Classic Dengue Fever Research Articles

Immune Thrombocytopenia Following Dengue Fever

Introduction: Dengue is an endemic mosquito-borne infection in tropical countries. The manifestations vary from asymptomatic infection to classic dengue fever, to more critical forms like dengue hemorrhagic fever and dengue shock syndrome. The critical phase occurs typically within the timeline of 4-7 days from the onset of symptoms. Case Report: We, hereby, report the case of a 7-year-old girl child who initially recovered from classic dengue fever. However, she was readmitted 18 days after the onset of initial symptoms with major bleeding manifestations due to immune thrombocytopenia responding to intravenous immunoglobulin. Discussion: Dengue fever may be associated with mild to moderate thrombocytopenia in the febrile phase and moderate to severe thrombocytopenia in the critical phase. Here, the index case developed thrombocytopenia much after the expected critical phase was over. Conclusion: Awareness of this possibility and continued monitoring, even after apparent recovery from dengue, is important for detecting and managing late-onset thrombocytopenia.

Dengue fever as autochthonous infectious disease in Italy: Epidemiological, clinical and virological characteristics

BackgroundSince August to November 2023, 82 cases of autochthonous or non-travel related Dengue virus (DENV) infection have been reported in Italy, highlighting a concerning trend of local transmission. We describe the clinical and laboratory findings of 10 autochthonous DENV in the metropolitan area of Rome admitted to the Lazzaro Spallanzani National Institute for Infectious Diseases. Method and resultsTen patients (3 males, 7 females; median age: 51) with classic dengue fever symptoms were admitted between August and November 2023. Laboratory tests confirmed dengue infection through DENV non-structural protein 1 and/or immunoglobulins (IgM/IgG) positive tests, moreover leukopenia, thrombocytopenia, elevated transaminases were detected. A subset of patients underwent extensive biological sampling, including real-time RT-PCR and immunofluorescence, to monitor DENV-RNA and antibody levels over 30 days. DENV-1 was detected in 8 patients and DENV-3 in 2. Upon admission specific IgM antibodies were found in 7 patients while IgG antibodies in 4 patients. DENV RNA was consistently detected in blood within the first 8 days but was less common in saliva and urine. No DENV RNA was detected after day 24. ConclusionThese findings contribute to the understanding of the clinical course of DENV infection in a non-endemic setting as integrated epidemiological and clinical model to increase syndromic surveillance and timely diagnosis of DENV infections.

Retrospective Study of Various Factors In Pediatric To Severe Dengue Infection

Introduction: Dengue epidemics are known to have occurred over the last three centuries in tropical, subtropical and temperate areas of the world. Annually a 100 million cases of Dengue fever and half a million cases of dengue hemorrhagic fever (DHF) occur in the world with a case fatality in Asian countries of 0.5%–3.5%. Objective: To assess the various factors in pediatric to severe dengue infection. Methods: A hospital-based Retrospective study was conducted at Department Of Paediatric, Mugda Medical College Hospital, Dhaka, Bangladesh from October to December 2023. Number of patients included in the study was 50. In children with high degree clinical suspicion of Dengue infection NS 1 antigen (who came within first 48 hours of fever) and/or Dengue antibody IgM, IgG (who came after five days of fever) were performed. Positive Dengue cases were taken written informed consent & interviewed on the risk factors of Dengue infection. Data related to patients demography, risk factors, clinical presentation, pattern of Dengue infection and outcome were documented on the pre-structured questionnaire. Results: The study was enrolled 100 patients of suspected dengue fever of whom 50 (50.0%) were serologically confirmed to have dengue infection. 30 (60%) patients were males and 20 (40%) were females. 38 (76%) patients had classic dengue fever while 12 (24%) fulfilled the criteria of dengue hemorrhagic fever. Of those patients with dengue hemorrhagic fever, 6 patients had developed dengue shock syndrome. Among the study 44 (88%) from urban and 6 (12%) rural area patients. All cases and is the most common symptom followed by headache, myalgia, vomiting etc. Hemorrhagic manifestations were seen that included petechiae, ecchymosis, gum bleeding, hematuria, malena, hematemesis and epistaxis. Most common complicationswere hepatic dysfunction, renal failure, multi organ failure, encephalopathy and ARDS. Among 50 suspected dengue cases 38 (76.0%) cases were serologically dengue positive. Among the 38 serologically dengue positive patients 17 (44.7%) were NS1 antigen positive, 13 (34.2%) IgM antibodies and 8(21.0%) both IgM and IgG antibodies positive. The distribution of the serologically dengue positive patients out of 50 clinically suspected cases. Conclusion: Dengue is one amongst the key causes of dedifferentiated fever. It presents as an extremely broad wellness and is hardly recognized as a clinical entity by primary health care physicians. This study highlights the practician the importance of break bone fever to clinicians within the areas of medical specialty, manifestations, complications and outcome of the wellness

