Arthropod-borne Disease Research Articles

Cardiac Biomarkers in a Brazilian Indigenous Population Exposed to Arboviruses: A Cross-Sectional Study

Arthropod-borne viral diseases are acute febrile illnesses, sometimes with chronic effects, that can be debilitating and even fatal worldwide, affecting particularly vulnerable populations. Indigenous communities face not only the burden of these acute febrile illnesses, but also the cardiovascular complications that are worsened by urbanization. A cross-sectional study was conducted in an Indigenous population in the Northeast Region of Brazil to explore the association between arboviral infections (dengue, chikungunya, and Zika) and cardiac biomarkers, including cardiotrophin 1, growth differentiation factor 15, lactate dehydrogenase B, fatty-acid-binding protein 3, myoglobin, N-terminal pro-B-type natriuretic peptide, cardiac troponin I, big endothelin 1, and creatine kinase-MB, along with clinical and anthropometric factors. The study included 174 individuals from the Fulni-ô community, with a median age of 47 years (interquartile range 39.0 to 56.0). High rates of previous exposure to dengue, chikungunya, and Zika were observed (92.5%, 78.2%, and 95.4% anti-IgG, respectively), while acute exposure (anti-IgM) remained low. The biomarkers were linked to age (especially in the elderly), obesity, chronic kidney disease, and previous or recent exposure to chikungunya. This study pioneers the use of Luminex xMAP technology to reveal the association between cardiac inflammatory biomarkers and exposure to classical arboviruses in an Indigenous population undergoing urbanization.

Comparative study of two Rift Valley fever virus field strains originating from Mauritania.

Rift Valley fever (RVF) is one of the major viral arthropod-borne diseases in Africa. In recent decades, RVF virus (RVFV), the causative agent of RVF, has been responsible for multiple outbreaks in West Africa with important consequences on human and animal health. In particular, an outbreak occurred in 2010 after heavy rains in the desertic region of Adrar, Mauritania. It was characterized by the appearance of severe clinical signs among dromedary camels. Another one occurred in 2013-2014 across Senegal and the southern part of Mauritania. In this study, we characterized two RVFV field strains isolated during these two outbreaks. The first strain, MRU25010-30, was isolated from a camel (2010) while the second, MRU2687-3, was isolated from a goat (2013). By deep-sequencing and rapid amplification of cDNA-ends by polymerase chain reaction, we successfully sequenced the complete genome of these two RVFV strains as well as the reference laboratory strain ZH548. Phylogenetic analysis showed that the two field viruses belong to two different RVFV genetic lineages. Moreover, we showed that MRU25010-30 replicates more efficiently in various in vitro cell culture models than MRU2687-3 and ZH548. In vivo, MRU25010-30 caused rapid death of BALB/c mice and proved to be more virulent than MRU2687-3, regardless of the route of inoculation (subcutaneous or intranasal). The virulence of MRU25010-30 is associated with a high viral load in the liver and serum of infected mice, while the death of mice infected with MRU2687-3 and ZH548 correlated with a high viral load in the brain. Altogether, the data presented in this study provide new avenues to unveil the molecular viral determinants that modulate RVFV virulence and replication capacity.

Research progress toward arthropod salivary protein vaccine development for vector-borne infectious diseases.

Hematophagous arthropods, including mosquitoes, ticks, and flies, are responsible for the transmission of several pathogens to vertebrates on whom they blood feed. The diseases caused by these pathogens, collectively known as vector-borne diseases (VBDs), threaten the health of humans and animals. In general, attempts to develop vaccines for pathogens transmitted by arthropods have met with moderate success, with few vaccine candidates currently developed. Nowadays, there are vaccine candidates under clinical trials, including different platforms, like mRNA, DNA, recombinant viral vector-based, virus-like particles (VLPs), inactivated-virus, live-attenuated virus, peptide and protein-based vaccines, all of them based on the presentation of pathogen antigens to the host immune system. A new approach to prevent VBDs has arose during the last decades, based on the design of vaccines that target vector-derived antigens. The salivary secretions of arthropods, in addition of causing allergic reactions and harbor pathogens, are also involved in the transmission and infection establishment in the host, altering its immune responses. In this review, we summarize the achievements in the arthropod salivary-based vaccine development for different vector-borne infectious diseases. This provides a rationale for creating vaccines against different types of arthropod salivary proteins, such as mosquitoes, ticks, and sand flies. Using salivary proteins of clinically important vectors might contribute to achieve protection against and control multiple arthropod-borne infection diseases.

