Mosquito-borne Viral Infection Research Articles

Health Literacy in Preventing and Controlling Dengue Hemorrhagic Fever Among Village Health Volunteer, Pattani Province, Thailand

Background: Dengue Haemorrhagic Fever (DHF) is a mosquito-borne viral infection caused by the dengue virus (DENV). The situation of the DHF prevalence rate was still high in the community. One reason for this high rate involves community members, who had less participated in the prevention and control measures of DHF. Objectives: This descriptive study aimed to study factors associated with preventing and controlling DHF among village health volunteer, Pattani Province. Methods: Population consisted of 6,841 village health volunteers registered in Pattani Province, Thailand, in fiscal year 2020, and the sample size was calculated using Daniel formula for 215 cases, and systematic random sampling was carried out for collecting data. Data were collected by questionnaires composed of 3 parts, including characteristics, health literacy factors, and preventing and controlling DHF. In addition to check questionnaire standardization, validity was checked by three experts and try out testing reliability by Cronbach’s coefficient alpha about 0.87. Data were analysed using statistical as Pearson product moment correlation coefficient and Stepwise Multiple Regression Analysis. Results: The analysis found that health literacy factors were associated with preventing and controlling DHF among village health volunteer, Pattani Province such as access skill (r=0.310, p-value<0.001) communication skill (r=0.201, p-value=0.003) media literacy skill (r=0.386, p-value<0.001) decision skill (r=0.349, p-value<0.001) self-management skill (r=0.480, p-value<0.001), respectively. Conversely, cognitive skill had no association (r=0.117, p-value=0.086). Conclusion: The finding showed that health literacy of village health volunteer was associated with the preventing and controlling DHF. Therefore, health workers should encourage the village health volunteers to participate in sustainable prevention and control of DHF.

CHARACTERIZATION OF CLINICAL AND BIOLOGIC MANIFESTATIONS OF CHIKUNGUNYA AMONG CHILDREN IN AN URBAN AREA, THAILAND: A RETROSPECTIVE COHORT STUDY.

Chikungunya virus (CHIKV), transmitted by Aedes mosquitoes, has reemerged in Southeast Asia since 2019. A retrospective review of CHIKV cases was conducted. Children commonly presented with high-grade fever, rash, arthralgia, and lymphopenia. Neurological manifestations or shock occurred in 20% of hospitalized children. These findings indicate the need for increased vigilance for CHIKV alongside dengue in travelers from Southeast Asia with suspected mosquito-borne viral infections.

Dengue Fever: A Public Health Threat to Bangladesh

Dengue fever has become a significant health concern in Bangladesh, with a substantial number of reported cases in recent years. This mosquito-borne viral infection is caused by the dengue virus, transmitted by the Aedes mosquito. The effects of dengue fever can range from mild symptoms such as high fever, muscle and joint pains, to severe complications that can be life-threatening. This paper aims to provide an update on the current situation of dengue fever in Bangladesh, the measures taken by the government and healthcare systems, and the challenges faced in controlling the spread of this disease. In recent years, Bangladesh has experienced a surge in dengue fever cases, particularly during the monsoon season when mosquitoes thrive. According to the Directorate General of Health Services (DGHS), the number of dengue cases has been increasing rapidly, with thousands of reported cases each year. The densely populated urban areas of Dhaka, the capital city, are particularly affected, as inadequate waste management and sanitation contribute to the breeding grounds for mosquitoes. The impact of dengue fever extends beyond health, as it also poses a significant economic burden on affected individuals and the healthcare system. To combat the spread of dengue fever, the government of Bangladesh has taken several measures. These include implementing public awareness campaigns to educate the population about the importance of mosquito control, encouraging practices such as removing standing water and using mosquito repellents, and promoting early diagnosis and treatment. The government has also strengthened its vector control and surveillance programs, focusing on increased mosquito control measures and the early detection of cases. Additionally, efforts have been made to improve healthcare infrastructure and capacity to handle the growing number of dengue cases. However, despite these efforts, challenges remain in controlling the spread of dengue fever in Bangladesh. Factors such as limited resources, inadequate urban planning, and a lack of community participation continue to hinder progress. Furthermore, the emergence of new strains of the dengue virus and the potential for future outbreaks make it crucial to continuously monitor and adapt control strategies. Collaborative efforts between the government, healthcare systems, and the community are essential to effectively manage and prevent the spread of dengue fever in Bangladesh. Only through a comprehensive and sustained approach can the country hope to combat this public health threat effectively. CBMJ 2024 July: vol. 13 no. 02 P: 282-289