CLINICAL MANIFESTATIONS AND LABORATORY PROFILE OF DENGUE FEVER CASES AT THE TIME OF PRESENTATION IN TERTIARY CARE HOSPITAL

Dengue is the most common arboviral disease worldwide in tropical and subtropical regions. Clinical manifestations of dengue fever are mild illnesses like classical dengue fever and severe illnesses like dengue shock syndrome, and dengue hemorrhagic fever. The study was aimed to determine the clinical manifestations and laboratory parameters of patients with Dengue fever Materials And Methods: This prospective study was conducted at a tertiary teaching hospital, Nellore over 6 months. All the patients above the age of 14 years who were diagnosed with Dengue with a positive result for NS1Ag or IgM or IgG antibodies were included. All the necessary clinical and laboratory investigation parameters of the patients were noted and the data was analyzed by frequency and percentage. Results: During the study period, a total of 73 dengue cases were included in the study. Of these, there were 38 (52%) males and 33 (48%) females between 15 and 80 years of age. The most common clinical presentations were fever (100%), headache 56 (76.7%), myalgia 52 (71.2%), and nausea/vomiting 46 (63%). The common hematological findings were thrombocytopenia 58 (79.4%), followed by raised liver transaminases 42 (57.5%), leucopenia 37 (50.6%), leucocytosis 22 (30.1%) and raised hematocrit 21(28.7%) Conclusion: Fever, headache, and anorexia are the most prevalent clinical manifestations of Dengue fever. Low platelet count, raised liver transaminases, and a rise in hematocrit are the most prevalent laboratory abnormalities. Early detection and monitoring of dengue cases can prevent the serious complications of dengue fever.

Elevated NS1 serum levels reduce CD119 expression and CXCL-10 synthesis in patients with dengue hemorrhagic fever.

The intensity of dengue virus (DV) replication and circulating non-structural protein 1 (NS1) levels may promote changes in the human immune response and favor severe forms of infection. We investigated the correlations between NS1 with CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels, and IFN-γ receptor α chain (CD119) expression, and CXCL10 production by peripheral blood mononuclear cells (PBMCs) stimulated with recombinant IFN-γ in DV-infected patients with different clinical forms. Dengue virus NS1, CXCL-8, CXCL-10, IFN-γ, and IL-12p40 serum levels were measured in 152 DV-infected patients with different clinical forms and 20 non-infected individuals (NI) using enzyme-linked immunosorbent assay (ELISA). In addition, we investigated the CXCL-10 production after in vitro IFN-γ stimulation of PBMCs from 48 DV-infected individuals (with different clinical forms of dengue fever) and 20 NI individuals using ELISA, and CD119 expression on CD14+ cells with flow cytometry. Patients with dengue hemorrhagic fever (DHF) had significantly higher NS1, CXCL-8, and CXCL-10 serum levels than those with classic dengue fever (DF). The response of PBMCs to IFN-γ stimulation was lower in patients with DHF than in those with DF or dengue with complications (DWC), with lower CD119 expression and reduced CXCL-10 synthesis. In addition, these alterations are associated with high NS1 serum levels. Patients with DHF reported high NS1 levels, low CD119 expression, and low CXCL-10 synthesis in PBMCs, which may be associated with infection progression and severity.

