGS Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. CONCLUSION The findings suggest that alterations of platelet count and AST level-in the first 72 hours of fever onset-are independent markers predicting the development of severe dengue.
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Affiliation(s)
- Tran Quang Thach
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
| | - Heba Gamal Eisa
- Faculty of Medicine, Menoufia University, Shebin El-Koum, Egypt
| | | | - Hazem Faraj
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Nam Xuan Ha
- Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Michael Noeske
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | | | - Nguyen Hai Nam
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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14
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Pradeep SP, Hoovina Venkatesh P, Manchala NR, Vayal Veedu A, Basavaraju RK, Selvasundari L, Ramakrishna M, Chandrakiran Y, Krishnamurthy V, Holigi S, Thomas T, Ross CR, Dias M, Satchidanandam V. Innate Immune Cytokine Profiling and Biomarker Identification for Outcome in Dengue Patients. Front Immunol 2021; 12:677874. [PMID: 34335578 PMCID: PMC8318829 DOI: 10.3389/fimmu.2021.677874] [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: 03/08/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Early biomarkers of progression to severe dengue are urgently required to enable effective patient management and control treatment costs. Innate immune cells, which comprise the earliest responders to infection and along with the cytokines and chemokines they secrete, play a vital role in orchestrating the subsequent adaptive immune response and have been implicated in the enhancement of infection and “cytokine storm” associated with dengue severity. We investigated the early innate immune cytokine profile of dengue patients during acute phase of disease in a prospective blinded study that included subjects with acute dengue and febrile controls from four major hospitals in Bengaluru, India along with healthy controls. We used intracellular cytokine staining and flow cytometry to identify innate immune biomarkers that can predict progression to severe dengue. Results Dengue infection resulted in enhanced secretion of multiple cytokines by all queried innate immune cell subsets, dominated by TNF-α from CD56+CD3+ NKT cells, monocyte subsets, and granulocytes along with IFN-γ from CD56+CD3+ NKT cells. Of note, significantly higher proportions of TNF-α secreting granulocytes and monocyte subsets at admission were associated with mild dengue and minimal symptoms. Dengue NS1 antigenemia used as a surrogate of viral load directly correlated with proportion of cytokine-secreting innate immune cells and was significantly higher in those who went on to recover with minimal symptoms. In patients with secondary dengue or those with bleeding or elevated liver enzymes who revealed predisposition to severe outcomes, early activation as well as efficient downregulation of innate responses were compromised. Conclusion Our findings suggested that faulty/delayed kinetics of innate immune activation and downregulation was a driver of disease severity. We identified IFN-γ+CD56+CD3+ NKT cells and IL-6+ granulocytes at admission as novel early biomarkers that can predict the risk of progression to severity (composite AUC = 0.85–0.9). Strong correlations among multiple cytokine-secreting innate cell subsets revealed that coordinated early activation of the entire innate immune system in response to dengue virus infection contributed to resolution of infection and speedy recovery.
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Affiliation(s)
- Sai Pallavi Pradeep
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru, India
| | | | - Nageswar R Manchala
- Division of Infectious Diseases Unit, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Arjun Vayal Veedu
- Division of Infectious Diseases Unit, St. John's Research Institute, St. John's Medical College, Bengaluru, India
| | - Rajani K Basavaraju
- Department of Medicine, Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, India
| | | | - Manikanta Ramakrishna
- Department of Medicine, Bengaluru Medical College and Research Institute, Bengaluru, India
| | - Yogitha Chandrakiran
- Department of Medicine, Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, India
| | | | - Shivaranjani Holigi
- Department of Medicine, Bengaluru Medical College and Research Institute, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St. John's Medical College, Bengaluru, India
| | - Cecil R Ross
- Department of Medicine, St. John's Medical College, Bengaluru, India
| | - Mary Dias
- Department of Microbiology, St. John's Medical College, Bengaluru, India
| | - Vijaya Satchidanandam
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru, India
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15
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Meng M, Zhang R, Han R, Kong Y, Wang R, Hou L. The polysaccharides from the Grifola frondosa fruiting body prevent lipopolysaccharide/d-galactosamine-induced acute liver injury via the miR-122-Nrf2/ARE pathways. Food Funct 2021; 12:1973-1982. [DOI: 10.1039/d0fo03327h] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The polysaccharides from Grifola frondosa fruiting body can be used as a potential hepatoprotective agent in the treatment of acute liver injury.