Dengue rhabdomyolysis successfully treated with hemoperfusion using CytoSorb® in combination with continuous renal replacement therapy: a case report

BackgroundDengue fever is a mosquito-borne viral infection with a broad spectrum of clinical manifestations. Expanded dengue syndrome includes unusual manifestations that do not fall into the categories of dengue fever, dengue hemorrhagic fever, or dengue shock syndrome. Rhabdomyolysis causing acute renal failure in dengue is one such unusual manifestation, the pathophysiology of which is incompletely understood.Case presentationWe describe a 21-year-old Sri Lankan man with dengue fever who developed severe rhabdomyolysis and acute kidney injury with extremely high creatinine phosphokinase levels (> 2 million U/L). Management of this patient was challenging as his creatinine phosphokinase kept rising with persistent anuria despite hydration, intermittent hemodialysis, and, later, continuous venovenous hemodiafiltration. Further therapeutic options were explored, and CytoSorb® adsorber was added as an adjunct to continuous venovenous hemodiafiltration, following which we observed a marked reduction in his creatinine phosphokinase and myoglobin levels over the next 12 hours and complete renal recovery over the next 5 weeks.ConclusionWe report a rare case of significant rhabdomyolysis secondary to dengue infection leading to acute kidney injury. Continuous venovenous hemodiafiltration performed with the hemofilter Pecopen 140 was ineffective, and the addition of CytoSorb® adsorber as an adjunct therapy to continuous venovenous hemodiafiltration may have a potential benefit in removing high-molecular-weight proteins such as myoglobin.

Inflammatory & Apoptotic Factor Fluctuations Associated with Japanese Encephalitis Virus Infection in Transgenic IFNAR1-/- Mice.

Japanese encephalitis virus (JEV) is an orthoflavivirus that causes Japanese encephalitis, a mosquito-borne viral infection that primarily affects humans and animals. JEV is a major cause of encephalitis in many parts of Asia, particularly in rural and agricultural areas. In this study, we used the IFNAR1-/- mice model to investigate alterations in cytokine and apoptotic factor levels in IFNAR1-/- mice upon JEV infection. A 5-week-adult female C57BL/6 IFN-α/β receptor knockout (IFNAR1-/-) transgenic mice were intramuscularly inoculated with several viral titers and monitored within 10 dpi. The weight changes and survival rates were evaluated during the study period. Gene expression analysis was performed using RT-qPCR, targeting genes related to specific cytokines and apoptotic factors, to identify the inflammatory factors fluctuations associated with JEV strain KBPV-VR-27 infection in IFNAR1-/- mice. The expression of cytokine genes was enhanced in IFNAR1-/- mice infected with JEV KBPV-VR-27. Notably, a significant induction of cytokines, such as IL-13, IL-17α, IFN-β, and IFN-γ, was observed in the brain, while upregulation of IL-6, IFN-β, and IFN-γ was exhibited in the lung. In addition, among the targeted apoptotic factors, only significant induction of Bak was observed in the brain. We also found that the spleen exhibited a higher viral load compared to the brain and lungs. In conclusion, the findings of this study shed light on the varying viral loads across targeted organs, with the brain exhibiting a lower viral load but pronounced expression of targeted pro-inflammatory cytokines in IFNAR1-/- mice.

Health System Preparedness, Response, and Incidence of Dengue in District Mianwali