Опыт лечения тяжелой лихорадки денге препаратом риамиловир

The article presents the experience of using riamilovir in the treatment of a case of severe dengue fever. It describes a case of severe form of dengue fever in a tourist who returned from Thailand and was hospitalized in the State Budgetary Institution Infectious Clinical Hospital No 2 in Moscow and the successful use of off-label nucleoside analogue riamilovir to treat the patient. A patient with dengue fever confirmed by detection of IgM to dengue virus (DV) and DV RNA in serum had widespread petechial rash and profuse uterine bleeding on the 5th day of the disease, and developed thrombocytopenia up to 70·109 cells/liter. A second DV infection was suspected. On the same day, serum examination revealed high titer IgG to DV, and DV genotyping was performed (virus genotype I was detected). The patient's condition was considered as repeated DV infection, development of severe form of infection. Based on the data on the successful use of the nucleoside analog riamilovir for the treatment of classical dengue fever by Russian specialists in the Republic of Guinea, a council of specialists at the medical board decided to use the “off-label” drug to treat the patient. Within a day after the start of therapy, the symptoms of the disease began to regress and on the 10th day of the disease the patient was discharged from the hospital in satisfactory condition. The obtained positive experience of using the nucleoside analog Riamilovir in real clinical practice in the treatment of a patient with severe form of dengue fever opens new opportunities for the treatment of this infection. Full-scale clinical trials of this drug are needed to evaluate the possibility of including a new indication for use. Key words: Dengue fever, severe form, Riamilovir, antiviral therapy, vector-borne viral infections

Clinical Profile and outcome of Dengue Fever in Under 5 Children Admitted at a Tertiary Care Hospital, Dhaka

Background: Dengue has become a major public health problem in Bangladesh with gradually increasing infectivity and severity. Most vulnerable population are children especially children below 5 years of age. However, data regarding dengue among this age group is limited. The objectives of this study were to see the clinical and laboratory profile of dengue fever (DF) in children below 5 years of age and their outcome. Methods: This cross – sectional observational study was carried out in the department of Paediatrics, BIRDEM General Hospital from May 2023 to September 2023. One hundred eighty nine confirmed dengue cases were enrolled in the study. Their clinical profile and laboratory findings including haemoglobin (Hb%), haematocrit (Hct), total count of white blood cells (TC), platelet count (PC), serum alanine aminotransferase (S. ALT), serum aspartate aminotransaminase (S. AST), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), serum calcium and serum sodium level were documented and analyzed. Results: Among 189 children 57(30.1%) were infants and 132(69.8%) patients were aged 1 to 5 years. Depending upon the severity of dengue 98(51.8%) were classical dengue fever, 65(34.3%) and 14(7.4%) presented with dengue shock syndrome (DSS) and dengue heamorrhagic fever (DHF) respectively. Fever was present in all children, other common features were vomiting (34.9%), cough (25.9%), dehydration (26.9%), pleural effusion (34.3%), ascites (23.2%) and skin rash (18.5%). Shock were present in 41.1% cases. Warning signs like restlessness, lethargy, altered level of consciousness, convulsion was present in 16.4%, 9.5%, 2.6% and 11.6% respectively. All the children were improved and discharged. Conclusion: In this study dengue presented classically in most of the children. Dengue shock syndrome and dengue haemorrhagic fever were below 10%. The outcome was excellent with no modality. Early reporting to hospital appeared important. J Bangladesh Coll Phys Surg 2023; 41: 25-28

