Manifestations Of Dengue Virus Infection Research Articles

Reversible neurological manifestation of dengue virus infection: A case series and short review for clinical practice

In this short review we are presenting few cases of dengue infection with reversible neurological manifestation. It is our attempt to put light on these diseases, to strengthen the neurotropic propensity of Dengue virus and prompt diagnosis and management of the same.7 cases were chosen from 22 cases of dengue infection with neurological complication which were presented in the Department of Neurology from July 22 to October 22. We present here with salient clinical and radiological features of those cases.In this case series we would like to show the neurotropic character of dengue virus targeting different part of nervous system through a plethora of mechanism. The main ideas of these case series is to help clinicians to identify different neurological manifestation of the dengue infection, which are mostly reversible and helping in proper and prompt treatment of the same.

Network meta-analysis of transcriptome expression changes in different manifestations of dengue virus infection

BackgroundSeveral studies have been performed to study transcriptome profiles after dengue virus infections with partly different results. Due to slightly different settings of the individual studies, different genes and enriched gene sets are reported in these studies. The main aim of this network meta-analysis was to aggregate a selection of these studies to identify genes and gene sets that are more generally associated with dengue virus infection, i.e. with less dependence on the individual study settings.MethodsWe performed network meta-analysis by different approaches using publicly available gene expression data of five selected studies from the Gene Expression Omnibus database. The study network includes dengue fever (DF), hemorrhagic fever (DHF), shock syndrome (DSS) patients as well as convalescent and healthy control individuals. After data merging and missing value imputation, study-specific batch effects were removed. Pairwise differential expression analysis and subsequent gene-set enrichment analysis were performed between the five study groups. Furthermore, mutual information networks were derived from the top genes of each group comparison, and the separability between the three patient groups was studied by machine learning models.ResultsFrom the 10 possible pairwise group comparisons in the study network, six genes (IFI27, TPX2, CDT1, DTL, KCTD14 and CDCA3) occur with a noticeable frequency among the top listed genes of each comparison. Thus, there is an increased evidence that these genes play a general role in dengue virus infections. IFI27 and TPX2 have also been highlighted in the context of dengue virus infection by other studies. A few of the identified gene sets from the network meta-analysis overlap with findings from the original studies. Mutual information networks yield additional genes for which the observed pairwise correlation is different between the patient groups. Machine learning analysis shows a moderate separability of samples from the DF, DHF and DSS groups (accuracy about 80%).ConclusionsDue to an increased sample size, the network meta-analysis could reveal additional genes which are called differentially expressed between the studied groups and that may help to better understand the molecular basis of this disease.

SENSITIVITY VALUE OF IgA AND NS1 SEROLOGIC TEST IN EARLY DIAGNOSIS OF DENGUE INFECTION IN FEBRIS PATIENTS 3-5 DAYS, WHICH ONE IS MORE EFFECTIVE?

The aim of this study was to determine the sensitivity level of IgA and NS1 serological tests in early diagnosis of dengue infection in febris patients 3–5 days in Cimahi. Next is to find out which of the two serological tests is the most effective for early diagnosis of dengue infection in febris patients for 3-5 days. The incidence and death rate due to dengue virus infection is still quite high, especially in several areas in Indonesia. The clinical manifestations of dengue virus infection are very diverse and the outcome of dengue infection (prognosis) is difficult to predict. An efficient and accurate diagnosis of dengue is the most important part of the patient care process. Serological examination is a laboratory diagnostic method that is often used to confirm the presence of dengue virus infection. NS1 and IgA anti-dengue are serologic tests that are often used, especially in the acute phase of the disease. This study aims to determine differences in the sensitivity of NS1 and IgA in patients with dengue infection with a fever of 3–5 days. This study was a prospective analytic observational study with a cross-sectional design. The subjects of this study were patients with dengue infection with a duration of 3-5 days. The number of samples that met the inclusion criteria was 69 people. The results of this study showed differences in the sensitivity of NS1 and IgA to antidengue in patients with dengue infection with a fever of 3-5 days. NS1 examination had the highest sensitivity value on the 3rd day of 75.0% and the lowest on the 5th day of 52.4%. Anti-dengue IgA examination had the lowest sensitivity value on the 3rd day of 10.0% and the highest on the 5th day of 42.9%. Keywords : S1, IgA Antidengue, Dengue infection, sensitivity.

