Dengue Infected Patients Research Articles

Association of viral kinetics, infection history, NS1 protein with plasma leakage among Indonesian dengue infected patients.

Plasma leakage, a hallmark of disease in Dengue virus (DENV) infection, is an important clinical manifestation and is often associated with numerous factors such as viral factors. The aim of this study is to investigate the association of virus serotype, viral load kinetics, history of infection, and NS1 protein with plasma leakage. Subjects with fever ≤ 48 hours and positive DENV infection were included. Serial laboratory tests, viral load measurements, and ultrasonography examination to assess plasma leakage were performed. DENV-3 was the most common serotype found in the plasma leakage group (35%). Patients with plasma leakage demonstrated a trend of higher viral load and a longer duration of viremia compared to those without. This was significantly observed on the fourth day of fever (p = 0.037). We found higher viral loads on specific days in patients with plasma leakage in both primary and secondary infections compared to those without. In addition, we also observed more rapid viral clearance in patients with secondary infection. NS1 protein, especially after 4 days of fever, was associated with higher peak viral load level, even though it was not statistically significant (p = 0.470). However, pairwise comparison demonstrated that peak viral load level in the group of patients with circulating NS1 detected for 7 days was significantly higher than the 5-day group (p = 0.037). DENV-3 was the most common serotype to cause plasma leakage. Patients with plasma leakage showed a trend of higher viral load and a longer duration of viremia. Higher level of viral load was observed significantly on day 5 in patients with primary infection and more rapid viral clearance was observed in patients with secondary infection. Longer duration of circulating NS1 protein was also seen to be positively correlated with higher peak viral load level although not statistically significant.

Significance of Platelets and its Indices in Patients with Dengue Fever

Background: Dengue is a viral infection affecting different parts of the world, particularly the under developed countries including Pakistan. Changes in hematological parameters are frequently observed in dengue viral infection out of which the changes in the structure of platelets and their levels are a predominant factor in dengue viral infection. In view of the foresaid, this study was conducted to find the platelet levels and indices in confirmed cases suffering from dengue fever. Methods: This descriptive cross-sectional study was conducted in Peshawar in a duration of five months from September to December 2022. A total of five hundred patients were screened for dengue viral infection. Blood samples were collected from all suspected dengue infected patients and processed for complete blood count (CBC). Percentage and mean standard deviation were calculated and data were expressed in tables and graphs. Results: Among total suspected patients, one hundred fifty patients were found positive in which highest number of patients were male (65.3%) than female patients (34.7%). The minimum hemoglobin, white blood cells, and platelets were 6.9 g/dl, 2400 g/dl, and 43000 g/dl respectively. Low level of hemoglobin was found in 9.4% patients, 25.3% patients had below normal white blood cell count, and 30.4% patients were observed with less than normal platelet count. Few patients were noted with lower mean platelets volume and plateletcrit than normal. Conclusion: The study showed a significant impact of dengue viral infection on complete blood count. The hemoglobin, WBC, platelets, and platelet indices were potentially affected with dengue viral infection. It is necessary to design a strategy for early diagnosis of dengue infected patients for timely treatment, which can together save patients from severe impact of dengue viral infection such as dengue shock syndrome which could be fatal. Keywords: Dengue viral infection, Hematological parameters, Platelets, Mean Platelets Volume, Plateletcrit, Platelet distributive width.

Efficient generation and characterization of chimeric dengue viral-like particles

Viral-like particles (VLPs) because of their non-infectious and high immunogenic properties have important applications in diagnostics, drug delivery, and vaccine production. They also serve as an attractive model system to study virus assembly and fusion processes. Unlike other flaviviruses, Dengue virus (DENV) is not very efficient in the production of VLPs on the expression of DENV structural proteins. On the other hand, the stem region and transmembrane region (TM) of G protein of Vesicular Stomatitis virus (VSV) alone are sufficient for budding.Here we generated chimeric VLPs replacing regions of stem and transmembrane domain (STEM) or only transmembrane domain (TM) of E protein of DENV-2 with corresponding regions of VSV G protein. Both chimeric proteins secreted VLPs at higher levels than the wild type (2–4 folds) without any significant change in the expression in the cell. Chimeric VLPs could be recognized by a conformational monoclonal antibody, 4G2. They were also found to interact with dengue-infected patient sera effectively thus implying that their antigenic determinants are preserved. In addition, they were able to bind to its putative receptor, heparin with similar affinity as the parent counterpart thus retaining its functional property. However, cell-cell fusion revealed that there is no significant increase in the fusion ability of chimeras as compared to the parent clone, whereas VSV G protein displayed high cell-cell fusion activity. Overall, this study suggests that chimeric dengue VLPs can be taken forward for their likely potential as vaccine production and serodiagnosis.