CLINICAL PROFILE OF DENGUE INFECTION IN PEDIATRIC AGE GROUP AT SOCIAL SECURITY TEACHING HOSPITAL,LAHORE

Dengue viral infection is a significant tropical disease and have become a major global public health concern. The present study sketches the evolving clinical spectrum of dengue especially highlighting the unusual manifestations. Methodology: Data of 120 suspected dengue fever cases was collected, compiled, and analysed during the monsoon and post-monsoon seasons in the year 2022 at the Department of Pediatric Medicine, Social Security Teaching Hospital, and Lahore. Patients with serological confirmation of dengue infection were classified according to Dengue GCP Guidelines 2020. Clinical parameters were studied. Results: Out of 120 suspected patients with dengue fever enrolled in the study, 48 (40%) had serologically confirmed dengue infection. Out of 120 cases, 68 (56.66%) patients were males and 52(43.33%) were females. 66.66 % patients had classical dengue fever while 33.33% had dengue hemorrhagic fever. DHF grade I/II was seen in 25 % cases and grade III DHF in 8.33% The most common symptoms after fever were vomiting (85.4% ), abdominal pain ( 68.75%), headache (37.5%), rash (20.83%) and itch (16.66%). Hemorrhagic manifestations were observed in 43.75% patients. Atypical manifestations were documented in 4 patients (8.33%) patients. Overall outcome in this study was good with no mortality.
 Conclusion: Dengue infection has posed a huge burden to the health-care system. Its spectrum ranges from mild self-limiting disease to severe fatal disease. It can have varied and multi-systemic manifestations which can go unnoticed. Pediatricians should have a high index of suspicion for atypical manifestations so revelation of the exact clinical profile is important for patient effective management.

Clinical presentation of Dengue in a general hospital in Bangladesh

Dengue is one of the commonest viral diseases of Africa and tropical Asia. This disease is characterized by headache, fever, generalized body pain, severe malaise and back pain. The uncomplicated Dengue which is also named the classical dengue fever usually begins 3-8 days after biting of an infected mosquito. This is a cross sectional study on clinical presentation of Dengue in a general hospital in Bangladesh. The total number of patients was 198. The study period was 6 months (July 2004 to December 2004). All the patients who were admitted in the ‘Dengue ward’ and diagnosed as Dengue by serological test were included in this study. The aim of this study was to evaluate the common clinical presentations of Dengue in a General hospital in Bangladesh. The aim and objective was to compare the clinical presentations of Dengue in Bangladesh patients with those of other international studies. Most of the patients were male (3.7 :1) in sex and young adult(s) in age (80.3%). Fever and severe backache were the commonest clinical features. Nearly two-third (74%) patients presented with hemorrhagic features. Gum bleeding (20.2%) was the commonest bleeding feature. The result of this study showed a similarity with that of other international studies.

Various Factors in Pediatric to Severe Dengue Infection-A Retrospective Study

Introduction: Dengue epidemics are known to have occurred over the last three centuries in tropical, subtropical and temperate areas of the world. The World Health Organization (WHO) estimated that approximately 2.5 billion people living in dengue-endemic countries. Objective: To assess the various factors in pediatric to severe dengue infection-A Retrospective study. Methods: A hospital-based Retrospective study was conducted at Emergency, Observation and Referral Unit, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh from January to June 2021. Number of patients included in the study was 52. In children with high degree clinical suspicion of Dengue infection NS 1 antigen (who came within first 48 hours of fever) and/or Dengue Antibody IgM, IgG (who came after five days of fever) were performed. Results: The study was enrolled 102 patients of suspected dengue fever of whom 52 (50.98%) were serologically confirmed to have dengue infection. 29 (55.8%) patients were males and 23 (44.2%) were females. 38 (37.25%) patients had classic dengue fever while 12 (11.76%) fulfilled the criteria of dengue hemorrhagic fever. Of those patients with dengue hemorrhagic fever, 6 patients had developed dengue shock syndrome. Most of dengue cases occurred during the month of June to September depicts the role of rainy season on clustering of cases. Maximum number of cases 52 cases (68.49%) was in the children age groups. All cases and is the most common symptom followed by headache, myalgia, vomiting etc. Hemorrhagic manifestations were seen that included petechiae, ecchymosis, gum bleeding, hematuria, malena, hematemesis and epistaxis. Most common complications were hepatic dysfunction, renal failure, multi organ failure, encephalopathy and ARDS. Conclusion: Dengue is one amongst the key causes of dedifferentiated fever. It presents as an extremely broad wellness and is hardly recognized as a clinical entity by primary health care physicians. This study support additional studies on applying intervention measures to boost the diagnostic accuracy and exactness at the first tending level in dandy fever endemic regions.