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Affiliation(s)
- Meng Meng
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
| | - Rui Zhang
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
| | - Ran Han
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
| | - Yu Kong
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
| | - Ruhua Wang
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
| | - Lihua Hou
- State Key Laboratory of Food Nutrition and Safety
- Key Laboratory of Food Nutrition and Safety
- Ministry of Education
- College of food Engineering and Biotechnology
- Tianjin University of Science and Technology
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Correlation of Clinical Severity and Laboratory Parameters with Various Serotypes in Dengue Virus: A Hospital-Based Study. Int J Microbiol 2020; 2020:6658445. [PMID: 33488722 PMCID: PMC7803134 DOI: 10.1155/2020/6658445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Dengue fever, being hyperendemic with analogous presentations as in many other acute febrile illnesses, poses a challenge in diagnosis during the acute stage. Additionally, the coexistence of multiple serotypes further complicates the disease prognosis. The study was undertaken to determine the dengue virus serotypes, clinical, and laboratory markers as predictors in the severity of infection. Methods A prospective study was conducted among 106 patients admitted with acute febrile illness having positive NS1 antigen/IgM ELISA. Clinical data were extracted from medical records including demographics, presence of comorbid conditions, clinical presentation, laboratory investigations, and course including length of hospital stay and outcome. Detection of dengue serotypes was done by multiplex reverse transcriptase polymerase chain reaction (RT_PCR). Results Out of 106 RT-PCR-confirmed cases, DENV-3 was the most common serotype found in 56 (52.8%) patients, followed by DENV-3 and DENV-4 coinfection in 27 (25.4%) patients. Coinfection with more than one serotype was witnessed in our study. Raised liver enzymes and increased ferritin are good biomarkers in differentiating dengue from severe dengue with cutoff levels for AST (134 U/L), ALT (88 U/L), and ferritin (3670 ng/ml). Musculoskeletal, followed by gastrointestinal, manifestations were comparatively higher than respiratory and cutaneous manifestations. Conclusion This study provides more information on the dengue serotypes. The clinical spectrum along with laboratory parameters such as ferritin, liver enzymes, platelet can be used as potential biomarkers in prediction of dengue severity. The data demonstrated will be useful in early detection and monitoring of the disease.
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Gupta S, Mall P, Alam A. Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue. Trans R Soc Trop Med Hyg 2020; 114:838-846. [PMID: 32964929 DOI: 10.1093/trstmh/traa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/07/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Taking into consideration, the variable performance of WHO's dengue case definition and the magnitude of epidemics in India, a score based on clinical and laboratory parameters is required for the early identification of severe dengue. METHODS A retrospective observational study of children (aged ≤12 y) presenting with dengue, defined as per the WHO 2009 classification and NS1 antigen/IgM ELISA positivity, was conducted at a tertiary care hospital from 2013 to 2015. Clinical laboratory parameters were compared between severe/non-severe dengue using univariate and multivariate analysis. Areas under receiver operating characteristic curves (AUROCs), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for independent and composite markers. RESULTS Of 135 dengue patients, 46 (34.1%) had non-severe dengue and 89 (65.9%) had severe dengue. Logistic regression determined prolonged capillary refill time (CRT), lactate ≥2.9 mmol/L and serum aspartate transaminase (AST) ≥135 IU/L as predictive for severe dengue. AUROCs of lactate, AST and combined score incorporating AST, lactate and prolonged CRT for identifying severity were 7.55, 7.23 and 8.5, respectively. The combined score cut-off ≥1 had 87.6% sensitivity, 65.2% specificity, 83% PPV and 73.2% NPV. The combined score cut-off ≥3 had 100% specificity and 100% PPV. However, AST >135 IU/L and lactate >2.9 mmol/L together had 97.8% specificity and 97.1% PPV for identifying severity. CONCLUSIONS The presence of either 'prolonged capillary refill time with one deranged biochemical parameter' or 'both deranged biochemical parameters' is nearly 100% specific for severity of dengue.
