Dengue Research Articles

Radiological Evaluation of Various Complications of Dengue Hemorrhagic Fever

Abstract: Objective: This retrospective study aimed to investigate the spectrum of imaging findings in patients with Dengue Hemorrhagic Fever (DHF) and explore the associated clinical parameters. Methods: A total of 237 patients diagnosed with DHF confirmed via ELISA were included in the study. Imaging modalities including abdominal and chest ultrasound in every patient, HRCT (n=19), and CT brain scans (n=3)in patients having symptoms related to chest or brain were performed as part of the diagnostic workup. Demographic data, platelet counts, DHF grading, and imaging findings were recorded. Descriptive analysis was conducted using SPSS v26. Results: The mean age of the patients was 34.50 ± 16.4, with a male preponderance (58.2%). Grade I DHF was observed in 69.2% of patients, followed by Grade II (23.6%) and Grade III (7.1%). Abdominal ultrasound revealed hepatomegaly (19.4%) and splenomegaly (19.6%). Thick-walled gall bladder (34.7%), pericholecystic fluid (7.1%), and gall bladder sludge (5.06%) were also noted. Ascites was present in 19% of cases. Chest ultrasound detected pleural effusion in 11.8% of patients, predominantly mild. HRCT scans showed pleural effusion (89.5%), ground glass opacities and consolidations (36.8%), alveolar shadowing (26.3%), and signs of non-cardiogenic edema (10.5%). CT brain scans revealed intracerebral bleed in 2 out of 3 patients with neurological manifestations. Conclusion: This study provides insights into the spectrum of imaging findings in DHF. Abdominal ultrasound demonstrated hepatomegaly, splenomegaly, and gall bladder abnormalities, while chest ultrasound and HRCT revealed pleural effusion and pulmonary manifestations. CT brain scans identified intracerebral bleeding in some cases. These findings highlight the importance of imaging modalities in evaluating DHF complications and guiding appropriate management. Prospective studies with larger sample sizes are warranted to validate these findings and further enhance our understanding of imaging features in DHF.

A Cross-Sectional Study on Bedside Abdominal Ultrasound Findings as a Diagnostic and Prognostic Tool in Dengue Fever in Manipal Hospital, Bengaluru, India.

Background Dengue fever poses a significant health burden globally, particularly in tropical and subtropical regions. Early diagnosis and effective management are crucial in reducing morbidity and mortality associated with the disease. Bedside abdominal ultrasound has emerged as a promising tool for assessing dengue patients, providing real-time imaging of abdominal organs, and aiding clinical decision-making. Materials and methods This cross-sectional study was conducted in55 adult emergency departments of Manipal Hospital, Bengaluru, from March 2017 to March 2018. Adult patients presenting with signs and symptoms suggestive of dengue fever were included. Clinical data, laboratory investigations, and bedside abdominal ultrasound findings were systematically recorded and analyzed using appropriate statistical methods. Results Descriptive statistics revealed characteristic clinical measurements and symptom ratings observed in dengue fever patients. Frequency distributions highlighted common symptoms encountered, while statistical analyses demonstrated significant associations between ultrasonic parameters, disease severity, and outcomes. The study found notable correlations between ultrasonic findings and dengue severity levels, emphasizing the potential of bedside ultrasound as a diagnostic and prognostic tool. Conclusion Bedside abdominal ultrasound shows promise as a valuable adjunctive tool in assessing dengue fever patients. The significant associations between ultrasonic parameters and disease severity suggest its utility in risk stratification and guiding clinical management decisions. Incorporating bedside ultrasound into routine practice may improve patient care and outcomes in dengue fever management. Further research is warranted to validate these findings and explore additional bedside ultrasound applications in dengue fever diagnosis and prognosis.

Repurposing of FDA-approved drugs against oligomerization domain of dengue virus NS1 protein: a computational approach.