Serosurvey of Arboviruses in Free-ranging Mantled Howler Monkeys (Alouatta palliata) in Costa Rica.

We investigated the prevalence of arthropod-borne viral diseases in a population of free-ranging mantled howler monkeys (Alouatta palliata) in Costa Rica in 1998. Blood samples were opportunistically collected from monkeys anesthetized for another study. Serology was performed on 64 individuals to assess exposure of this population to vesicular stomatitis virus, equine encephalitis viruses, Mayaro virus, St. Louis encephalitis virus, yellow fever virus, and dengue virus. The New Jersey serotype of vesicular stomatitis (VSV-NJ) was the only pathogen for which the population tested positive (44% [28/64]). This is the first report of antibodies against VSV-NJ in nonhuman primates in Costa Rica.

Spontaneous splenic rupture as a complication of dengue fever

Dengue is a mosquito-transmitted virus and the leading cause of arthropod-borne viral disease in the world. Clinical manifestations can vary from asymptomatic disease to severe illness and death. Dengue is also known to cause myocarditis, hepatitis, and neurological manifestations, and rarely to cause splenic rupture. We report a 34-year-old man with splenic rupture complicating dengue fever which was managed conservatively with excellent outcome.

Imported arboviral disease cases and entomological surveillance of Aedes albopictus in Valencian Autonomous Region (Spain) along 2022

Abstract The Laboratory of Entomology and Pest Control (LEPC) of the University of Valencia, hired by the regional government of the Generalitat Valenciana, carried out the entomological surveillance of the Asian tiger mosquito along 2022 in the Valencian Autonomous Region, excepting the city of Valencia for which the surveillance was conducted by a private pest control company. The main purpose of this plan of action was both to continue the detection and monitoring of Aedes albopictus in the Valencian municipalities free of its presence until the end of 2021, and to carry out the entomological surveys related to imported arbovirus cases notified by the Regional Health System. The active search and detection of the mosquito breeding sites in both urban and peri-urban environments throughout the provinces of Alicante, Castellón and Valencia, has revealed the absence of new populations of this allochthonous mosquito in all those municipalities free of this species in December of 2021. Besides, the LEPC has conducted the mosquito surveys in 31 municipalities of the three provinces, in relation to the declaration of 33 cases of arthropod-borne diseases due to Chikungunya, dengue or Zika viruses, which were reported in travellers returning from countries of Latin America, Asia, or West Africa. The methods used to minimise the risk of local transmission of these viruses by Ae. albopictus were focused on detecting the presence of the tiger mosquito and other common native mosquito populations, at both adult and larval stages, in the surroundings of the residence of imported cases to guide the treatments of the detected resting and breeding sites. As result, tiger mosquito populations were recorded in 18 of the 33 municipalities where imported arbovirus cases were reported in 2022.

The Influence of Climate Change on Vector-Borne Diseases in a Wilderness Medicine Context.

The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.

Scanning of antennae and maxillary palps of anthropophilic Aedes aegypti and ornithophilic Culex pipiens as potential arbovirus vectors

Background and Aim: Efficient mosquito vectors are required to persist and propagate arthropod-borne diseases that seriously affect impoverished populations worldwide. Mosquito sensilla plays a crucial role in host-seeking and disease transmission to humans. This study aimed to distinguish between the several types of sensilla found on the antennae and maxillary palps of Culex pipiens and Aedes aegypti, matching this diversity with host preference and disease transmission. Materials and Methods: Overall, 1300 mosquitoes were collected and examined using dissection and light microscopy. Scanning electron microscopy was used to identify and describe the diverse types of sensilla found on the antennae and maxillary palps of C. pipiens and A. aegypti. Results: In total, 900 C. pipiens and 400 A. aegypti mosquitoes were identified. The antennae and maxillary palps of C. pipiens and A. aegypti carry both sensilla trichoidea and sensilla chaetica. The C. pipiens antenna has long and short grooved peg sensilla, whereas A. aegypti lacks long pegs and expresses only occasional short pegs. The maxillary palps express Capitate pegs in both mosquito species and exclusively show sensilla campaniform in A. aegypti. Conclusion: The lack of long-grooved pegs and the presence of few short pegs, along with campaniform sensilla, limit the host range of A. aegypti and reduce its susceptibility to many infections, unlike C. pipiens. Keywords: Aedes aegypti, Culex pipiens, Scanning electron microscopy, Sensilla.