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Affiliation(s)
- Sarika Gupta
- Department of Paediatrics, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, India
| | - Pranaya Mall
- Department of neonatology, PGIMER, Dr RML Hospital, Presidents's Estate, New Delhi, India
| | - Areesha Alam
- Department of Paediatrics, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi road, Lucknow, Uttar Pradesh, India
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Risk factors and biomarkers of severe dengue. Curr Opin Virol 2020; 43:1-8. [PMID: 32688269 DOI: 10.1016/j.coviro.2020.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
Dengue virus infects several million people each year. Although usually a self-limiting disease, some patients can develop life-threatening severe complications, characterized by plasma leakage, hemorrhaging, and shock. The signs and symptoms of severe disease usually arise late in the disease course when patients are recovering and fever has subsided, making it difficult to predict. Efforts are underway to identify risk factors and biomarkers that can accurately predict disease severity in the acute febrile phase of the disease, facilitating early intervention and treatment strategies for those at greatest risk. In this review we discuss recent advancements in identifying risk factors and biomarkers for the prognosis of severe dengue.
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Yeh CY, Lu BZ, Liang WJ, Shu YC, Chuang KT, Chen PL, Ko WC, Ko NY. Trajectories of hepatic and coagulation dysfunctions related to a rapidly fatal outcome among hospitalized patients with dengue fever in Tainan, 2015. PLoS Negl Trop Dis 2019; 13:e0007817. [PMID: 31805088 PMCID: PMC6894745 DOI: 10.1371/journal.pntd.0007817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Hepatic dysfunction and coagulopathy are common in acute dengue illness. We analyzed the trajectories of the above parameters in the survivors and fatal patients in the outbreak in Tainan, 2015. Methods A retrospective study was conducted using data from a tertiary hospital between January and December 2015. Multilevel modeling (MLM) was used to identify the changes in aminotransferase (AST), alanine aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts from Day 0 to Day 7 of the onset of dengue infection. The machine-learning algorithm was used by purity measure assumption to calculate the accuracy of serum transaminases and coagulation variables to discriminate between the fatal and survival groups. Results There were 4,069 dengue patients, of which 0.9% died in one week after illness onset (i.e., early mortality). Case fatality rate was the highest for those aged ≥70 years. Both AST and ALT values of the fatal group were significantly higher than those of the survivor group from Day 3 (AST median, 624 U/L vs. 60 U/L, p < 0.001; ALT median, 116 U/L vs. 29 U/L, p = 0.01) of illness onset and peaked on Day 6 (AST median, 9805 U/L vs. 90 U/L, p < 0.001; ALT median, 1504 U/L vs. 49 U/L, p < 0.001). AST ≥ 203 U/L, ALT ≥ 55 U/L, AST2/ALT criteria ≥337.35, or AST/platelet count ratio index (APRI) ≥ 19.18 on Day 3 of dengue infection had a high true positive rate, 90%, 78%, 100%, or 100%, respectively, of early mortality. The platelet counts of the fatal group declined significantly than those of the survivor group since Day 3 of illness onset (median, 19 x103/μl vs. 91 x103/μl, p < 0.01), and aPTT values of the fatal group significantly prolonged longer since Day 5 (median, 68.7 seconds vs. 40.1 seconds, p < 0.001). Conclusions AST, ALT, and platelet counts should be monitored closely from Day 0 to Day 3 of dengue infection, and aPTT be followed up on Day 5 of infection to identify the individuals at risk for early mortality. Dengue fever (DF) is currently one of the most severe public health problems. Clinical presentations of dengue are diverse and non-specific, often with unpredictable clinical progression and outcome. Hepatic dysfunction and abnormal coagulation factors are common in acute dengue illness, reflected by abnormal alanine aminotransferase (AST), aspartate aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts. However, there is no information available about the monitoring frequency required, which could help identify those dengue patients who are likely to die, especially during epidemic outbreaks with limited healthcare resources. We examined all the laboratory-confirmed dengue patients who admitted to the major tertiary hospital in Tainan during the 2015 dengue outbreak, and the different trajectories of hepatic function and coagulation factors between survivors and rapidly fatal dengue patients were analyzed. Although there were no differences in AST, ALT, aPTT, and platelet counts between the survivor and fatal groups on the day DF symptoms first appeared, the differences increased from the early stages of infection and became more prominent during the early stages of the illness. The necessity of monitoring the AST, ALT, aPTT, and platelet count frequently during the febrile phase is emphasized by this study.