Dengue fever is a serious health hazard on a global scale and its primary causative agent is the dengue virus (DENV). The non-structural protein 1 (NS1) of DENV plays a pivotal role in pathogenesis. It is associated with several autoimmune events, endothelial cell apoptosis, and vascular leakage, which increase mainly during the critical phase of infection. In this study, important residues of the oligomerization domain of NS1 protein were identified by literature searches. Virtual screening has been conducted using the entire dataset of the DrugBank database and the potential small-molecule inhibitors against the NS1 protein have been chosen on the basis of binding energy values. This is succeeded by molecular dynamics (MD) simulations of the shortlisted compounds, ultimately giving rise to five compounds. These five compounds were further subjected to RAMD simulations by applying a random direction force of specific magnitude on the ligand center of mass in order to push the ligand out of the protein-binding pocket, for the quantitative estimation of their binding energy values to determine the interaction strength between protein and ligand which prevents ligand unbinding from its binding site, ultimately leading to the selection of three major compounds, DB00826 (Natamycin), DB11274 (Dihydro-alphaergocryptine), and DB11275 (Epicriptine), with the DB11274 having a role against idiopathic Parkinson's disease, and thus may have possible important roles in the prevention of dengue-associated Parkinsonism. These compounds may act as prospective drugs against dengue, by preventing the oligomerization of the NS1 protein, thereby preventing disease progression and pathogenesis.

Understanding the unprecedented 2023 dengue outbreak in Bangladesh: a data-driven analysis

ObjectivesThis study aims to elucidate the epidemiological characteristics, spatial distribution, and potential contributing factors associated with the 2022-2023 dengue outbreak in Bangladesh. MethodsWe retrospectively analyzed dengue fever cases reported by national health surveillance systems, focusing on incidence, geographical spread, and fatalities. Statistical methods were used to explore correlations between population density, healthcare capacity, and disease prevalence. ResultsOur study revealed that in 2023, dengue cases and deaths surged five-fold (from 62,382 to 320,835) and nearly six-fold (from 281 to 1699) compared with 2022. Major cities such as Dhaka and Chittagong emerged as epicenters with significantly higher caseloads and mortality rates. The analysis identified a strong positive correlation between population density and disease prevalence, suggesting urbanization as a contributing factor. In addition, a shift in the peak dengue season from August to September was observed. Furthermore, disparities in health care infrastructure were identified, with densely populated areas experiencing critical shortages of hospital beds, potentially impacting fatality rates. ConclusionsThis unprecedented dengue outbreak in Bangladesh highlights the need for a multifaceted approach. Prioritizing vector control, targeted public awareness in identified hotspots, addressing healthcare resource inequities, and further research on environmental and demographic determinants of transmission are crucial for mitigating future outbreaks in Bangladesh.

Monocyte-lymphocyte, neutrophil-lymphocyte, and platelet-lymphocyte ratios as inflammatory biomarkers of clinical dengue severity

The literature describes monocyte-lymphocyte (MLR), neutrophil-lymphocyte (NLR), and platelet-lymphocyte (PLR) ratios as prognostic biomarkers. However, in the case of dengue infection, patient clinical management and nonspecific laboratory tests determine the prognosis. Therefore, this study analyzed MLR, NLR, and PLR as prognostic biomarkers of dengue infection. Our study was based on a clinical cohort of dengue patients in Brazil between 2012 and 2013. From 193 patients, 164 (85.0%) were classified as dengue fever (DF), 19 (9.8%) as dengue hemorrhagic fever (DHF), and 10 (5.2%) as intermediate DF/DHF. DHF cases were significantly associated with MLR > 0.13 (OR: 5.72, 95% CI: 1.28-25.60, p < 0.05) and PLR ≤ 80.68 (OR: 4.26; 95% CI 1.60-11.33; p < 0.05). Our results suggest that MLR increase, and PLR decrease indicate a higher likelihood of worsening the clinical status.

Clinical spectrum and risk factors of severe dengue among hospitalized patients - a cross-sectional study during the 2023 dengue epidemic in Bangladesh

Introduction: Dengue is a significant public health concern for Bangladesh with recurrent epidemics. This study aimed to investigate the clinical and biochemical presentations and identify risk factors for severe dengue among patients admitted to a tertiary care hospital during the 2023 epidemic in Bangladesh. Methods: This cross-sectional study was conducted at a tertiary care hospital in Bangladesh between July and September 2023. Data were collected from 176 adult patients with serologically confirmed dengue infection. Clinical and laboratory parameters were recorded, and severity of dengue was categorized according to WHO guidelines. Logistic regression was performed to identify predictors of severe dengue. Results: Of the 176 patients included, 113 had severe dengue and 63 had non-severe dengue. The mean age was 34.5 (SD 14.3) years, with a male-female ratio of 1:1.07. Conventional symptoms including fever, myalgia, headache, and retro-orbital pain were present in majority of patients, with warning signs present in twothirds of them. Laboratory findings showed leukocytopenia (53%), thrombocytopenia (25.6%), elevated hematocrit level (4.5%), elevated ALT, AST and ferritin level (36%, 24% and 50% respectively). Logistic regression identified persistent vomiting (aOR 3.22, 95% CI 1.41–8.04), clinical fluid accumulation (aOR 2.23, 95% CI 1.13–5.74), and elevated serum AST (aOR 3.13, 95% CI 1.30–7.79) as predictors of severe dengue. Conclusion: Most dengue cases presented with typical symptoms and warning signs, with associated laboratory abnormalities. Persistent vomiting, clinical fluid accumulation, and elevated serum AST levels upon admission could predict severe dengue. J MEDICINE 2024; 25: 121-128