Analysis of Disease Parameters in Dengue Hemorrhagic Fever versus Classic Dengue Fever Patients

Dengue fever (DF) is mosquito born disease infecting 390 million individuals globally. It may present with several classical DF, dengue hemorrhagic fever (DHF) or Dengue shock syndrome. Clinical symptoms included headache, fever, bone pain or some time flue like symptoms. It is commonly diagnosed by serological detection of IgM, NS1 antigen in patients’s serum. The disease progression and management is monitored by a simple complete blood picture test. This hematological test is readily available at all health care facilities. This study was designed to investigate the differentiation of hematological parameters in DF and DHF. This was a retrospective cross sectional study, performed on 158 patients. The data was collected from the Allied Laboratory Lahore, Pakistan between March 2020 to February 2022. Demographic and clinical data was analysed by SPSS V.26. Data suggest that the dengue infection was more common in active age group i.e.15-30 years of age. The data showed significance difference between of the hematological parameters in both groups (P value less than 0.05). The group comparison of hematological parameters showed TLC (DF: Mean=4.25, DHF: Mean=3.21), RBC count (DF:DHF, Mean=5.66:6.68), Platelets count (DF:DHF, Mean=129.31: 84.39) and Hb levels (DF:DHF, Mean=13.08: 14.27) and HCT (DF:DHF, Mean=51.08: 59.27). Results showed that in DHF, malfunction in intrinsic coagulation pathway is observed. DF patients might have no bleeding while DHF can have no shock or shock, resulting in DSS. The study concludes that these laboratory findings help in efficient understanding of clinical picture of dengue fever and in early identification of the disease in narrow resources areas. The development and implementation of sustainable preventive and control strategies that will reverse the trend of emerging dengue hemorrhagic fever is a serious problem for public health experts in Pakistan and the world at large.

Detection of homozygous wildtype V1016V using allele-specific polymerase chain reaction in Aedes albopictus

Abstract. Setiawan AR, Fadila SZ, Sucipto TH, Fauziyah S, Madaniyah S, Dewi EC, Naw SW, Tukiran, Cahyaningrum SE. 2023. Detection of homozygous wildtype V1016V using allele-specific polymerase chain reaction in Aedes albopictus. Biodiversitas 24: 62-67. Aedes sp. is a carrier of several viruses that can infect humans and cause diseases such as zika, yellow fever, chikungunya, and dengue fever. Symptoms of dengue infection vary, consisting of classic dengue fever (DD), dengue hemorrhagic fever (DHF), and dengue shock syndrome. Insecticide spray can be used to manage Aedes mosquitoes chemically. Insecticide substances target nervous system proteins. Voltage-gated sodium channels (VGSC) are rendered inactive by pyrethroid binding. Knockdown is a signal indicating an insect has been knocked down in response to a specific insecticide. However, using insecticides for a long time can cause mosquitoes to become resistant. The pesticide resistance of mosquitoes is known as knockdown resistance (kdr). This study aims to detect kdr mutations (V1016G) in two male Aedes albopictusmosquitos named A1 and A2 collected from settlements in Kranggan, Sawahan, Surabaya, East Java, Indonesia, using allele-specific polymerase chain reaction (AS-PCR) assay. RNA was extracted from the two mosquito samples using an RNA extraction kit. After that, the extracted RNA was tested for kdr mutations using the AS-PCR method. After assaying, both samples are homozygous wildtype (V1016V) because the results showed bands appearing from samples A1 and A2 at 60 bp. On the other hand, this study has the potential to serve as preliminary monitoring for the program controlling vectors.

Differential Infectivity of Human Neural Cell Lines by a Dengue Virus Serotype-3 Genotype-III with a Distinct Nonstructural Protein 2A (NS2A) Amino Acid Substitution Isolated from the Cerebrospinal Fluid of a Dengue Encephalitis Patient.