Identifying disease severity associated genetic regions in Dengue virus using computational and machine learning approaches

Background: Virus phenotypic characteristics, such as virulence and transmissibility, are dictated by specific functional regions in viral proteins. This type of knowledge is largely buried in scientific publications in textual form. To make such information more easily searchable and analyzable, we have curated Sequence Features (SFs) from literature and database sources, and made them available through the Virus Pathogen Resource (ViPR; www.viprbrc.org), a US NIH/NIAID-funded, freely-available online Bioinformatics Resource Center supporting research on a broad range of human virus pathogens. These SFs not only provide useful protein sequence annotations, but also facilitate genotype-phenotype association studies. Methods and materials: We utilized the ViPR-curated SFs to explore the correlations between clinical manifestations of Dengue virus infection and Dengue genetic sequence variations to determine if specific SFs are associated with severe disease. Toward this aim, we used both statistical and machine learning methods to analyze a dataset of over 2,000 Dengue genomes isolated from patients with disease severity clinical metadata - mild (Dengue fever) or severe (Dengue hemorrhagic fever, Dengue shock syndrome). Results: First, Pearson's Chi-squared test was used to analyze 144 Dengue virus functional SFs and the sequence variations in these SFs (Variant Types, VTs) retrieved from ViPR. This analysis identified 10 significant SFs in NS2B, NS3, NS4A, NS4B and NS5 for Dengue 2 and one SF in NS5 for Dengue 3. Second, a severe disease classifier was built for Dengue 2 using Random Forest machine learning and 87 Dengue 2 functional SFs as classification features. Analyzing 563 sequences (75% for training and 25% for testing), 74% accuracy, 81% sensitivity and 64% specificity was achieved in the test set. Importantly, the top 10 SF features used by the severe disease classifier corresponded to the significant SFs identified by the Chi-squared test. These SFs include regions known to be involved in nuclear localization, ATPase and helicase activity, IFN antagonism, STAT degradation, and polymerase activity. Conclusion: In summary, ViPR SFVT data was used to study genotype-phenotype association in Dengue virus and identified SFs potentially associated with disease severity. This SFVT approach provides a way to analyze the effects of genetic variations on virus pathogenesis at a finer level.

Prevalence and Hemodynamic Outcome of Dengue Shock Syndrome in Children Attending the Department of Pediatrics, Dr. Soetomo General Hospital

Abstract
 The prevalence of Dengue infection has increased markedly worldwide. Dengue shock syndrome (DSS) is a severe manifestation of dengue virus infection. Higher mortality of DSS was found in children. This study’s aim was to portray prevalence and hemodynamic outcome in children attending the department of pediatric in Dr. Soetomo General Hospital. A Descriptive Retrospective study of children aged <15 years old with DSS was performed and evaluated from 2013-2016. The samples were divided into 5 groups, aged <1 years old, 1-2 years old, 3-5 years old 6-11 years old and 12-15 years old. Data were taken secondarily and calculated with Microsoft Excel 2010. The most common findings were prevalence of DSS in 6-11 years old group and mortality rate in <1 years old group. This can be seen as in the hemodynamic outcome; the average HR was higher in aged group 1-2 years old while RR was higher in group under 1-year-old. Meanwhile, the average blood pressure, PP, and MAP were lower in children under 2 years old. The hemodynamic outcome varies on each group based on age. Incidence of DSS remained high in older children but mortality rates were high in younger children.

TROMBOSIT TERENDAH, KENAIKAN HEMATOKRIT DAN KADAR TNF-α SEBAGAI INDIKASI KEPARAHAN INFEKSI VIRUS DENGUE PADA PASIEN DD DAN DBD