Mechanisms of programmed cell death associated to severe dengue in human renal lesions

Dengue virus (DENV) is a global health problem. Severe dengue can manifest with hemorrhage and signs of organ dysfunction, including the kidneys. The innate immune system is an important barrier against arbovirus infection and, specifically in dengue, the cytokines IL1β and IL18 and caspase-1 activation make up a set of host immune strategies. Cell death mechanisms include pyroptosis, necroptosis and autophagy, each with peculiar markers: gasdermin, RIPK3/MLKL, LC3, respectively. In DENV infection, necrosis and apoptosis are involved and, when infecting monocytes and macrophages in vitro, DENV is capable of inducing pyroptosis. Our objective was to explore the presence of markers of necroptosis, pyroptosis and autophagy in renal lesions caused by DENV. Material and Methods: twenty specimens of lesions from patients who died due to DENV infection, from the pathology department of Hospital Guilherme Álvaro, Santos, SP, were subjected to histological and immunohistochemical studies. Histological sections were stained with hematoxylin-eosin to evaluate tissue changes or collected for research with antibodies: anti-DENV (Instituto Evandro Chagas-PA), RIPK3 (NBP2-45592), MLKL (ab184718), gasdermin D (#36425), LC3 (14600-AP), caspase 1 (#98033), IL1β (AF201-NA) and IL18 (SC6178). Semi-quantitative analysis was performed on 20 glomeruli and evaluation on tubules and mononuclear cells. This study was approved by the ethics committee of the USP Faculty of Medicine. Results: histological analysis demonstrated glomerular congestion, glomerulitis (medium to severe), acute kidney injury and hyalinization of the glomeruli. Viral antigens were visualized on mononuclear cells. LC3 (autophagy) expression ranged from moderate to intense (++/+++) in glomeruli, tubules and mononuclear cells. The expression of gasdermin (pyroptosis) was mild (+) in most cases in the glomeruli and moderate (++) in the tubules. RIPK3 and MLKL (necroptosis) mild in tubules and mononuclear cells (+). The expression of the cytokines IL1β and IL18 and caspase 1 was moderate (++). Statistical analysis showed greater expression of LC3 over the others. Conclusions: Our results contribute to the understanding of the pathogenesis of renal involvement in severe dengue, considering the likely anti-viral mechanism of autophagy. To a lesser extent, pyroptosis is also present, corroborating previous data.

Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection

BackgroundDengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases.Case PresentationA 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay.ConclusionsDengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.

Two-sample testing with local community depth

AbstractIn this paper, we investigate nonparametric two-sample hypothesis testing with local community depth, a measure of data depth calculated from pairwise distances between observations. Unlike many common “center-outwards” measures of data depth, local community depth captures local features of a distribution such as multimodality and can adapt to modes with different scales. This gives local community depth greater power to detect scale changes in multimodal distributions, and importantly the method is parameter-free. The local depth employed supplements existing adaptations of depth to local regions and is computationally cheaper in high dimensions than many classic depths such as halfspace depth, regression depth, simplicial depth, and Mahalanobis depth. We test hypotheses by using local community depth in the Liu–Singh test and give conditions under which our method is consistent against fixed alternatives (and has a limiting null distribution). In simulations and an application to diagnosing dengue fever, we show that local community depth outperforms other depths when the underlying distribution is multimodal or asymmetric, and is comparable to other methods when the data is unimodal and symmetric.

Utility of the WHO dengue guidelines in pediatric immunological studies.