Dengue is a mosquito-borne viral infection caused by the dengue virus. It has 4 different serotypes and is mainly spread by Aedes mosquitoes. The disease is a significant public health problem worldwide. Objective: Assess district health system preparedness for Dengue outbreaks, identify gaps, strengthen surveillance, and determine incidence post-preventive measures. Methods: The study was a mixed-method design, using both qualitative and quantitative approaches. A cross-sectional design was used to assess the incidence of dengue. Results: A total of 118 participants were selected for questionnaire-based interviews out of which 47.9% were male and 51.3% were females. The average age of the participants was 38.58 ± 9.63 with a minimum age of 24 years and minimum age of 55 years was observed. Overall 8.4% of the participants belonged to the Supervisor cadre, 5.9% were entomologists, 32.8% were CDC supervisors and 52.1% were clinical doctors. Most healthcare professionals find it easy to diagnose and report a case of dengue fever. Only 0.85% of the participants felt it very difficult to diagnose and report a dengue case, 45.76% felt somewhat easy and 44.07% felt very easy in reporting a dengue case. Some of the participants 9.32% neither felt it easy nor difficult to report dengue cases. Conclusions: Punjab, Pakistan's dengue surveillance system has improved but needs further enhancements in case detection, reporting, communication, and stakeholder collaboration. The province has established dengue monitoring units and implemented a comprehensive reporting system.

Stochastic behavior of within-host progression in primary dengue infection

Dengue is a mosquito-borne viral infection that triggers a series of intracellular events in the host immune system, which may result in an invasion of the virus into the host and cause illness with a spectrum of severity. Depending on the degree of the infection, mild to severe clinical symptoms appear when the T-cell and B-cell-initiated immune responses fail to eradicate the virus particles and subsequently become compromised. Here, we propose a mathematically tractable simple model that exhibits important biological features of dengue infection. Dynamical analysis of our model explores the factors influencing viral persistence in the body over an extended period. To investigate plausible variability in viral dynamics in different hosts, we perform stochastic simulations of our model using Gillespie’s algorithm. Our simulation results recapitulate the distribution of the intrinsic incubation period, daily viral load, and the day of peak viremia. In addition, we observe that the invasion probability of the virus into the host is correlated with the initial virus population injected by the mosquito. However, considering the biting behavior of Aedes mosquitoes, a lower initial virus injection could end up increasing the epidemic potential of the virus.

A case report on heart failure prevalence in dengue patients with concurrent fluid leakage syndrome: Unveiling a cardio-leakage co-existence

Dengue fever, a mosquito-borne viral infection, has been a growing global health concern with significant morbidity and mortality. Among the myriad complications that Dengue can manifest, fluid leakage syndrome has emerged as a particularly severe and challenging aspect of the disease. This case study delves into the prevalence of heart failure in patients who not only suffer from Dengue but also concurrently experience fluid leakage syndrome. Through an analysis of clinical data, patient histories, diagnostic criteria, and treatment outcomes, we explore the intricate relationship between these two conditions and their impact on the cardiovascular system. Our findings shed light on the complexities of managing these co-morbid conditions and explore the need for enhanced clinical approaches and awareness in addressing this dual health burden. This case study aims to contribute to the broader understanding of the interplay between Dengue, fluid leakage syndrome, and heart failure, with the ultimate goal of improving patient care and outcomes in such challenging clinical scenarios.

Seroprevalence Study of Dengue at a Tertiary Care Hospital in Jaipur, Rajasthan

Background and Aim: Dengue is one of the most severe mosquito-borne viral infection. In the absence of specific treatments and vaccines for dengue fever (DF), vector control is the only method by which the spread of dengue can be prevented. This study investigates the seroprevalence of DF cases by detecting NS1 antigen and immunoglobulin (Ig)-G and IgM antibody by enzyme-linked immunosorbent assay (ELISA) test. Materials and Methods: This study was carried out in the Department of Microbiology, at a Tertiary Care Hospital, Jaipur (Rajasthan), done between 6 months. Blood samples from clinically suspected cases of dengue were tested immediately for qualitative detection of NS1 Ag, IgM, and IgG antibodies by ELISA. Results: One thousand seven hundred and sixty-three serum samples were tested for dengue NS1 antigen, IgM, and IgG, out of which 1066 were positive for one or more serological parameters. Dengue cases for the NS1 infection are 52.53%, for the IgM infection is 33.39%, and for the IgG infection is 14.07%. Sixty-two percentage positive samples were of male patients and 57% of positive samples were from 19 to 40 years of age group (adult population) (59%). The seasonal trend showed a gradual increase in dengue-positive cases that started in September with a peak in October (46.24%). Conclusion: The monsoon and postmonsoon seasons are times of high virus activity and enhanced vector breeding. The population must thus be constantly monitored to prevent the virus from spreading further, and serological tests are crucial for making an early diagnosis. ELISA is advised for all suspected dengue patients to initiate therapy and decrease the morbidity and fatality rate.