S-Adenosyl-l-Homocysteine Exhibits Potential Antiviral Activity Against Dengue Virus Serotype-3 (DENV-3) in Bangladesh: A Viroinformatics-Based Approach.

Dengue outbreak is one of the concerning issues in Bangladesh due to the annual outbreak with the alarming number of death and infection. However, there is no effective antiviral drug available to treat dengue-infected patients. This study evaluated and screened antiviral drug candidates against dengue virus serotype 3 (DENV-3) through viroinformatics-based analyses. Since 2017, DENV-3 has been the predominant serotype in Bangladesh. We selected 3 non-structural proteins of DENV-3, named NS3, NS4A, and NS5, as antiviral targets. Protein modeling and validation were performed with VERIFY-3D, Ramachandran plotting, MolProbity, and PROCHECK. We found 4 drug-like compounds from DRUGBANK that can interact with these non-structural proteins of DENV-3. Then, the ADMET profile of these compounds was determined by admetSAR2, and molecular docking was performed with AutoDock, SWISSDOCK, PatchDock, and FireDock. Furthermore, they were subjected to molecular dynamics (MD) simulation study using the DESMOND module of MAESTRO academic version 2021-4 (force field OPLS_2005) to determine their solution's stability in a predefined body environment. Two drug-like compounds named Guanosine-5'-Triphosphate (DB04137) and S-adenosyl-l-homocysteine (DB01752) were found to have an effective binding with these 3 proteins (binding energy > 33.47 KJ/mole). We found NS5 protein was stable and equilibrated in a 100 ns simulation run along with a negligible (<3Å) root-mean-square fluctuation value. The root-mean-square deviation value of the S-adenosyl-l-homocysteine-NS5 complex was less than 3Å, indicating stable binding between them. The global binding energy of S-adenosyl-l-homocysteine with NS5 was -40.52 KJ/mole as ∆G. Moreover, these 2 compounds mentioned above are non-carcinogenic according to their ADMET (chemical absorption, distribution, metabolism, excretion, and toxicity) profile (in silico). These outcomes suggest the suitability of S-adenosyl-l-homocysteine as a potential drug candidate for dengue drug discovery research.

Dengue Infected Patients in Local Population of Lahore

Over the past 20 years, dengue fever's demographic characteristics have significantly altered in Pakistan. Different facets of particular epidemics have been covered in small-scale research from around the nation during this time. However, there is a dearth of information on the country's general trend of dengue virus infection. Objectives: To examine liver function test of dengue infected patients, age and gender wise distribution of dengue virus infected patients. Methods: During August-November 2011, patients with clinical presentation of DF, who came to Emergency department of Mayo Hospital Lahore, were included in this study. Total 64 patients were included in this study and LFTs were performed photometrically to see the effect of dengue virus infection on liver of affected patients during early days of infection from 2-7 days. Results: Out of 64 patients, 47 were males and 17 were females. Dengue fever was more common among the age group of 16-25 years and less common among children and older age group. All the patients had low platelet level with 29 patients had complaint of bleeding. Serum raised level of ALT and ALP was observed in some patients. Conclusions: Presently widespread throughout the year with a high frequency in the post-monsoon season, dengue fever is currently endemic in Pakistan. The median patient age for dengue has dropped, and younger patients, particularly men, may be more vulnerable. Total and differential leukocyte counts can assist identify individuals who are at risk for bleeding, and LFTs can show whether dengue virus infection has an impact on the liver.