Dengue is a significant health problem due to the high burden of critical infections during outbreaks. In 1997, the World Health Organization (WHO) classified dengue as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). It was revised in 2009 (updated in 2015), and the new guidelines recommended classifying patients as dengue without warning signs (DNS), dengue with warning signs (DWS), and severe dengue (SD). Although the utility of the revised 2009 classification for clinical studies is accepted, for immunological studies it needs to be clarified. We determined the usefulness of the 2009 classification for pediatric studies that analyze the circulating interleukin (IL)-6 and IL-8, two inflammatory cytokines. Plasma levels of IL-6 and IL-8 were evaluated in the acute and convalescent phases by flow cytometry in children with dengue classified using the 1997 and 2009 WHO guidelines. The plasma levels of IL-6 and IL-8 were elevated during the acute and decreased during convalescence, and both cytokines served as a good marker of acute dengue illness compared to convalescence. There were no differences in the plasma level of the evaluated cytokines among children with different clinical severity with any classification, except for the IL-8, which was higher in DWS than DNS. Based on the levels of IL-8, the 2009 classification identified DWS plus SD (hospital-treated children) compared to the DNS group [area under the curve (AUC): 0.7, p = 0.028]. These results support the utility of the revised 2009 (updated in 2015) classification in studies of immune markers in pediatric dengue.

Immunogenicity, Safety and Efficacy of the Dengue Vaccine TAK-003: A Meta-Analysis.

The TAK-003 dengue vaccine was licensed in Europe in December 2022, and the official recommendations from most EU countries are still under formulation. To support policymakers, we performed a meta-analysis to quantify TAK-003's immunogenicity, efficacy and safety among seronegative and seropositive populations after the administration of one or two vaccine doses. We included trials retrieved from MEDLINE, Scopus and ClinicalTrials.gov. The outcomes were the rates of seroconversion, virologically confirmed dengue fever and serious adverse events after each vaccine dose. Data were combined using random-effect proportion or head-to-head meta-analyses. We retrieved a total of 19 datasets, including >20,000 participants. TAK-003 showed an excellent safety profile, and the immunogenicity after two doses against the four DENV serotypes was ≥90% among both adults and children/adolescents who were either seronegative or seropositive at baseline. A single dose was able to elicit a high immunogenic response among adults (≥70%) and children/adolescents (≥90%). The primary two-dose immunization course halved the risk of all types of virologically confirmed dengue fever among seropositive children/adolescents, but seronegative minors were only protected against the diseases caused by DENV-1 and DENV-2. Overall, the results support the use of TAK-003 for the prevention of dengue fever in the pediatric population of endemic countries. Uncertainties remain on the use of a single vaccine dose in non-endemic countries.

In Silico Analysis of Active Compounds from Allium tuberosum as Drug Candidate for Inhibitor DENV-3 Envelope Protein

Dengue fever has become a global health issue, the development of dengue vaccine has not yet been established. Medicinal plants are an ideal alternative for DENV infection drugs. The purpose of this study was to determine in silico the potential of active compounds from Allium tuberosum as envelope protein inhibitors of DENV-3. The method of this research is to do docking analysis of compounds with DENV-3 envelope protein and analysis of amino acid residues using MVD, pharmacokinetic analysis using SwissADME, toxicity analysis using ProTox-II. The best docking value for the potential activity to inhibit the receptor DENV-3 is the thymidine compound (RS: -81.1245 kcal/mol). The highest activity of thymidine is the most promising as a drug candidate, as evidenced by the toxicity analysis which is predicted to have non-carcinogenic, non-mutagenic, inactive properties against hepatotoxicity, cytotoxicity and immunotoxicity parameters, as well as pharmacokinetic analysis that fulfills 6 parameters of lipopolicity, molecular weight, polarity. , insolubility, insaturation, and flexibility which indicate the drug candidate of thymidine is safe for its bioavailability. The conclusion from the results of this study is that one compound has the ability as an antiviral, binding score with DENV-3 is good, and is safe in terms of pharmacokinetics and toxicity, namely thymidine compound.

When it itches, dengue switches off: a retrospective case series

BackgroundDengue fever (DF) is a viral illness caused by the dengue virus transmitted by Aedes aegypti mosquitoe. It manifests with a range of symptoms, from mild DF to severe forms like dengue hemorrhagic fever and dengue shock syndrome. Common symptoms include fever, headache, rash, muscle and joint pain, and itching. The relationship between itching and clinical improvement in dengue patients remains unclear.Case presentationA retrospective analysis was conducted on hospital data from a tertiary care centre in South India from April 2021 to April 2023. Patients diagnosed with dengue fever (confirmed by Immunoglobulin (Ig) M and Non-Structural protein (NS) 1 positivity) who experienced itching were included. Clinical details, age, sex, and laboratory findings were collected. A total of 261 patients were examined. Itching typically occurred around day eight from fever onset and was associated with improved platelet count and hematocrit levels.ConclusionsDengue fever, caused by the dengue virus, presents with various symptoms, including itching during the recovery phase. Studies suggest a correlation between itching and clinical improvement in dengue patients, indicating itching as a potential prognostic marker. Possible mechanisms for itching include direct viral infection of skin cells and cytokine release. However, further research is needed to understand this association fully. Despite limitations such as retrospective analysis, these findings highlight the significance of itching in dengue prognosis and emphasise the need for large-scale studies.