The Current Epizootiological Situation of Three Major Viral Infections Affecting Cattle in Egypt.

One of the major factors hindering efficient livestock production is the presence of high-impact infectious animal diseases, such as foot and mouth disease (FMD), lumpy skin disease (LSD), and bovine ephemeral fever (BEF), which are notable viral infections affecting cattle in Egypt, leading to significant economic losses. FMD is caused by the foot and mouth disease virus (FMDV) of the genus Aphthovirus in the Picornaviridae family. LSD is caused by lumpy skin disease virus (LSDV) of Capripox genus within the Poxviridae family, subfamily Chordopoxvirinae. BEF is caused by bovine ephemeral fever virus (BEFV) of genus Ephemerovirus in the Rhabdoviridae family. FMD is a highly contagious viral infection of domestic and wild cloven-hooved animals and can spread through the wind. On the other hand, LSD and BEF are arthropod-borne viral diseases that mainly affect domestic cattle and water buffalo. Despite government vaccination efforts, these three viral diseases have become widespread in Egypt, with several reported epidemics. Egypt's importation of large numbers of animals from different countries, combined with unregulated animal movements through trading and borders between African countries and Egypt, facilitates the introduction of new FMDV serotypes and lineages not covered by the current vaccination plans. To establish an effective control program, countries need to assess the real epizootic situation of various infectious animal diseases to develop an efficient early warning system. This review provides information about FMD, LSD, and BEF, including their economic impacts, causative viruses, global burden, the situation in Egypt, and the challenges in controlling these diseases.

Tick extracellular vesicles undermine epidermal wound healing during hematophagy.

Wound healing has been extensively studied through the lens of inflammatory disorders and cancer, but limited attention has been given to hematophagy and arthropod-borne diseases. Hematophagous ectoparasites, including ticks, subvert the wound healing response to maintain prolonged attachment and facilitate blood-feeding. Here, we unveil a strategy by which extracellular vesicles (EVs) ensure blood-feeding and arthropod survival in three medically relevant tick species. We demonstrate through single cell RNA sequencing and murine genetics that wildtype animals infested with EV-deficient Ixodes scapularis display a unique population of keratinocytes with an overrepresentation of pathways connected to wound healing. Tick feeding affected keratinocyte proliferation in a density-dependent manner, which relied on EVs and dendritic epidermal T cells (DETCs). This occurrence was linked to phosphoinositide 3-kinase activity, keratinocyte growth factor (KGF) and transforming growth factor β (TGF-β) levels. Collectively, we uncovered a strategy employed by a blood-feeding arthropod that impairs the integrity of the epithelial barrier, contributing to ectoparasite fitness.

Bovine Ephemeral Fever Viruses in Israel 2014-2023: Genetic Characterization of Local and Emerging Strains.

Bovine ephemeral fever (BEF) is an arthropod-borne viral disease, which frequently causes significant epizootics in susceptible water buffalo and cattle in Africa, Australia, Asia and the Middle East. In the current study, a two-stage protocol for BEFV viral isolation was developed. Data on the clinical signs, geographic distribution and phylogenetic analysis of BEFV strains isolated in Israel in 2015, 2018, 2021 and 2023 were summarized. It was found that during 2015-2021, all BEF outbreaks were caused by local BEFV strains, whereas the epizootic of BEFV in 2023 was caused by a new "Mayotte-like" BEFV strain. A comparison of bluetongue (BT) and BEF outbreaks during 2023 in Israel demonstrated that the incidence of BEFV was 2.21 times higher and its pathogenicity was more serious for the cattle population compared to that caused by BTVs. A phylogenetic analysis of Israeli and global BEFV revealed the emergence of non-local strains in new areas. This finding suggests that BEFV can no longer be classified based only upon geographic distribution. Considering a phylogenetic, genetic and proteomic analysis of all available BEFV strains, we suggest classifying them as a single serotype, which includes four lineages.