Differences in CD95L Levels and Blood Test Results in Primary and Secondary Dengue Infection Patients

Dengue is a disease caused by dengue virus (DENV) that is transmitted mainly by the female Aedes aegypti mosquito. There are four serotypes of DEN, leading to a possibility that a person may be infected four times by this virus, albeit with different serotypes. Recovery from infection with one viral serotype provides lifelong immunity to the same serotype but not to the other serotypes. Secondary infection by other serotypes increases the risk of developing severe dengue. The pathogenesis of severe dengue involves apoptosis of microvascular endothelial cells that leads to plasma leakage. In addition, there is usually a decrease in platelets and leukocytes and an increase in hematocrit. This study aimed to compare the results of the CD95L examination involved in the apoptotic process and the results of blood tests in primary and secondary dengue patients. This was a cross-sectional study performed in a four months period (September–December 2019) involving several clinics and doctor's private practices in Medan, Indonesia. Subjects were eighty-four dengue patients, consisting of 18 (21%) patients with primary infection and 66 (79%) with secondary infection. Data collected were tested with the Mann Whitney test with p-value of &lt;0.05 considered significant. A significant difference (p value=0.007) was observed in the lymphocyte counts between primary and secondary dengue patients, but no differences were seen in CDL95 level, platelet count, leukocyte count, and hematocrit. In conclusion, except for the lymphocyte count, there is no difference in CD95L level and blood test results between primary and secondary dengue patients.

Cepharanthine inhibits dengue virus production and cytokine secretion

Dengue virus (DENV) infection is a public health problem in tropical and subtropical regions. It can cause a spectrum of clinical manifestations ranging from mild dengue fever (DF) to severe dengue haemorrhagic fever (DHF) and potentially life-threatening disease including dengue shock syndrome (DSS). Severe DENV infection is caused by high viral load and cytokine storm in dengue-infected patients. Currently, there is no specific antiviral drug for DENV infection. An anti-DENV agent that demonstrates inhibitory effects on both DENV replication and cytokine secretion is urgently needed. In this study, cepharanthine (CEP), which is an anti-inflammatory, anti-HIV, and anti-tumor compound isolated from Stephania cepharantha Hayata, was tested for inhibition of DENV infection. We investigated the efficacy of CEP to inhibit DENV infection, replication, and cytokine production. The inhibitory effect of CEP treatment was studied in DENV-infected human chronic myeloid leukemia (K562) cells. The levels of DENV E protein and DENV production were determined by flow cytometry and FFU assay, respectively. CEP treatment significantly reduced viral E protein and viral production in all DENV-1, 2, 3, 4 serotypes. In addition, CEP treatment reduced the IL-6 proinflammatory cytokine production in DENV-infected A549 cells. Taken together, CEP has inhibitory effects on DENV infection specifically at the initial viral replication states and proinflammatory cytokine secretion, and is a promising candidate for further development as an anti-DENV treatment.

1181. Predictive Score for Dengue Infection with Complete Blood Count Parameters, Including the New Monocyte Distribution Width – a Retrospective Single Center Derivation and Validation Study

Abstract Background Dengue infection is a differential diagnosis in patients with acute undifferentiated fever. Early detection and management may reduce mortality. Monocyte distribution width (MDW) is a new parameter in complete blood count (CBC). It is recently approved for early detection of sepsis. We have noticed high MDW in Dengue patients. This study aimed to describe MDW changes in Dengue infection and to develop predictive score for early detection of Dengue infected patients. Methods We retrospectively retrieved data of adult patients with acute fever who had CBC and Dengue serology (NS1 antigen, IgM and IgG) performed during September 2019 to May 2020 at Thammasat University Hospital. Medical records were reviewed. MDW was compared between groups. Patients were randomly divided into training and validation set. Predictive score was developed from the training set and validated in the validation set with multivariable analysis. Results A total of 431 patients, with Dengue infection in 127 patients (29.5%), were included in the analyses. The median (interquartile range) of MDW in Dengue patients were higher than non-Dengue patients [29.7% (26.5 – 34.7) vs. 24.2% (21.1 – 27.8), P &amp;lt; 0.001]. In patients with confirmed Dengue infection, MDW increased with increasing severity (Figure). Training and validation sets included 216 and 215 patients with 64 and 63 Dengue infection, respectively. Independent predictive factors of Dengue infection were white blood cell &amp;lt; 4 x 109 /L (score 1), platelet &amp;lt; 100 x 109 /L (score 1) and MDW &amp;gt; 24% (score 1). No clinical features were independently predictive of Dengue infection. The area under receiver-operating-characteristic curve (95% confidence interval) of the prognostic score in the training and validation set were 0.839 (0.779 – 0.899) and 0.742 (0.674 – 0.811), respectively. With the cut-off score ≥ 1, the sensitivity and specificity of the score were 92.2% and 40.8% in the training set and 88.9% and 44.1% in the validation set. Monocyte distribution width in Dengue and non-Dengue patients Box-plot showing monocyte distribution width in patients with Dengue in comparison with non-Dengue (panel A) and compared between each Dengue severity (panel B) Conclusion MDW increase in patients with Dengue infection and also increase with Dengue severity. We have developed and internally validated a simple predictive score for Dengue infection based on only results from CBC and MDW. Further large-scale external validation study is required to confirm the utility of our predictive score. Disclosures All Authors: No reported disclosures.