Exploring potential therapeutics: Targeting dengue virus NS5 through molecular docking, ADMET profiling, and DFT analysis

Dengue fever is defined as a mosquito-borne Flaviviridae viral infection. It has become a huge public health issue worldwide. Dengue research has grown in recent years. The structure of the viral genome has been decoded, with the nonstructural protein NS5 acting as a possible target. The NS5 compound has an MTase domain contributing in RNA capping, adding an RdRp domain contributing in viral replication process. On the light of considering the NS5 as a possible medicinal target, this research included molecular docking studies executed using the Schrödinger suite software to examine 1412 compounds that were 80% similar to s-adenosyl-l-homocysteine,Top five compounds were chosen based on their sTable binding energies comparing to the reference. We next used the pkcsm web server to examine the ADMET characteristics of the top five ligands. Four compounds were identified as promising candidates for future therapeutic development. Finally, further analyzed using density functional theory approach.

Addressing the Dengue fever challenges in Nigeria: A narrative review and recommendations for control.

Dengue fever is a mosquito-borne viral infection that continues to pose a significant public health threat globally, including Nigeria. Here, we provided a review of dengue fever outbreaks in Nigeria from 1972 to 2023, examining the epidemiology, prevention strategies, challenges faced in combating the disease, and recommendations to mitigate its spread and transmission. We utilized scholarly databases such as PubMed and Google Scholar in writing this paper. The search keywords like, "dengue fever", "break-bone fever", "dengue fever virus" "outbreak", "Nigeria", "prevalence", and "epidemiology", were used to get appropriate published articles about the subject areas. Over the past five decades, Nigeria has experienced intermittent outbreaks of dengue fever, with varying degrees of severity and geographic distribution. Factors such as urbanization, climate change, and inadequate healthcare infrastructure have contributed to the resurgence and spread of the disease in the country. Despite efforts to control dengue transmission through vector control measures and public health interventions, challenges persist, including limited surveillance capacity, diagnostic delays, and gaps in vector control strategies. The emergence of new dengue virus serotypes and the potential for co-circulation with other arboviruses further complicate control efforts. This review highlights the importance of strengthening surveillance systems, enhancing vector control measures, improving diagnostic capabilities, and increasing public awareness to effectively mitigate the burden of dengue fever in Nigeria. Collaboration between government agencies, healthcare providers, researchers, and international partners is crucial in addressing the growing threat of dengue fever and reducing its impact on public health in Nigeria.

Precision Medicine in Dengue Management: Advancements and Challenges

Dengue, a globally impactful mosquito-borne viral infection, is explored in Dr. Richa Gupta and Mansi Bhandari’s review on precision medicine. With an annual toll of 390 million infections and 22,000 deaths, primarily affecting children, dengue places immense strain on healthcare systems. The absence of specific antiviral medication makes supportive care the prevailing treatment

Awareness of Dengue Disease among Female Community Health Volunteers of Sainamina Municipality, Nepal

Dengue is a mosquito-borne viral infection that is a major public health problem in Nepal. Female community health volunteers play a vital role in dengue prevention and control by providing health education and services to the community. This study aimed to provide a comprehensive understanding of the level of dengue awareness among female community health volunteers in Sainamina Municipality, Nepal. This study involved a cross-sectional survey of 50 female community health volunteers aged 20 and above, actively engaged in health-related activities in Sainamina Municipality. A structured questionnaire was used to gather information on their knowledge of dengue transmission, symptoms, preventive measures, and available treatments. The findings revealed that 98 percentage of the female community health volunteers had a general knowledge of dengue, but there was some confusion regarding the specific mode of transmission. Their knowledge about the signs and symptoms, transmission routes, and preventive measures was inadequate. Only 74 percentage identified that dengue is transmitted through the bite of an infected Aedes mosquito. Additionally, 48 percentage of respondents were able to identify the Aedes mosquito, and 36 percentage knew that there was no specific medicine for dengue patients. Targeted efforts are needed to address the areas of confusion among the female community health volunteers and enhance awareness of comprehensive prevention strategies. It is recommended to conduct training, provide educational materials, and encourage them to share their knowledge with their communities to improve dengue awareness and prevention efforts.