Reduced effectiveness of permethrin-treated military uniforms after prolonged wear measured by contact irritancy and toxicity bioassays with Ixodes scapularis (Acari: Ixodidae) nymphs.

Factory-treated permethrin uniforms are the primary method used by the US Army to prevent arthropod bites and transmission of arthropod-borne diseases. In this study previously worn uniforms were collected from cadets at the United States Military Academy in West Point, NY to determine the amount of permethrin remaining after prolonged wear and subsequent effects on ticks. Six trousers were collected from cadets in the sophomore, junior, and senior classes. A new, unwashed uniform served as a positive control and an untreated maternity uniform served as a negative control. Fabric samples were removed from each trouser and used in bioassays with laboratory-reared Ixodes scapularis Say nymphs. Contact irritancy bioassays measured the nymphs' ability to remain in contact with fabric for a period of 5 min. Toxicity bioassays measured tick survival at 1 and 24 h after contacting uniform samples. liquid chromatography-mass spectrometry was used to quantify the permethrin content (mg/cm2) in each uniform after the bioassays were complete. The results showed significant amounts of permethrin were lost after extended wear and it was related to the cadet year group. The contact irritancy assays found uniforms with less permethrin did not irritate ticks and cause them to dislodge. Mortality was also affected by permethrin levels, with less ticks dying at 24 h on older uniforms. The results from this study show older uniforms lose most of their permethrin and no longer provide the same levels of protection.

New member of Plasmodium (Vinckeia) and Plasmodium cyclopsi discovered in bats in Sierra Leone – nuclear sequence and complete mitochondrial genome analyses

Malaria remains the most important arthropod-borne infectious disease globally. The causative agent, Plasmodium, is a unicellular eukaryote that develops inside red blood cells. Identifying new Plasmodium parasite species that infect mammalian hosts can shed light on the complex evolution and diversity of malaria parasites. Bats feature a high diversity of microorganisms including seven separate genera of malarial parasites. Three species of Plasmodium have been reported so far, for which scarce reports exist. Here we present data from an investigation of Plasmodium infections in bats in the western Guinean lowland forest in Sierra Leone. We discovered a new Plasmodium parasite in the horseshoe bat Rhinolophus landeri. Plasmodium cyclopsi infections in a member of leaf-nosed bats, Doryrhina cyclops, exhibited a high prevalence of 100%. Phylogenetic analysis of complete mitochondrial genomes and nine nuclear markers recovered a close relationship between P. cyclopsi and the new Plasmodium parasite with the rodent species Plasmodium berghei, a widely used in vivo model to study malaria in humans. The data suggests that the “rodent/bat” Plasmodium (Vinckeia) clade represents a diverse group of malarial parasites that would likely expand with a systematic sampling of small mammals in tropical Africa. Identifying the bat Plasmodium repertoire is central to our understanding of the evolution of Plasmodium parasites in mammals.

Acute Liver Failure with Intracerebral Hemorrhage in Dengue Fever: A Rare Clinical Presentation

Dengue is the major cause of arthropod-borne viral disease in the world. It presents with high fever, headache, rash, myalgia, and arthralgia and it is a self-limiting illness. Severe dengue can occur in some cases resulting in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). We present a case of a young patient aged 25-year-old male who presented with fever, jaundice, decreased urine output for 5 days, and altered mental status for the last 1 day. After investigation, he was diagnosed with dengue fever and later developed sepsis-induced acute liver failure with acute kidney injury. The patient was treated with intravenous antibiotics and hemodialysis. Plasmapheresis was done in view of acute liver failure. Gradually patient condition improved and he gained consciousness. But later on, the patient developed spontaneous intracerebral hemorrhage (ICH) and the patient succumbed to his illness after 2 days of developing ICH. ICH is a very rare and atypical manifestation in the case of severe dengue patients, research for effective treatment is crucial now.