Clinical manifestations of dengue virus infection vary from unspecified fever, dengue fever (DF) and dengue hemorrhagic fever (DHF). The fundamental difference in the diagnosis between DF and DHF is plasma leakage, hypotension, thrombocytopenia and hemorrhagic diathesis in DHF. The objectives of the study were to determine the lowest platelet, haematocrit increase, and TNF-α levels in DF and DHF patients as an indication of severity of dengue virus infection. The cross-sectional study was conducted by taking 54 blood samples of patients aged 26-45 years who were infected by dengue virus and grouped into two groups: DF patient group (27 blood samples) and DHF group (27 blood samples). The lowest platelets and hematocrit rise were determined by Hematology Analyzer and the TNF-α levels were determined by ELISA. The data obtained were statistically analyzed by independent Mann-Whitney test. The results showed that the lowest mean platelet counts of DF patients were significantly (p <0.01) higher than those of DHF patients. The mean hematocrit increase in DF patients was significantly (p <0.01) lower than that of the DHF patients and the mean TNF-α levels of DF patients were significantly (p <0.01) lower than the DHF patients. Based on the results of this study it can be concluded that the lowest platelets, hematocrit increase and TNF-α levels are an indication of the severity of dengue virus infection.

CORRELATION OF DENGUE VIRUS SEROTYPE AND DVI SEVERITY IN ADULT PATIENTS

The clinical manifestation of dengue virus infection is often not clear, varies widely from mild to severe. Exposure of dengue virus which serotype is different from a previous infection is a risk factor for the severe manifestation of dengue virus infection. Dengue hemorrhagic fever is classified into four degrees of severity based on clinical manifestations and laboratory results. Real-time RT-PCR Dengue can detect dengue virus serotype in early dengue virus infection. The aimed of this study was to prove the correlation between dengue virus serotype and degree of severity in adult patients. This study was a cross-sectional observational design done in February until July 2016. Subjects consisted of 100 dengue virus infection patients. Serum of the patients was examined using Real-time RT-PCR Dengue (Simplexaâ„¢ Dengue). It was shown that from 46 patients with DENV-3 serotype was 63%, DENV-2 serotype 17.4%, DENV-1 serotypes 17.4% and mixed infection of DENV-1 and DENV-3 serotype 2.2%. There was not any DENV-4 serotype. Dengue Hemorrhagic Fever (DHF) stage I was 47.8%, DHF stage II was 30.4%, DHF stage III was 10.9% and Dengue Fever was 10.9%. There was not any DHF stage IV. There was not enough evidence that DENV-3 correlated with the degree of severity (p= 0.510). Based on this research, DENV-3 serotype was the dominant serotype prevalent at the Dr. Soetomo Hospital. There was no correlation between viral dengue serotype and severity in dengue adult patients in this study.

NILAI DIAGNOSTIK ANTI DENGUE IgA DAN NS1, SERTA IgM/IgG DI INFEKSI VIRUS DENGUE (The Diagnostic Value of Anti Dengue IgA and Anti Dengue IgM/IgG in Dengue Virus Infection)

The clinical manifestations of dengue virus infection are varied and thus a specific diagnostic examination is required. Usually antidengueIgM is often used, but the presence in the circulation is 3−8 months long. NS1 is sensitive in the detection of primary infection,whereas IgG is more better used in secondary infection. The examination of anti-dengue IgA as a new marker is estimated to be ableto detect the acute primary and secondary infection, however the diagnostic value of anti-dengue IgA is not much well known for theIndonesian population. This study was done at the Tropical Infectious Disease Ward of Dr. Soetomo Hospital, Surabaya during February– April 2013. The samples consisted of 37 sera from patients infected by dengue virus and 37 sera from those non one (dengue virusinfection patients). The NS1 serum, anti-dengue IgM and anti dengue IgG were examined by ELISA and anti-dengue IgA was examined byan indirect immunochromatography method using Assure@ Dengue IgA Rapid Test (MP Biomedicals Asia Pacific Pte Ltd). The diagnosticvalue was analyzed by 2x2 table with a confidence interval of (CI) 95%. The used gold standards were from the 1997th WHO criteriaand one of the positive dengue serological tests by ELISA (NS1/anti dengue IgM/anti dengue IgG). AUC and anti-dengue IgA cut-off weredetermined by ROC curve. The Diagnostic value of anti-dengue IgA showed a sensitivity and specificity of 83.8% (67.3 to 93.2) and 81.1%(64.3 to 91.4). A positive predictive value of 81.6% (65.1 to 91.7) and a negative predictive value of 83.3% (66.5 to 93.0) was found. Thepositive likelihood ratio was 4.4 times (2.2 to 8.8) and negative likelihood ratio of only 0.2 times (0.09 to 0.42). The best cut off valueof 0.2 was shown by the area under the curve of 83.5%. Based on this study, the diagnostic value of anti-dengue IgA had a good validityfor the diagnosis of dengue virus infection.