Dengue encephalitis is considered as a severe but unusual clinical presentation of dengue infection. Limited molecular information is available on the neurotropism of dengue virus (DENV), highlighting the need for further research. During a dengue outbreak in Vietnam in 2013, two DENV-3 strains were isolated, in which one was isolated from cerebrospinal fluid (CSF) samples from a dengue encephalitis patient and another strain was isolated from a patient with classical dengue fever in Hai Phong, Vietnam. DENV serotype-3 (DENV-3) isolated from these samples belonged to genotype III, marking the first report of this genotype in the country at that time. Genetic variation between both strains was elucidated by using a full genome sequencing by next-generation sequencing (NGS). The infectivity of the isolated DENV-3 strains was further characterized using human and mouse neuronal cell lines. Phylogenetic analysis of the isolates demonstrated high homogeneity between the CSF-derived and serum-derived DENV-3, in which the full genome sequences of the CSF-derived DENV-3 presented a Thr-1339-Ile mutation in the nonstructural 2A (NS2A) protein. The CSF-derived DENV-3 isolate grew preferentially in human neuronal cells, with a significant proportion of cells that were positive for nonstructural 1 (NS1), nonstructural 4B (NS4B), and nonstructural 5 (NS5) antigens. These results suggest that NS2A may be a crucial region in the neuropathogenesis of DENV-3 and its growth in human neuronal cells. Taken together, our results demonstrate that a CSF-derived DENV-3 has unique infectivity characteristics for human neuronal cells, which might play a crucial role in the neuropathogenesis of DENV infection.

Pattern of Presentation and Outcome in Dengue Fever in Hospitalized Children in A Hospital in Dhaka

Background : A large number of people are becoming infected with dengue fever, which is a mosquito borne viral disease. It is mostly self-limiting, but complications can result with significant morbidity and mortality. In recent years, there has been a significant increase in the number of cases, with the majority of the population being children. There is scarcity of data regarding dengue in children in our country. Hence, to evaluate, the clinical and laboratory profile of Dengue Fever (DF) among the children and their outcome was aim of this research work.
 Materials and methods: This is a retrospective observational study, performed among the serologically confirmed dengue virus infected 200 children, admitted in Department of Paediatrics, Kurmitola General Hospital (KGH) Dhaka from April 2019 to December 2021. Clinical and laboratory indicators were documented daily in the study cases, and the data were analyzed by SPSS version 25.
 Result: Out of the 200 cases, 100 patients (50 percent) had classical DF, 61 patients (30.5 percent) had Dengue Hemorrhagic Fever (DHF) while 39 patients (19.5 percent) had Dengue Shock Syndrome(DSS). Mean age of patients were 5.8±3.6 years, male predominance. Most patients belong to urban area and middle socioeconomic background. Gastrointestinal symptoms were more prevalent in DHF patients. Most of the patients had thrombocytopenia and raised hematocrit. Thrombocytopenia, an elevated Hematocrit (hct) an elevated hypertransaminesemia were all found to be statistically significant in DHF. 85% patients were treated with crystalloid and 14% with colloid, found excellent outcome with no death.
 Conclusion: Dengue fever is a major health problem, with a wide range of symptoms, from mild and self-limiting to severe and fatal. Unrecognized manifestations include a wide range of symptoms spanning multiple organ systems. Doctors should be on the lookout for atypical signs and symptoms.
 IAHS Medical Journal Vol 4(2), December 2021; 41-45

SIADH (Syndrome of Inappropriate ADH Secretion): Perplexing Look of Dengue Fever

Dengue is a mosquito-borne disease (female mosquitoes of the Aedes genus, principally Aedes aegypti) caused by any one of four closely related dengue viruses. It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifests as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever (with or without shock). Isolated organopathy or expanded dengue syndrome (EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystemic and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system. Dengue virus has long been considered as a non-neurotropic virus, as animal studies have shown that virus does not cross blood brain barrier. Hyponatremia may be found in association with dengue fever and is thought to be caused by peripheral fluid extravasation and resulting intravascular hypovolaemia. But hyponatremia due to syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) in Dengue fever is rare. We report a 40 years old male who was diagnosed as Dengue fever (Dengue Ns1Ag positive) with thrombocytopenia and hyponatremia. He was admitted and further investigations revealed SIADH. He responded well to cautious sodium replacement and addition of tolvaptan. He recovered completely and was discharged after one week. Thus, all clinicians should keep in mind the possibility of SIADH as a part of expanded dengue syndrome.