Study of association of thrombocytopenia and serological parameters in dengue fever with special reference to NS1 antigen in hilly Region of Northern India

Background: Dengue fever is an arthropod-borne disease transmitted to humans by Aedes aegypti mosquitoes and one of the leading causes of arthropod-borne viral disease in the world. Aims and Objectives: The present study aims to analyze any association between platelet count and immunochromatography -based dengue serology tests. Materials and Methods: This was a cross-sectional study conducted in Government Doon Medical College and Hospital. A total of 19,208 clinically suspected cases of dengue who reported in various outpatient departments, emergency services, and inpatient departments of our hospital between June 2023 and November 2023 were included in this study. Samples were tested by rapid immunochromatographic test for dengue non-structural protein 1 (NS1) antigen, immunoglobulin M (IgM), IgG, and platelet count was also obtained and a comparison was made. Results: Out of total 19,208 samples tested, 4876 (25.38%) samples were positive for NS1, 589 (3.06%) samples were positive for IgM. Majority of the patients were in the age group of 21–40 years 9274 (48.28%). 11,753 (61.19%) were males and 7455 (38.80%) were females. A strong correlation was seen between NS1 and thrombocytopenia where a total of 2737/4876 (n=56.13%) patients showed positivity in NS1 with low platelet counts. Conclusion: Detection of NS1 antigen helps in early diagnosis of dengue to avoid complications significantly. In confirmed dengue cases with fever, thrombocytopenia is more consistently found and can be used as a predictor to reduce the morbidity and mortality of dengue disease.

Epidemiological assessment of Anaplasma marginale, Babesia bigemina, and Babesia bovis infections in Colombian creole cattle breeds: A molecular survey in northeastern Colombia

Anaplasmosis and babesiosis are globally distributed arthropod-borne diseases known for causing substantial economic losses due to their high morbidity and mortality rates. This study aims to assess the frequency and epidemiological features associated with the infection of Anaplasma marginale, Babesia bigemina, and Babesia bovis in three Creole cattle breeds (Chino Santandereano (Chino), Casanareño (CAS), and Sanmartinero (SM)) in northeastern Colombia. Between June 2019 and March 2020, a total of 252 Creole cattle were sampled, with Chino, CAS, and SM accounting for 42.8%, 29.5%, and 29.5% of the samples, respectively. Blood samples were subjected to molecular analysis to detect the DNA of A. marginale, B. bigemina, and B. bovis, using species-specific primers. Additionally, Packed Cell Volume (PCV), total serum proteins, and body condition were evaluated. Molecular analyses revealed the presence of B. bigemina, A. marginale, and B. bovis in 83.7% (211/252; 95% CI = 79.1%–88.3%), 59.9% (151/252; 95% CI = 53.8%–66.1%), and 40.9% (103/252; 95% CI = 34.7%–46.9%) of the samples, respectively, with 69% (174/252; 95% CI = 57.8%–80.3%) exhibiting coinfections. Notably, in infected animals, no significant alterations in PCV, total serum proteins, or body condition were observed. Multivariate analyses indicated a statistically significant association between the frequency of A. marginale infection and the breed and season, with a higher frequency in SM during the rainy season (P < 0.05). To our knowledge, this is the first molecular survey that evaluates multiple arthropod-borne pathogens in Colombian Creole breeds. The results revel a high frequency of B. bigemina and A. marginale infections, coupled with a notable frequency of coinfections, all without significant alteration in the PCV, total serum proteins and body conditions. Our findings enhance the understanding of the epidemiological aspects of arthropod-borne pathogens in Colombian Creole breed and contribute to the improvement of sanitary programs for these animals.

Evaluation for Antiviral Potential of Ficus deltoidea Against Dengue Virus Type-2

Dengue is one of the most widespread arthropod-borne viral diseases that cause negative impact globally. Presently, no effective drug is available to safeguard people against dengue. Ficus deltoidea is Malaysia's famous traditional herb belonging to Moraceae family due to its pharmacological potential. F. deltoidea leaves (FDL) were extracted with n-hexane, ethyl acetate and methanol. Cell cytotoxicity study using MTT assay measuring the formazan absorbance was conducted to determine maximum non-toxic concentration on Vero cells. The antiviral activities of various concentrations of FDL extracts were assessed using virus reduction neutralisation tests against dengue virus type 2. The CC20 value of n-hexane, ethyl acetate and methanol FDL extracts were 2.99 ± 0.31, 22.15 ± 2.39, and 25.22 ± 0.42 µg/mL, respectively. Methanol FDL extract at maximum non-toxic concentration exerted strongest direct extracellular virucidal effect against DENV-2. In cell protection assay, ethyl acetate FDL extract achieved highest reduction in viral infectivity (98.17%), whereas n-hexane FDL extract showed strongest inhibition in DENV-2 viral replication in post-infection assay. Methanol FDL extract showed highest selectivity index value in direct virus inhibition, cell protection and post-infection assay. Conclusively, FDL extracts, especially methanol FDL showed potential antiviral activity against DENV-2, thus considered as promising anti-dengue agent.