Dengue induces iNOS expression and nitric oxide synthesis in platelets through IL-1R.

Dengue is an arthropod-born disease caused by dengue virus (DENV), that may manifest as a mild illness or severe form, characterized by hemorrhagic fever and shock. Nitric oxide (NO) is a vasodilator signaling molecule and an inhibitor of platelet aggregation known to be increased in platelets from dengue patients. However, the mechanisms underlying NO synthesis by platelets during dengue are not yet elucidated. IL-1β is a pro-inflammatory cytokine able to induce iNOS expression in leukocytes and present in dengue patients at high levels. Nevertheless, the role of IL-1β in platelet activation, especially regarding iNOS expression, are not clear. We prospectively followed a cohort of 28 dengue-infected patients to study NO synthesis in platelets and its relationship with disease outcomes. We used in vitro infection and stimulation models to gain insights on the mechanisms. We confirmed that platelets from dengue patients express iNOS and produce higher levels of NO during the acute phase compared to healthy volunteers, returning to normal levels after recovery. Platelet NO production during acute dengue infection was associated with the presence of warning signs, hypoalbuminemia and hemorrhagic manifestations, suggesting a role in dengue pathophysiology. By investigating the mechanisms, we evidenced increased iNOS expression in platelets stimulated with dengue patients´ plasma, indicating induction by circulating inflammatory mediators. We then investigated possible factors able to induce platelet iNOS expression and observed higher levels of IL-1β in plasma from patients with dengue, which were correlated with NO production by platelets. Since platelets can synthesize and respond to IL-1β, we investigated whether IL-1β induces iNOS expression and NO synthesis in platelets. We observed that recombinant human IL-1β enhanced iNOS expression and dose-dependently increased NO synthesis by platelets. Finally, platelet infection with DENV in vitro induced iNOS expression and NO production, besides the secretion of both IL-1α and IL-1β. Importantly, treatment with IL-1 receptor antagonist or a combination of anti-IL-1α and anti-IL-1β antibodies prevented DENV-induced iNOS expression and NO synthesis. Our data show that DENV induces iNOS expression and NO production in platelets through mechanisms depending on IL-1 receptor signaling.

Case Report on Dengue Induced Myocarditis

Background: Due to the wide range of clinical symptoms, myocarditis is a difficult diagnosis. Myocarditis can range from mild to severe, resulting in congestive heart failure, arrhythmias, cardiogenic shock, and death. It predicts morbidity and mortality in dengue-infected patients. Case presentation: we presented a 12year old child who came to the pediatric department brought by mother with a chief complaint of high grade Fever insidious onset since 5 days, Episodes of vomiting non projectiles, non-foul smelling contain food particles since 5 days and pain in abdomen more in right hypochondrial region, non-radiating. He has a no previous history of hospitalization.During a physical examination Head to toe examination reveals few abnormalities; the kid is slim and skinny, with a dreary appearance. He is frail and uncooperative.. Though it found that he develop acute myocarditisand the patient treated with antibiotic, antacid , antipyretic, antidiuretic as well as antiemetic.Conclusion: Dengue-induced myocarditis is a serious condition. Through direct virus activity on cardiomyocytes, dengue virus can induce unusual symptoms such as acute myocarditis, cardiogenic shock, and death. Physicians caring for dengue patients should be aware of this potential result. Elevated cTn-I predicts length of stay and in-hospital death in dengue-infected patients. Diabetes, hypertension, low blood bicarbonate, high serum creatinine, and any echocardiographic abnormalities were all linked to poor outcomes in dengue-infected people.