Biochemical Profile and Degree of Liver Involvement in Dengue Fever

Dengue disease has emerged globally as the most frequent and medically relevant viral infection transmitted by mosquito bite. Acute hepatitis is a manifestation of dengue virus infection. This study shows the impact of dengue on liver function was studied by biochemical tests on 80 patients out of them 53 male (age 42±12 yrs) and 27 female (age 39±13 yrs). The patients were diagnosed as dengue fever and were admitted in Holy Family Red Crescent Medical college Hospital from June 2014 to December 2016. All the patient were diagnosed by anti-dengue IgM positive by ELISA method. Abnormal level of aspartate aminotransferase (ASV, alanine aminotransferase (ALT), bilirubin, alkaline Phosphatase (Alp), gamma-glutamyl transferase (G-GT) and albumin and urinary albumin were observed in 82.5%, 82.5%, 47.5%, 38.75%, 71.25% ,66.25% and, 76.25% of the patients respectively. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever should be considered in the differential diagnosis of acute hepatitis.

Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children.

Dengue shock syndrome (DSS) represents one of the most severe manifestations of dengue virus infection. The objective of the present study was to analyze the clinical and laboratory characteristics, risk factors and outcome of DSS in children. Patients <15 years old admitted with DSS during the 2012 and 2013 outbreak of serotype 2 of dengue virus in Paraguay were included. Demographic, clinical and laboratory data of patients with/without DSS were analyzed. Of 471 children hospitalized with dengue, 354 patients (75%) presented with shock at admission or developed later. The mean age of patients with DSS was 10.2 ± 4 years (no difference with patients without shock), without gender preference. Rash (50% vs. 56%), myalgias (45% vs. 40%), vomiting (66% vs. 68%) and bleeding manifestations (24% vs. 21.2%) were similar for 2 groups. Similarly, there was no difference in the frequency of DSS between primary versus secondary infection cases (76.2% vs. 71.6%, P = 0.3). Age group >5 years [odds ratio (OR) 1.6, 95% confidence interval (CI): 1-2.8, P < 0.05), presence of abdominal pain (OR 2.5, 95% CI: 1.3-4.9, P = 0.006), an activated partial thromboplastin time prolonged (OR 4; 95% CI: 1.6-10, P < 0.001) and low fibrinogen level (OR 2.5; 95% CI: 1-5.9, P = 0.02) were found significantly associated with DSS. About 12% of patients required intensive care unit admission, and 2 patients died (lethality 0.35%). This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.

Oxidative Stress Markers and Its Correlation with Aminotransferases in Hepatic Manifestation of Dengue Virus Infection

Objective: To study the correlation between oxidative stress markers and Aminotransferases in patients of dengue fever with hepatic manifestations. Background: Manifestation of viral infection may be contributed by the alteration of oxidation/reduction (Redox) status in virus infected patients and this alteration starts prior to symptoms of disease appear. Increased level of Aminotransferases may be a useful marker of hepatic insult. Method: We conducted a cross sectional hospital based study of 90 patients serologically confirmed to have dengue virus infection who have hepatic manifestations. Blood samples were collected on 4 th day and onwards after the fever and analysed for liver function tests (LFT), prothombin time (PT) and thrombocytes and other haematological parameters. And to measure the oxidative stress blood was analysed for malondihyde (MDA), catalase (CAT), glutathione peroxidase(GPx ) and paraoxanase(PON). Results: Among the LFT parameters the level of Aspartate transaminase (AST) was significantly raised followed by alanine transaminase (ALT) and other parameters were either within normal limit or not significant. The level of MDA was significantly raised and level of GPx , CAT and PON was reduced. The significant correlation was found between ALT, AST and oxidative stress markers. Conclusion: So we can conclude that in patients of dengue infection, raised liver enzyme (AST, ALT) may be associated with oxidative stress and AST can be used in a severity index and as prognostic marker in hepatic manifestations. INTRODUCTION Dengue is the most common and widespread arthropod borne viral infection in the world today and is caused by a flavivirus spread by the Aedes aegypti mosquito. It is estimated that worldwide, each year 50-100 million cases of dengue fever occur and in South East Asia it continues to be the major challenge to public health. [1,2] In India dengue is endemic in 31 states /UTs. During 2011-12 about 18059 cases were reported with around 120 deaths with case fatality rate 0.65%. [3] www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.81

The Epidemiology, Virology and Clinical Findings of Dengue Virus Infections in a Cohort of Indonesian Adults in Western Java.