All four dengue virus serotypes co-circulate in concurrent dengue infections in a single dengue session in Chittagong, Bangladesh

Purposes: Dengue fever, a mosquito-borne viral disease, is a global public health burden affecting millions of people each year and over 40% of world populations are at risk of dengue. Therefore, prompt and accurate dengue diagnosis is inevitable for disease surveillance and for aiding disease management. In this study we report dengue virus (DENV) seroprevalence in Chittagong, Bangladesh along with clinical manifestation of dengue infections. Methods: All samples included in this study were selected based on dengue NS1-based diagnosis, clinical sign and symptoms were judged by expert clinical physicians and infecting DENV serotyping was done by RT-PCR. The blood cells (Platelet, Haematocrit, WBC etc) were analyzed using Haematology cell counter. Results: First, among the 112 DENV infected serum samples tested by RT-PCR, 42 were DENV positive where 76% samples had single DENV serotype infection and 24% were concurrently infected with two or more DENV serotypes, indicating that all four DENVs were present in a single dengue session in Chittagong, Bangladesh. Then, DENV4 was the most prevailed serotype, followed by DENV2, DENV1 and DENV3 in single DENV serotype infections. However, in almost 90% cases of concurrent multiple DENV infections DENV1 serotype was present. A detail analysis of clinical data clearly indicated that DENV1 and DENV2 resulted very similar patterns of clinical symptoms which were quite different from those caused by DENV3 and DENV4. For example, ache and pain were absent in DENV3 infection and diarrhea was absent in DENV4 infections. Furthermore, DENV3, both in single and concurrent multiple DENV infections, might increase dengue disease severity as observed highly reduced platelet counts along with increased WBC in patients infected with DENV3 serotype. Conclusion: All four DENV serotypes, both as single and concurrent multiple DENV infections, were present in single dengue session in Bangladesh. Despite having very similar sequences and structures all four DENVs might produce different disease spectra, ranging from classical dengue fever to dengue hemorrhagic fever. Concurrent multiple DENV infections could contribute increased dengue disease severity in dengue outbreaks in Bangladesh. Bioresearch Commu. 8(1): 1042-1048, 2022 (January)

Dengue: Foreshadowing from Ancient Foe

Dengue is a painful, debilitating mosquito-borne disease(female mosquitoes of the Aedes genus, principally Aedes aegypti)caused by any one of four closely related dengue viruses. It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifest as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever (with or without shock). Expanded dengue syndrome(EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystem and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system.

Liver Function Derangement and Bleeding Morbidity in Dengue Fever and Dengue Haemorrhagic Fever in a tertiary Hospital in Bangladesh