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Affiliation(s)
- Chun-Yin Yeh
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bing-Ze Lu
- Department of Mathematics, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Jie Liang
- Department of Artificial Intelligence, CTBC Business School, Tainan, Taiwan
| | - Yu-Chen Shu
- Department of Mathematics, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Ta Chuang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (PLC); (NYK)
| | - Wen-Chien Ko
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (PLC); (NYK)
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Valiant WG, Mattapallil MJ, Higgs S, Huang YJS, Vanlandingham DL, Lewis MG, Mattapallil JJ. Simultaneous Coinfection of Macaques with Zika and Dengue Viruses Does not Enhance Acute Plasma Viremia but Leads to Activation of Monocyte Subsets and Biphasic Release of Pro-inflammatory Cytokines. Sci Rep 2019; 9:7877. [PMID: 31133721 PMCID: PMC6536518 DOI: 10.1038/s41598-019-44323-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/15/2019] [Indexed: 01/06/2023] Open
Abstract
The consequences of simultaneous infection with Zika (ZIKV) and Dengue (DENV) viruses are poorly understood. Here we show that rhesus macaques experimentally coinfected simultaneously with ZIKV and DENV-2 demonstrated ZIKV or DENV replication without an enhancement of either infection. Coinfection was accompanied by an increase in the proportions of CD14+CD16+ pro-inflammatory subsets of monocytes and release of pro-inflammatory cytokines in the plasma. Numerous cytokines such as I-TAC, Eotaxin, RANTES, MCP-1, IFNγ and MIG demonstrated a biphasic peak that coincided with the differences in kinetics of ZIKV and DENV replication suggesting that viral replication likely differentially modulated the release of these cytokines. Red blood cell indices significantly declined during acute infection suggesting transient anemia, and was accompanied by elevated levels of muscle, liver and renal injury markers. These findings have implications for understanding the pathogenesis of coinfection in ZIKV and DENV endemic regions, and is the 1st report of an experimental coinfection using the rhesus macaque model for ZIKV and DENV infections.
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Affiliation(s)
- William G Valiant
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Mary J Mattapallil
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephen Higgs
- Biosecurity Research Institute, Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Yan-Jang S Huang
- Biosecurity Research Institute, Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Dana L Vanlandingham
- Biosecurity Research Institute, Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | | | - Joseph J Mattapallil
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA.
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Bujang MA, Kuan PX, Tiong XT, Saperi FE, Ismail M, Mustafa FI, Abd Hamid AM. The All-Cause Mortality and a Screening Tool to Determine High-Risk Patients among Prevalent Type 2 Diabetes Mellitus Patients. J Diabetes Res 2018; 2018:4638327. [PMID: 30116741 PMCID: PMC6079498 DOI: 10.1155/2018/4638327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to determine the all-cause mortality and the associated risk factors for all-cause mortality among the prevalent type 2 diabetes mellitus (T2DM) patients within five years' period and to develop a screening tool to determine high-risk patients. METHODS This is a cohort study of T2DM patients in the national diabetes registry, Malaysia. Patients' particulars were derived from the database between 1st January 2009 and 31st December 2009. Their records were matched with the national death record at the end of year 2013 to determine the status after five years. The factors associated with mortality were investigated, and a prognostic model was developed based on logistic regression model. RESULTS There were 69,555 records analyzed. The mortality rate was 1.4 persons per 100 person-years. The major cause of death were diseases of the circulatory system (28.4%), infectious and parasitic diseases (19.7%), and respiratory system (16.0%). The risk factors of mortality within five years were age group (p < 0.001), body mass index category (p < 0.001), duration of diabetes (p < 0.001), retinopathy (p = 0.001), ischaemic heart disease (p < 0.001), cerebrovascular (p = 0.007), nephropathy (p = 0.001), and foot problem (p = 0.001). The sensitivity and specificity of the proposed model was fairly strong with 70.2% and 61.3%, respectively. CONCLUSIONS The elderly and underweight T2DM patients with complications have higher risk for mortality within five years. The model has moderate accuracy; the prognostic model can be used as a screening tool to classify T2DM patients who are at higher risk for mortality within five years.
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Affiliation(s)
- Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Pei Xuan Kuan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Xun Ting Tiong
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Fatin Ellisya Saperi
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Mastura Ismail
- Health Clinic Seremban 2, Ministry of Health, Seremban, Malaysia
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