Predictors of complicated dengue infections in endemic region of Pakistan

Objective: To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue. Methods: The study was conducted in a tertiary care hospitaldengue ward from September to November 2021 including confirmed dengue infected patients (positive NS1 antigen or anti-dengue-antibodies IgM). Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients. Detailed history, physical examination, laboratory and radiological parameters, hospital stay (days) and mortality percentages were noted. Patients were classified into three groups according to disease severity: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The predictors of complicated dengue infection were determined by regression analysis. Results: The most common symptom was fever (96.9%). Among 129 patients, 62.8% had DF, 31.0% had DHF and only 6.2% developed DSS. History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100% DSS patients and nearly 75.0% DHF patients (P&lt;0.05). The moratlity rate in patients with DSS, DHF and DF was 50.0%, 2.5% and none respectively (P&lt;0.05). Clinical parameters (body aches, bleeding, conjunctival hemorrhage, maculopapular rash, right hypochondrial tenderness, ascites, pleural effusion) and laboratory parameters (thrombocytopenia, raised alanine aminotransferase and secondary dengue infection) were determinants that complicate the dengue infection. Conclusions: Thrombocytopenia, raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.

PREDICTORS OF SEVERITY OF DENGUE IN PATIENTS ADMITTED TO ICU: A CROSS SECTIONAL STUDY

Background &amp; Objectives: Dengue mostly causes a mild self-limiting disease but a small proportion may progress to develop severe dengue clinical manifestations, which require interventions in intensive care. The objective of the study was to describe the clinical profile, course, and outcome of dengue-infected patients admitted to intensive care units (ICU) and to evaluate factors associated with morbidity and mortality. Methods: This is an observational, descriptive study. Patients above the age of 18 admitted directly or transferred to ICU from another ward with serological evidence of dengue (positive NS1 antigen and/or IgM antibodies to dengue) were included in the study. The severity of the illness was assessed using APACHE and SOFA Scores. The primary outcome was mortality, while the secondary outcome was the length of stay in the ICU. Results: A total of 80 patients were studied and the mean age of the study subjects was 36.53 (± 15.28) years. The median duration of ICU stay was 2 days with an IQR of (1-3) days. The mean APACHE was 21.53 (±10.91) while the mean SOFA score was 12.05 (± 4.70). The area under the curve for the WHO classification of severe dengue was 79%, with a positive predictive value of 58.70. The area under the curve for lactate was 89% with a positive predictive value of 90.48. Interpretation &amp; Conclusion: Lactate alone is a good predictor of mortality in severe dengue. APACHE and SOFA scores are good predictors of mortality.

Seroepidemiology of Dengue Viral Infection in Peshawar

Background: Dengue viral infection is the most prevalent infection particularly in the months of September to December in different region of Khyber Pakhtunkhwa. The aim of this study was to determine the prevalence of dengue viral infection in district Peshawar. Methods: A cross-sectional study was conducted and recruited two hundred suspected dengue viral infected patients. Blood were collected for diagnosis of dengue viral infection through immunochromatograpy technique. All the collected data analyzed through Microsoft Excel 2020. Results: A total of 200 suspected dengue viral infected patients participated. Among total, 59.5% were male and 40.5% were female patients. Out of total, 61 were found positive through NS-1 strips. IgG antibodies were more found in male than female. Whereas, IgM antibodies were more prevalent found in female patients. Conclusion: Overall, the prevalence of dengue viral infection is more in our region. The prevalence of dengue viral infection is greater in male patients as compared to female patients. It is important to arrange different prevention programs including seminars, workshops and conference throughout the district. Implementation of control and surveillance programs are highly essential to determine regarding the dengue level. Health policy makers need to pay attention towards the dengue disease and to provide different training session to health care providers and physician. Keywords: Dengue viral infection, Sero-prevalence, Epidemiology

Association of Dengue Disease with ABO RH Blood Group

Background: Dengue viral infection is a global public health issue. Several viral and other host factors are the contributed factors including the ABO blood group for transmission of dengue virus (DENV). ABO blood groups have been shown to involve in the intensity of DENV. This study aims to find the association ABO and Rh blood group with DENV infection. Methods: This cross-sectional study was conducted in tertiary care hospital. All DENV NS-1 positive patients were included irrespective of age and gender. The blood group of all DENV-infected patients was determined through ABO and Rh anti-sera (forward blooding grouping). Descriptive data were analyzed through SPSS and Microsoft Excel. Results: Among a total of 105 dengue-infected patients, male were 68 patients and female were 37 patients. The highest number of cases were found in the age group 21-30 years and 11-20 years. The predominant blood group was found A positive in dengue viral infected patients while AB negative blood group was found common in Rh negative blood groups. Conclusion: Blood group A positive and AB negative patients in Rh positive and Rh negative blood groups had more risk of dengue viral infection as compared to other blood groups. Further studies are necessary to find the severity of patients with different blood groups. Based on their differential distribution in the community and their correlation with mosquito performance, it can be deduced that the risk of contracting dengue infection differs with the ABO and Rh blood groups. Additional study is necessary to determine whether HLA, dengue serotype, and ABO are experimental/predictor factors, and whether certain blood subgroups are associated with a disproportionately higher risk of dengue virus infection. Keywords: Dengue viral infection, Serotype, Anti-A, Anti-B, Anti-D, ABO, Rh blood group