Background: Dengue is a major international health concern that is prevalent in tropical and sub tropical countries. Study of dengue infection and its Liver complications are scarce from countries like India. This study was done to assess the frequency and spectrum of liver dysfunction and bleeding morbidity in Dengue infection patients. Methods: A Cross sectional prospective observational study was performed in the of Department of Medicine Sir Salimullah Medical College Mitford Hospital. All the inpatients who were diagnosed with dengue infection between July 2015 to July 2016 were included in this study. A total of 70 patients were included in the study. Results: Patients were classified as classical dengue fever (DF) 61.5.% dengue haemorrhagic fever (DHF) 38.5%. The mean age was 28.607±10.45 years in DF group and 26.78±11.78 years in DHF group and male: female ratio was 3:1. Deranged serum glutamic-oxaloacetic transaminase (SGOT) and/or Serum glutamic pyruvic transaminase (SGPT) was present in most of the patients. Elevation of ALT level occured more in DHF group patient (81%) than DF group (46%). Out of 70 patient 28(40%) patient were within normal value. 42 (60%) patient had elevated ALT level which is statistically significant (p value-<0.05)..The degree of rise of SGOT, SGPT,and Bilirubin was significantly more in DHF and DSS, as compared to DF. About bleeding morbidity, purpura was a mentionable finding 29(41%) but gum bleeding 15(21%), echymosis 14(20%), are less in both DF and DHF group. Major bleeding like hematomesis 5 (7%), melaena 4 (5%) and haematuria 1 (1%) also occured in both group of patients. Conclusion: Liver dysfunction in the form of raised SGPT was seen in almost all patients. Preferentially high SGOT may serve as an early indicator of dengue infection while high values of bilirubin, SGOT, SGPT,may be an indicator of severe disease and poor prognosis. Bangladesh J Medicine July 2022; 33(1) : 44-51

Expanded Dengue Syndrome Presenting as Acute Pancreatitis

Dengue is a painful, debilitating mosquito-borne disease(female mosquitoes of the Aedes genus, principally Aedes aegypti)caused by any one of four closely related dengue viruses.It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifests as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever(with or without shock). Expanded dengue syndrome (EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystemic and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system. Here we present a case of 35 years old female without any comorbidities who was serologically diagnosed with dengue developed severe upper abdominal pain on 2ndafebrile day and eventually diagnosed as acute pancreatitis both by raised serum lipase and ultrasonographic evidence of swollen pancreas. She was treated conservatively and improved. Thus, all clinicians should keep in mind the possibility of acute pancreatitis as a part of expanded dengue syndrome.

Clinical profile and outcome of dengue patients with atypical features in the pediatric age group in a tertiary care center of East India

Background: Dengue is one of the most widespread arthropod borne diseases worldwide with an annual incidence of 50–100 million cases per year. The recent resurgence of dengue in the pediatric population has created concern among pediatricians, especially due to increased incidence of atypical features, leading to delayed diagnosis and increased mortality. There are few studies regarding this due to under reporting of the cases. Aims and Objectives: This study aims to study the clinical profile and outcome of dengue patients between the age groups of 1 month and 12 years with special emphasis on patients with atypical features. Dengue patients with atypical presentation are easily misdiagnosed by physicians, especially in the pediatric age group which increases the morbidity and mortality. Materials and Methods: This was a retrospective observational study conducted from May 2018 to September 2019 in the Department of Pediatrics, CNMCH. All pediatric patients who were dengue IgM or dengue NS1 positive were included in the study and their course of stay was followed through hospital records. The data were statistically analyzed through SPSS 16.0 software. Results: Sixty-two dengue patients were included in the study. Thirty-two patients presented as mild febrile illness, classical dengue fever (DF), dengue hemorrhagic fever, or shock syndrome without atypical manifestations. Atypical manifestations were found in 30 patients (48.38%) of our study. Eleven (17.7%) patients had splenomegaly, 5 (8.1%) patients had hepatitis, 3 (4.8%) patients had diarrhea, 2 (3.2%) patients had acalculous cholecystitis, 1 (1.6%) patient had hepatitis with acalculous cholecystitis, 1 (1.6%) patient had hepatitis with diarrhea, 1 (1.6%) patient had myocarditis, 1 (1.6%) patient had paroxysmal supraventricular tachycardia, 1 (1.6%) patient had acute pancreatitis, 1 (1.6%) patient had acute kidney injury, 1 (1.6%) patient had ARDS, 1 (1.6%) patient had encephalitis, and 1 (1.6%) patient had myositis. Need of intensive care facility was more in patients with atypical manifestations due to mis or late diagnosis which prolonged course of stay. Conclusion: Atypical manifestations of DF are more common than reported. Lack of awareness among physicians, especially in primary health center, leads to delayed diagnosis and increased mortality and morbidity.