BackgroundDengue has emerged as one of the most important infectious diseases in the last five decades. Evidence indicates the expansion of dengue virus endemic areas and consequently the exponential increase of dengue virus infections across the subtropics. The clinical manifestations of dengue virus infection include sudden fever, rash, headache, myalgia and in more serious cases, spontaneous bleeding. These manifestations occur in children as well as in adults. Defining the epidemiology of dengue in a given area is critical to understanding the disease and devising effective public health strategies.Methodology/Principal FindingsHere, we report the results from a prospective cohort study of 4380 adults in West Java, Indonesia, from 2000–2004 and 2006–2009. A total of 2167 febrile episodes were documented and dengue virus infections were confirmed by RT-PCR or serology in 268 cases (12.4%). The proportion ranged from 7.6 to 41.8% each year. The overall incidence rate of symptomatic dengue virus infections was 17.3 cases/1,000 person years and between September 2006 and April 2008 asymptomatic infections were 2.6 times more frequent than symptomatic infections. According to the 1997 WHO classification guidelines, there were 210 dengue fever cases, 53 dengue hemorrhagic fever cases (including one dengue shock syndrome case) and five unclassified cases. Evidence for sequential dengue virus infections was seen in six subjects. All four dengue virus serotypes circulated most years. Inapparent dengue virus infections were predominantly associated with DENV-4 infections.Conclusions/SignificanceDengue virus was responsible for a significant percentage of febrile illnesses in an adult population in West Java, Indonesia, and this percentage varied from year to year. The observed incidence rate during the study period was 43 times higher than the reported national or provincial rates during the same time period. A wide range of clinical severity was observed with most infections resulting in asymptomatic disease. The circulation of all four serotypes of dengue virus was observed in most years of the study.

ABSTRACT 579

Background and aims: DSS represent one of the most severe manifestations of dengue virus infection and currently is a major public health problem with high morbidity and mortality. Aims: To analize the clinical and laboratory characteristics and outcome of DSS in children. Methods: All cases of dengue in patients less than 15 years old admitted with DSS to the Institute of Tropical Medicine during the years 2011–2013. A standard physical examination and blood analysis were done daily. Clinical data and laboratory data of patients with/without DSS were comparatively analyzed. Risk factors of DSS were determined by Mantel-Haenzel test, logistic regression analysis. Results: 560 children with dengue were hospitalized, of which 409 pts (73%) developed shock at admission. The mean age of pts with DSS was 10,2 ± 4 years, with a male/female distribution 1:1. There was no difference in the frequency of DSS between primary vs secondary infection cases (74% vs 69%, p=0.2). 12% of patients required admission at ICU and only 2 patients died (letality 0.35%). Conclusions: This study reveals the difficulty of predicting the development of shock based on clinical history and routine laboratory and emphasizes the need to search for biological markers that allow anticipating the development of shock in patients with dengue.

Hemostatic derangement in dengue hemorrhagic fever

Dengue hemorrhagic fever (DHF) is a more severe manifestation of dengue virus infection. Patients with DHF exhibit abnormal hematological indices, including high hematocrit, low white blood cells, low neutrophils, high lymphocytes, increased atypical lymphocytes, low platelets, slightly prolonged activated partial thromboplastin time, prothrombin time, and thrombin time. Abnormal platelet functions manifest as impaired platelet aggregation to ADP, and concurrent increases in plasma thromboglobulin and platelet factor 4 levels are also seen. Variable reductions in the activities of coagulation factors including prothrombin, V, VII, VIII, IX, and X may be present. The plasma level of antithrombin is typically normal, but protein C and protein S are modestly reduced. Within the fibrinolytic system, slightly increased levels of tissue-plasminogen activator accompanied by slightly increased plasminogen activator inhibitor-1 and decreased thrombin activatable fibrinolysis inhibitor have been demonstrated. These derangements are prominent in patients with DHF grades III and IV, collectively known as dengue shock syndrome. Moreover, patients with excessive depletion of intravascular volume from plasma leakage and/or massive bleeding from endothelial dysfunction, thrombocytopenia, platelet dysfunction, and coagulopathy may exhibit shock, prolonged shock and repeated shock. DIC is also commonly found in these complicated patients. However, most patients recover spontaneously with normalization of abnormal laboratory profiles during the convalescent stage or within one to two weeks after defervescence.

Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital.

Dengue shock syndrome (DSS) is a severe manifestation of dengue virus infection that particularly affects children and young adults. Despite its increasing global importance, there are no prospective studies describing the clinical characteristics, management, or outcomes of DSS. We describe the findings at onset of shock and the clinical evolution until discharge or death, from a comprehensive prospective dataset of 1719 Vietnamese children with laboratory-confirmed DSS managed on a single intensive care unit between 1999 and 2009. The median age of patients was 10 years. Most cases had secondary immune responses, with only 6 clear primary infections, and all 4 dengue virus serotypes were represented during the 10-year study. Shock occurred commonly between days 4 and 6 of illness. Clinical signs and symptoms were generally consistent with empirical descriptions of DSS, although at presentation 153 (9%) were still febrile and almost one-third had no bleeding. Overall, 31 (2%) patients developed severe bleeding, primarily from the gastrointestinal tract, 26 of whom required blood transfusion. Only 8 patients died, although 123 of 1719 (7%) patients had unrecordable blood pressure at presentation and 417 of the remaining 1596 (26%) were hypotensive for age. The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion. All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever. With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.

Profile of human leukocyte antigen class I alleles in patients with dengue infection from Western India

Human leukocyte antigen (HLA) class I alleles are known to affect the cytotoxic T lymphocyte responses and influence susceptibility to viral infections. The objective of the present study was to find out whether HLA class I alleles are associated with clinical manifestations of dengue virus infection. The profile of HLA class I alleles were investigated in 224 human subjects [85 dengue fever (DF) cases, 29 dengue hemorrhagic fever (DHF) cases and 110 healthy controls (HCs)] from Western India using PCR based methods. Results revealed significantly higher frequency of HLA-A∗33 in DF cases compared to HCs [P=0.032, Odds ratio (OR) 2.12]. The frequency of HLA-A∗02:11 was higher in DHF cases compared to DF cases. The frequency of HLA-B∗18 was significantly higher in dengue (DEN) cases [P=0.047 Pc=0.846, OR 3.53]. The frequency of HLA-Cw∗07 allele was significantly higher in DEN cases [DEN vs. HCs: P=0.0120, Pc=0.168, OR 2.00]. Significance was observed even when the cases were categorized in to DF and DHF [DF vs. HCs: P=0.0349, Pc=0.49, OR 1.87; DHF vs. HCs: P=0.0399, Pc=0.56, OR 2.4]. The combined frequency of HLA-Cw∗07 with HLA-DRB1∗07/∗15 genotype was significantly higher in DHF cases as compared to DF and HCs [DHF vs. HCs: P=0.022, OR 5.31; DHF vs. DF: P=0.027, OR 5.49]. On the other hand, the frequency of combination of HLA-Cw∗07 without HLA-DRB1∗07 was significantly higher in DF cases compared to HCs [DF vs. HCs: P=0.002, OR 2.42 (1.28–4.55)]. The results suggest that HLA-A∗∗33 may be associated with DF while HLA-B∗18 and HLA-Cw∗07 alleles may be associated with symptomatic dengue requiring hospitalization. In the presence of HLA-DRB1∗07/∗15 genotype, HLA-Cw∗07 is associated with increased risk of developing DHF while in the presence of other HLA-DRB1 alleles, HLA-Cw∗07 is associated with DF.