Predicting Infection Positivity, Risk Estimation, and Disease Prognosis in Dengue Infected Patients by ML Expert System

Dengue fever has earned the title of a rapidly growing global epidemic since the disease-causing mosquito has adapted to colder countries, breaking the notion of dengue being a tropical/subtropical disease only. This infectious time bomb demands timely and proper treatment as it affects vital body functions, often resulting in multiple organ failures once thrombocytopenia and internal bleeding manifest in the patients, adding to morbidity and mortality. In this paper, a tool is used for data collection and analysis for predicting dengue infection presence and estimating risk levels to identify which group of dengue infections the patient suffers from, using a machine-learning-based tertiary classification technique. Based on symptomatic and clinical investigations, the system performs real-time diagnosis. It uses warning indicators to alert the patient of possible internal hemorrhage, warning them to seek medical assistance in case of this disease-related emergency. The proposed model predicts infection levels in a patient based on the classification provided by the World Health Organization, i.e., dengue fever, dengue hemorrhagic fever, and dengue shock syndrome, acquiring considerably high accuracy of over 90% along with high sensitivity and specificity values. The experimental evaluation of the proposed model acknowledges performance efficiency and utilization through statistical approaches.

Discovery and validation of circulating miRNAs for the clinical prognosis of severe dengue

BackgroundEarly prognostic markers of severe dengue may improve case management and reduce dengue-related mortalities. This study aimed to identify circulating microRNAs (miRNAs) as biomarkers for predicting severe dengue.MethodologySerum samples from dengue-infected patients were collected on the first day of admission. Patients were followed up for 14 days after admission to determine the final diagnosis. Participants were divided into non-severe and severe dengue, as defined by WHO 2009 criteria. Circulating microtranscriptome analysis was performed using NanoString miRNA Expression Assay. The expression level of candidate miRNAs were then validated by quantitative reverse transcription-PCR method.Principal findingsThe discovery cohort (N = 19) lead to the identification of 37 differentially expressed miRNAs between the two groups. Six up-regulated candidate miRNAs were selected and further validated in the larger cohort (N = 135). MiR574-5p and miR1246 displayed the highest diagnostic performance in discriminating between severe from non-severe dengue (ROC-AUC = 0.83). Additionally, miR574-5p and miR1246 had high sensitivity and high negative predictive value for detecting severe dengue. Multivariate analysis suggested that serum miR574-5p was an independent predictor of severe dengue (odds ratio 3.30, 95% CI 1.81–6.04; p<0.001).ConclusionOur study indicated that circulating miRNAs, especially miR-574-5p and miR-1246, might be a promising diagnostic and prognostic biomarker for severe dengue upon hospital admission, especially when using these biomarkers on days 1 to 2 before the onset of severe dengue complications.

Effect of prior Zika and dengue virus exposure on the severity of a subsequent dengue infection in adults

Given the structural similarity between Zika and dengue viruses, prior infection from one virus is hypothesized to modulate the severity of a subsequent infection from the other virus. A previous paediatric cohort study observed that a prior Zika infection may increase the risk of a subsequent symptomatic or severe dengue infection. The Colombo Dengue study is a prospective hospital-based cohort study in Sri Lanka that recruits symptomatic adult dengue patients within the first three days of fever. Anti-Dengue Envelope and anti-Zika NS1 IgG antibodies were tested by ELISA (Euroimmun, Lubeck, Germany) in all recruited patients. Associations between pre-morbid seroprevalence for either or both infections and adverse clinical outcomes of the current dengue infection were explored. A total of 507 dengue infected patients were assessed of whom 342 (68%) and 132 (26%) patients had anti-dengue IgG and anti-Zika IgG respectively. People with combined prior dengue and zika exposure as well as prior dengue exposure alone, were at increased risk of plasma leakage, compensated and uncompensated shock, and severe dengue (p < 0·05), compared to people without prior exposure to either infection. The effect of prior Zika exposure alone could not be established due to the small the number of primary dengue infections with prior Zika exposure.

