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Henriques P, Rosa A, Caldeira-Araújo H, Soares P, Vigário AM. Flying under the radar - impact and factors influencing asymptomatic DENV infections. Front Cell Infect Microbiol 2023; 13:1284651. [PMID: 38076464 PMCID: PMC10704250 DOI: 10.3389/fcimb.2023.1284651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
The clinical outcome of DENV and other Flaviviruses infections represents a spectrum of severity that ranges from mild manifestations to severe disease, which can ultimately lead to death. Nonetheless, most of these infections result in an asymptomatic outcome that may play an important role in the persistent circulation of these viruses. Also, although little is known about the mechanisms that lead to these asymptomatic infections, they are likely the result of a complex interplay between viral and host factors. Specific characteristics of the infecting viral strain, such as its replicating efficiency, coupled with host factors, like gene expression of key molecules involved in the immune response or in the protection against disease, are among crucial factors to study. This review revisits recent data on factors that may contribute to the asymptomatic outcome of the world's widespread DENV, highlighting the importance of silent infections in the transmission of this pathogen and the immune status of the host.
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Affiliation(s)
- Paulo Henriques
- Projecto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
| | - Alexandra Rosa
- Projecto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
| | - Helena Caldeira-Araújo
- Projecto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
| | - Pedro Soares
- Department of Biology, CBMA (Centre of Molecular and Environmental Biology), Braga, Portugal
- Department of Biology, Institute of Science and Innovation for Bio-Sustainability (IB-S), University of Minho, Braga, Portugal
| | - Ana Margarida Vigário
- Projecto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Nguyen TT, Nguyen DT, Vo TTH, Dang OTH, Nguyen BT, Pham DTT, Nguyen TTK, Duong YNH, Doan DH, Nguyen TH, Ho LT, Nguyen PH, Phan DN, Tran TV, Nguyen TK, Luong DC, Pham ATM, Dinh TTD, Do VC, Vo LT. Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome. Medicine (Baltimore) 2023; 102:e36054. [PMID: 37986332 PMCID: PMC10659721 DOI: 10.1097/md.0000000000036054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/13/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31-4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.
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Affiliation(s)
- Thanh Tat Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Dat Tat Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Tien Thi-Hong Vo
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Oanh Tran-Hoang Dang
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Bao Trung Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Dung Thi-Thuy Pham
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Thuong Thi-Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | | | - Duong Hung Doan
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Truc Huynh Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Lien Thi Ho
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Phuc Hoang Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Dung Ngoc Phan
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Tin Van Tran
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Tuyet Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Duc Cong Luong
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Anh Thi-Mai Pham
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Thuy Thi-Diem Dinh
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Viet Chau Do
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Luan Thanh Vo
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
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Usuda JN, Plaça DR, Fonseca DLM, Marques AHC, Filgueiras IS, Chaves VGB, Adri AS, Torrentes-Carvalho A, Hirata MH, Freire PP, Catar R, Cabral-Miranda G, Schimke LF, Moll G, Cabral-Marques O. Interferome signature dynamics during the anti-dengue immune response: a systems biology characterization. Front Immunol 2023; 14:1243516. [PMID: 37638052 PMCID: PMC10449254 DOI: 10.3389/fimmu.2023.1243516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Dengue virus (DENV) infection manifests as a febrile illness with three distinct phases: early acute, late acute, and convalescent. Dengue can result in clinical manifestations with different degrees of severity, dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. Interferons (IFNs) are antiviral cytokines central to the anti-DENV immune response. Notably, the distinct global signature of type I, II, and III interferon-regulated genes (the interferome) remains uncharacterized in dengue patients to date. Therefore, we performed an in-depth cross-study for the integrative analysis of transcriptome data related to DENV infection. Our systems biology analysis shows that the anti-dengue immune response is characterized by the modulation of numerous interferon-regulated genes (IRGs) enriching, for instance, cytokine-mediated signaling (e.g., type I and II IFNs) and chemotaxis, which is then followed by a transcriptional wave of genes associated with cell cycle, also regulated by the IFN cascade. The adjunct analysis of disease stratification potential, followed by a transcriptional meta-analysis of the interferome, indicated genes such as IFI27, ISG15, and CYBRD1 as potential suitable biomarkers of disease severity. Thus, this study characterizes the landscape of the interferome signature in DENV infection, indicating that interferome dynamics are a crucial and central part of the anti-dengue immune response.
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Affiliation(s)
- Júlia Nakanishi Usuda
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Desirée Rodrigues Plaça
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Dennyson Leandro M. Fonseca
- Interunit PostGraduate Program on Bioinformatics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Alexandre H. C. Marques
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Igor Salerno Filgueiras
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Victor Gabriel Bastos Chaves
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anny Silva Adri
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Paula Paccielli Freire
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rusan Catar
- Departament of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Gustavo Cabral-Miranda
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lena F. Schimke
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Guido Moll
- Departament of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Otavio Cabral-Marques
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
- Interunit PostGraduate Program on Bioinformatics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
- Departament of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
- Network of Immunity in Infection, Malignancy, Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, SP, Brazil
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Chen CY, Chiu YY, Chen YC, Huang CH, Wang WH, Chen YH, Lin CY. Obesity as a clinical predictor for severe manifestation of dengue: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:502. [PMID: 37525106 PMCID: PMC10388491 DOI: 10.1186/s12879-023-08481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Severe dengue often leads to poor clinical outcomes and high mortality; as a result, it is of vital importance to find prognostic factors associated with the severe form of dengue. Obesity is known to deteriorate many infectious diseases due to impaired immune responses. Several studies have suggested that obese patients with dengue infection tend to have more severe manifestations with poorer prognosis. However, a firm conclusion could not be drawn due to the varied results of these studies. Here, we aimed to conduct a systematic review and meta-analysis to investigate the association between obesity and dengue severity. METHODS A literature search for relevant studies was conducted in PubMed, Embase, Ovid Medline and Cochrane from inception to September 9, 2022. The two main keywords were "dengue" and "obesity". Mantel-Haenszel method and random effects model was used to analyze the pooled odds ratio with 95% confidence intervals. RESULTS A total of 15 article involving a total of 6,508 patients were included in the meta-analysis. Included patients in most studies were hospitalized pediatric patients. Only one study included adulthood data. Three cohort studies, four case-control studies, and one cross-sectional studies found a significant association between obesity and dengue severity. In contrast, three cohort studies, three case-control studies, and one cross-sectional study reported no significant relationship between obesity and dengue severity. Our analysis results showed that patient with obesity is 50% (OR = 1.50; 95%CI: 1.15-1.97) more likely to develop severe manifestation of dengue. CONCLUSION This meta-analysis revealed that overweight could be a clinical predictor for severe disease for pediatric patients with dengue infection.
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Affiliation(s)
- Chao-Ying Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Yu-Yao Chiu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Yu-Cheng Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Chung-Hao Huang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Wen-Hung Wang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Institute of Medical Science and Technology, School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Institute of Medical Science and Technology, School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, HsinChu 100, Taiwan
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- School of Medicine, Graduate Institute of Medicine, College of Medicine, Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Department of Medical Biochemistry and Microbiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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