The Clinical, Serological and Molecular Diagnosis of Emerging Dengue Infection at a Tertiary Care Institute in Southern, India

Dengue is an acute viral infection which presents as uneventful pyrexia to a fatal complication. This infection is increasingly being recognized as the world's major emerging tropical disease and an important public health problem. This article highlights the clinical manifestations of Dengue virus infection and the various molecular tests that were used for its laboratory diagnosis. Serum samples from 713 suspected cases of Dengue were collected between August and December 2007. The clinical profiles of 123 hospitalized patients were analyzed. Serology, RT- PCR, virus isolation and sequencing were done. The most common clinical symptoms were fever, thrombocytopenia, rash and elevated liver enzymes. The demonstration of the Dengue RNA in 5.16% samples, the detection of Dengue specific IgM antibodies in 18% samples and the isolation of the DENV-4 and the DENV-3 viruses from the clinical samples confirmed this Dengue outbreak. A co -infection with Chikungunya was observed in 2.06% of the cases. The phylogenetic analysis revealed that the Indian Dengue-4 isolates from this outbreak belonged to the genotype I. This study clearly indicated the sudden dominance of DENV-4 in an Indian Dengue outbreak. The surveillance of the Dengue viruses needs to be closely monitored for the emergence of newer serotype(s) in hitherto unknown areas.

Nephropathy and Encephalopathy in an Indonesian Patient with Dengue Viral Infection

Objective: To describe unusual manifestation of dengue virus infection that has been increasing in number and elucidate the indirect effect of dengue infection on the central nervous system which may explain the occurence of dengue encephalopathy. Methods: A case report of 6-year-old boy who was admitted with a history of fever for three days, accompanied with decreased consciousness, hypertension, and edema is presented. Laboratory examination showed hemoconcentration, thrombocytopenia, with positive anti dengue Immunoglobulin G (IgG) and IgM, microscopic glomerular hematuria, and proteinuria as well as normal creatinine serum level. He was treated with supportive treatment. Results: After six days, the consciousness was improved and blood pressure was normal. Proteinuia was alleviated by Day 11 and completely negative on Day 19. Microscopic glomerular hematuria was negative after 6 months. Conclusions: Recognition of unusual dengue manifestations is important in early diagnosis and effective treatment of the disease. Keywords: Dengue virus infection, encephalopathy, nephropathy DOI : 10.15850/ijihs.v1n1.108

Serotype and Clinical Performance of Dengue Virus Infection on the Year 2009

Dengue hemorrhagic fever is one of the important health problem in Indonesia, mortality rate is becoming decrease but many dengue shock syndrome cases is very difficult to be help. Previous study showed that some of DEN 2 and DEN 3 virus cases could show a clinical performance of severe dengue virus infection such as dengue shock syndrome. There are four serotype of dengue virus infection can cause primary and secondary infection. The aim of this research is to know the relationship between clinical performance of dengue virus infection and serotype dengue virus and also to know the role of primary and secondary infection and age of dengue virus cases. A prospective analytic observational study, which was conducted in Dr. Soetomo hospital since January 2009. RT-PCR was used to attempt to identify the infecting serotype from dengue virus isolated using vero cell. Antibody responses were measured by ELISA and clinical manifestation were measured with the WHO criteria 1997. Dengue serotype identification by RT-PCR was 70 patients. Virus types were DEN-2 65(92.8%), DEN-1 3(4.2%), and DEN-3 2(2.8%). Patients with DEN-1 genotype IV were more trend severe disease DSS and unusual infection. Commanly usually secondary exposure cause more severe clinical manifestation than primary exposure (p = 0.035) but in this study found that all of DEN-1 genotype IV, primary or secondary infection to show severe clinical manifestation of dengue virus infection. We can conclude that DEN-2 was the most dominant serotype in Dr. Soetomo Hospital. On Primary and secondary infection, DEN-1 genotype IV showing more severe than DEN-2 and DEN-3.

Dengue encephalitis: an entity now common in dengue-prone regions

As well as dengue fever (DF) and dengue haemorrhagic fever-dengue shock syndrome (DHF/DSS), other atypical manifestations of dengue virus infection have also been reported. The frequency of CNS involvement in dengue remains unknown, although isolated cases with neurological manifestations have been reported in Southeast Asia, Malaysia, Burma, Puerto Rico and India. We present two cases of encephalitis associated with DF and DHF from New Delhi, India.