Pembentukan Kader Juru Pemantau Jentik (JUMANTIK) pada Kader Kesehatan di Wilayah Kerja Puskesmas Pagar Agung Kecamatan Lahat, Indonesia Tahun 2023

Dengue hemorrhagic fever, or DHF, is a common disease affecting many countries worldwide, particularly in Southeast Asia and the Western Pacific. It is estimated that there are 100–400 million infections annually. Although there is no specific treatment for this virus, controlling mosquito vectors remains the primary focus in controlling its spread. The formation of mosquito surveillance cadres is a crucial strategy in reducing DHF cases by monitoring breeding sites of Aedes aegypti mosquitoes. Training for these cadres and clean village activities are vital for enhancing public knowledge and awareness of DHF prevention. These activities demonstrate that education and training increase the knowledge and participation of mosquito surveillance cadres. Therefore, the formation of mosquito surveillance cadres and practical training are critical steps in the efforts to prevent and control DHF.

Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study

IntroductionSevere multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management.MethodsMedical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital’s PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses.ResultsSeventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients.ConclusionAge, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.

Single-cell sequencing reveals the features of adaptive immune responses in the liver of a mouse model of dengue fever.

Dengue fever, an acute insect-borne infectious disease caused by the dengue virus (DENV), poses a great challenge to global public health. Hepatic involvement is the most common complication of severe dengue and is closely related to the occurrence and development of disease. However, the features of adaptive immune responses associated with liver injury in severe dengue are not clear. We used single-cell sequencing to examine the liver tissues of mild or severe dengue mice model to analyze the changes in immune response of T cells in the liver after dengue virus infection, and the immune interaction between macrophages and T cells. Flow cytometry was used to detect T cells and macrophages in mouse liver and blood to verify the single-cell sequencing results. Our result showed CTLs were significantly activated in the severe liver injury group but the immune function-related signal pathway was down-regulated. The reason may be that the excessive immune response in the severe group at the late stage of DENV infection induces the polarization of macrophages into M2 type, and the macrophages then inhibit T cell immunity through the TGF-β signaling pathway. In addition, the increased proportion of Treg cells suggested that Th17/Treg homeostasis was disrupted in the livers of severe liver injury mice. In this study, single-cell sequencing and flow cytometry revealed the characteristic changes of T cell immune response and the role of macrophages in the liver of severe dengue fever mice. Our study provides a better understanding of the pathogenesis of liver injury in dengue fever patients.

Risk of severe dengue during secondary infection: A population-based cohort study in Taiwan

BackgroundDengue poses a significant public health concern. Secondary dengue infections with different dengue virus (DENV) serotypes have been linked to an increased risk of severe dengue. This study aimed to assess the risk of severe dengue during secondary infection in Taiwan. MethodsA retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to identify dengue cases with secondary dengue infection born after 1944 from 2014 to 2015. Ten matched patients with primary infection were selected as controls using propensity score matching for each secondary dengue infection case. The odds ratio (OR) for severe dengue in secondary versus primary infections was calculated using conditional logistic regression. ResultsThis study included 357 cases with secondary dengue infection and 3570 matched controls. The risk of severe dengue was found to be 7.8% in individuals with secondary infection, compared to 3.8% in those with primary dengue infection. Secondary infection significantly increased the risk of severe dengue (OR 2.13, 95% CI: 1.40–3.25, P = 0.0004). Notably, a significant association between secondary infection and severe dengue was observed only when the interval between the first and secondary infection was greater than two years (OR 3.19, 95% CI 2.04–5.00, P < 0.0001). ConclusionSecondary dengue infection significantly increases the risk of severe disease in Taiwan, particularly when the interval between infections is over two years.Healthcare professionals should maintain heightened vigilance for individuals with a history of previous dengue infection, particularly if their initial diagnosis was more than two years prior.