Arctigenin from Arctium lappa L. inhibits chikungunya virus by affecting its entry and replication

BackgroundDengue and chikungunya, caused by dengue virus (DENV) and chikungunya virus (CHIKV) respectively, are the most common arthropod-borne viral diseases worldwide, for which there are no FDA-approved antivirals or effective vaccines. Arctigenin, a phenylpropanoid lignan from the seeds of Arctium lappa L. is known for its anti-inflammatory, anti-cancer, antibacterial, and immunomodulatory properties. Arctigenin's antimicrobial and immunomodulatory capabilities make it a promising candidate for investigating its potential as an anti-DENV and anti-CHIKV agent. PurposeThe aim of the study was to explore the anti-DENV and anti-CHIKV effects of arctigenin and identify the possible mechanisms of action. MethodsThe anti-DENV or anti-CHIKV effects of arctigenin was assessed using various in vitro and in silico approaches. Vero CCL-81 cells were infected with DENV or CHIKV and treated with arctigenin at different concentrations, temperature, and time points to ascertain the effect of the compound on virus entry or replication. In silico molecular docking was performed to identify the interactions of the compound with viral proteins. ResultsArctigenin had no effects on DENV. Various time- and temperature-dependent assays revealed that arctigenin significantly reduced CHIKV RNA copy number and infectious virus particles and affected viral entry. Entry bypass assay revealed that arctigenin inhibited the initial steps of viral replication. In silico docking results revealed the high binding affinity of the compound with the E1 protein and the nsp3 macrodomain of CHIKV. ConclusionThis study demonstrates the in-vitro anti-CHIKV potential of arctigenin and suggests that the compound might affect CHIKV entry and replication. Further preclinical and clinical studies are needed to identify its safety and efficacy as an anti-CHIKV drug.

Therapeutic Potential of Carica papaya Linn.: A Comprehensive Review of Its Pharmacological Properties and Health Benefits, with Emphasis on Dengue Fever Healing

For thousands of years, people have used various plant products, foods, spices, and herbs to treat and prevent illnesses. Sri Lankans have been using traditional and folk medicine to satisfy their basic health needs from the earliest days. Carica papaya Linn. (Caricaceae) is a commercially grown exotic plant in Sri Lanka. The entire plant, including the fruits both ripened and green, leaves, roots, peel, seed, and pulp, was used as medicine in traditional medicinal systems. Plant parts of Carica papaya Linn. were frequently used by ancient Sri Lankans to treat diabetes mellitus, hypertension, cancer, dengue fever, skin infections, renal disorders, and infections caused by bacteria, fungi, parasites, and viruses. Dengue fever is the most prevalent and significant arthropod-borne viral disease in humans, and it is extensively spread throughout Sri Lanka. Carica papaya Linn. extracts have been used to treat dengue patients to recover from its complications, which include thrombocytopenia, hemolysis, and leukopenia. Studies reveal that the papaya leaf extract can neutralize plasma with the dengue virus, reduce platelet aggregation, and increase the production of the enzyme ALOX12, which promotes platelet production. Moreover, the extract also upregulates the platelet-activating factor receptor (PTAFR) gene and inhibits serine proteases NS2B and NS3 involved in dengue virus replication. In this review, we have discussed extensively the ethnomedicinal and pharmacological properties of Carica papaya while highlighting its remarkable potency in healing dengue.

A Case of Dengue Meningitis Manifested as a Part of Expanded Dengue Syndrome

Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retro orbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported called expanded dengue syndrome. We report a 35 years old lady with atypical and rare presentation of dengue disease marked by meningitis. Condition improved after conservative treatment. Neurological complications in dengue are now increasingly observed with the most common case is aseptic meningitis. Dengue meningitis is self-limiting in almost all cases. Hepatic failure rarely dominates the clinical picture in adults. The main mechanism of dengue meningitis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for neurological complications in patients with dengue illness and should manage this accordingly