Hematologic parameters in thrombocytopenic patients with dengue fever

Background: Dengue fever is an endemic disease in Nepal that has shown increasing incidence each passing year. Dengue has a wide range of clinical presentations and laboratory findings. Thrombocytopenia is a common finding in dengue-infected patients along with other findings like leukopenia, lymphocytosis, raised hematocrit, and elevated liver enzymes. Thrombocytopenia is an indicator of disease severity and can lead to severe bleeding manifestations. This study aims to find the association of thrombocytopenia with other hematologic parameters. Materials and methods: This retrospective study enrolled 651 dengue patients tested at Patan Academy of Health Sciences who also underwent complete blood count at presentation. Results: Dengue-infected patients of all age groups with a slight male predominance. Thrombocytopenia was noted in 48.69% of cases. Thrombocytopenia showed a significant association with age (p=0.009), total leukocyte count(p=0.00), and hemoglobin levels (p= 0.015). Conclusions: Thrombocytopenia in dengue patients is frequently encountered. Increasing age, leukopenia, and anemia are factors significantly associated with thrombocytopenia at presentation.

Prognostic Indicators for the Early Prediction of Severe Dengue Infection: A Retrospective Study in a University Hospital in Thailand.

This study aimed to develop simple diagnostic guidelines which would be useful for the early detection of severe dengue infections. Retrospective data of patients with dengue infection were reviewed. Patients with diagnosed dengue infection were categorized in line with the International Statistical Classification of Diseases (ICD-10): A90, dengue fever; A91, dengue hemorrhagic fever; and A910, dengue hemorrhagic fever with shock. A total of 302 dengue-infected patients were enrolled, of which 136 (45%) were male and 166 (55%) were female. Multivariate analysis was conducted to determine independent diagnostic predictors of severe dengue infection and to convert simple diagnostic guidelines into a scoring system for disease severity. Coefficients for significant predictors of disease severity generated by ordinal multivariable logistic regression analysis were transformed into item scores. The derived total scores ranged from 0 to 38.6. The cut-off score for predicting dengue severity was higher than 14, with an area under the receiver operating curve (AUROC) of 0.902. The predicted positive value (PPV) was 68.7% and the negative predictive value (NPV) was 94.1%. Our study demonstrates that several diagnostic parameters can be effectively combined into a simple score sheet with predictive value for the severity evaluation of dengue infection.

Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted to a Tertiary Care Hospital of Low-Middle Income Country.

Background:Myocarditis is a challenging diagnosis due to the heterogeneity of clinical presentations. Myocarditis can present with a mildly raised cardiac enzyme to severe myocarditis leading to congestive heart failure, arrhythmias, cardiogenic shock, and death. It is a predictor of morbidity and mortality in dengue-infected patients. The exact prevalence of dengue myocarditis and its outcomes are unknown in Pakistan.Objectives:We aim to study the prevalence and association of myocarditis with the length of stay in the hospital and mortality of dengue-infected patients.Methods:A retrospective observational study done at a tertiary care hospital. We reviewed hospital record files of 1008 consecutive patients with dengue viral infection admitted from November 2018 to November 2019.Results:Out of 1008 dengue-infected patients, 55.4% of patients were older than 35 years and 68.4% were males. Hypertension (HTN) was the most common comorbid condition. The prevalence of myocarditis in hospitalized dengue-infected patients was 4.2%. All (100%) of dengue myocarditis patients had raised cardiac troponin I (cTn-I), 59.5% of patients had at least one electrocardiography (ECG) change, and 24% had reduced ejection fraction (EF) (defined as EF < 55%). On multivariable analysis, patients with raised cTn-I levels (adjusted odds ratios = 5.29; [95% confidence interval (CI): 2.16–12.96]) and abnormal echocardiography (ECHO) [aOR = 4.38; 95% CI: 1.26–15.27)] had a prolonged hospital stay (>3 days). Raised cTn-I levels (aOR = 8.2; [95% CI: 1.83–36.84]) was significantly associated with in-hospital mortality.Conclusions:Raised cTn-I is the predictor of length of stay and in-hospital mortality in dengue-infected patients. Atrial fibrillation, diabetes mellitus, hypertension, low serum bicarbonate, high serum creatinine, and any abnormality on echocardiography were associated with adverse outcomes in dengue-infected patients.