A comprehensive approach to integrated one health surveillance and response

A comprehensive approach to integrated one health surveillance and response Surveillance data plays a crucial role in understanding and responding to emerging infectious diseases; here, we learn why adopting a One Health surveillance approach to EIDs can help to protect human, animal, and environmental health. Over 75% of emerging infectious diseases (EIDs) affecting humans are zoonotic diseases with animal hosts, which can be transmitted by waterborne, foodborne, vector-borne, or air-borne pathways. (7) Early detection is important and allows for a rapid response through preventive and control measures. However, early detection of EIDs is hindered by several obstacles, such as climate change, which can alter habitats, leading to shifts in the distribution of disease- carrying vectors like mosquitoes and ticks. This can result in diseases such as malaria, dengue fever, and Lyme disease becoming more common in areas with established transmission or spreading to new areas entirely. (4) Environmental changes such as deforestation and urbanization disrupt ecosystems, increasing the likelihood of zoonotic disease spillover from wildlife to humans. In addition to working at the interface of these changes, detection and tracking of EIDs also requires sharing and standardization of complex data and integrating processes across different regions and health systems.

ANALISIS DAN VISUALISASI DATAPENDERITA PENYAKIT DBD DI SITUBONDO MENGGUNAKAN PLATFORM TABLEAU

Cases of dengue fever in Situbondo are very fluctuating and unpredictable. This shows that dengue fever is still a problem that requires serious health attention. The infectious disease dengue fever is caused by the bite of the Aedes aegypti mosquito. Fluctuations in dengue fever cases are due to erratic rainfall. Sometimes rainfall is higher and the rainy season is longer. On the other hand, sometimes rainfall is relatively lower and the dry season is longer. This research aims to analyze and visualize data on dengue fever sufferers in Situbondo using the Tableau platform. The data used is map data per region or spatial data that has geographical references and historical data on dengue fever patients in Situbondo from 2016 to 2022. Data was obtained from the website Tanahair.indonesia.go.id and the Situbondo Community Health Center. The research results show that data visualization using Tableau can produce good, effective, interesting and efficient information. The results of data visualization of dengue fever sufferers in Situbondo showed that there were 2 cases of death. Cases of dengue fever sufferers are spread throughout all villages in Situbondo. It is hoped that the results of this research can help in adopting appropriate policies to control dengue fever in Situbondo.

Pre-or co-SARS-CoV-2 Infections Significantly Increase Severe Dengue Virus Disease Criteria: Implications for Clinicians.

Few studies have investigated whether SARS-CoV-2 infections increase the incidence of dengue haemorrhagic fever/shock syndrome (DHF/DSS) and/or severe dengue (SD) in dengue virus (DENV)-infected patients. This study was performed on a site with high incidences of classical dengue, but relatively few DHF/DSS or SD cases as defined by the WHO 1997 or 2009 criteria, respectively. Clinical, haematological/biochemical, and viral diagnostic data were collected from febrile patients before, during, and after the COVID-19 epidemic to assess whether (a) DENV-infected patients with prior SARS-CoV-2 infections or (b) DENV-SARS-CoV-2-co-infected patients had increased incidences of SD/DHF/DSS using logistic regression and machine learning models. Higher numbers of DHF/DSS/SD occurred during the COVID-19 epidemic, particularly in males and 18-40-year-olds. Significantly increased symptoms in the DENV-SARS-CoV-2-co-infected cases were (a) haemoconcentration (p < 0.0009) and hypotension (p < 0.0005) (DHF/DSS and SD criteria), (b) thrombocytopenia and mucosal bleeding (DHF/DSS-criteria), (c) abdominal pain, persistent vomiting, mucosal bleeding, and thrombocytopenia (SD warning signs) and (d) dyspnoea, but without fluid accumulation. DENV-infected patients with prior SARS-CoV-2 infections had significantly increased incidences of thrombocytopenia (DHF/DSS-criteria) and/or abdominal pain and persistent vomiting and also thrombocytopenia (SD warning signs), but without significant haemoconcentration or hypotension. DENV-SARS-CoV-2 co-infections significantly increased the incidence of DHF/DSS/SD, while DENV-infected patients with prior SARS-CoV-2 infections displayed significantly increased incidences of thrombocytopenia (DHF/DSS-criteria) and three important SD warning signs, which are therefore very important for health workers/clinicians in assessing patients' DHF/DSS/SD risk factors and planning their optimal therapies.