Mathematical Modeling for Dengue Fever Transmission Dynamics in Kebri Dehar District, Somali Regional State, Ethiopia

Dengue is a mosquito-borne viral infection and is transmitted to humans by the bite of an infected female Aedes mosquito of the species Aedes Aegypti and Aedes Albopictus. In this study, we developed and analysed a Susceptible-Infected-Recovered-Susceptible (SIRS) mathematical model which describes the transmission dynamics of dengue in Kebri Dehar district of Somali regional state. To achieve the objective of the study, we employed different mathematical tools and available cumulative cases data from Kebri Dehar district health office. The model was developed using a system of nonlinear ordinary differential equations and we performed analysis for both local and global stability of the equilibrium points of the model and the basic reproduction number for the year 2017 to 2021 is R_0 ≈ 0.0421071. In addition the parameters of the model are estimated by using the confirmed dengue cases of Kebri Dehar district for the year 2017 to 2021. Moreover, we studied numerical simulation and sensitivity analysis of the based on reproduction number that revealed the death rate of the mosquitoes and the host transmission rate are the most influential parameters. Our results suggest that the prevention of mosquitoes from humans (measure to decreasing transmission rate from mosquito to human) and any measure the increases the mortality of mosquitoes can significantly reduce the infection of dengue fever and may reduce further spread of infection in the community.

Public knowledge, belief, and preventive practices regarding dengue: Findings from a community-based survey in rural Bangladesh.

Dengue fever, the most prevalent mosquito-borne viral infection, is a recurrent public health threat in Bangladesh. Despite the government's efforts, dengue outbreaks are on the upswing, and people's knowledge, belief, and preventive practices regarding the disease at the rural community level are unclear. The objective of this study was to assess the level of knowledge, belief and preventive practices regarding dengue and associated factors among community people from rural Bangladesh. A cross-sectional survey was conducted involving 401 people using a convenient sampling technique from three unions of Savar from August to September 2021. Participants' responses were collected through face-to-face interviews using a pre-tested structured questionnaire that included information related to socio-demographics, dengue-related knowledge, preventive practices, and the health belief model (HBM) constructs. Multiple linear regression analysis was performed to determine the factors associated with the knowledge and preventive practices of dengue. Overall, participants (mean age = 33.47 ± 12.96 years; age range = 18-75 years) correctly answered 66.15% of the knowledge questions regarding dengue. Higher education, travel to dengue-risk regions, and self-efficacy under the HBM construct were all shown to be strongly associated with dengue knowledge. Regarding HBM constructs, about 80% of the participants perceived dengue as dangerous, but less than half (41.4%) believed themselves susceptible to dengue. Considering perceived barriers, 73.07% of the participants believed their residential area was not suitable for Aedes mosquito breeding. Nearly all (93.52%) believed they always kept their surrounding area clean as part of self-efficacy. Moreover, on average participants engaged in 53.69% of all dengue preventive practices. Being older, female, having a higher education, being a service holder, having a good quality of house structure, and perceived susceptibility as well as self-efficacy under the HBM construct were all factors in participants' dengue prevention activities. Participants' dengue preventative practices were shown to be significantly influenced by their knowledge. The findings of this study found a moderate level of knowledge regarding dengue among the participants. Regarding dengue prevention, although participants scored highly in several indicators, the overall preventive practices were not satisfactory. This suggests that there is a pressing need for expanded education outreach aimed at increasing public awareness of dengue and encourage preventive practices within rural communities in Bangladesh.

Incidence of Liver Damage Related to a Patient with Dengue

Dengue, a mosquito-borne viral infection, is a global health concern with a substantial burden of disease. This bibliographic review article delves into the incidence of liver damage related to dengue, offering insights into the epidemiological aspects, clinical importance, severity criteria, complications, and medical management. With a focus on scientific language and a medical journal-like approach, this review contributes to a comprehensive understanding of the relationship between dengue and liver damage, highlighting the need for vigilance in clinical practice.

Normalization of RT-PCR protocol for detecting dengue viral RNA in infected clinical residual serum samples

Among mosquito-borne viral infections, dengue tops the list with a high prevalence of all four serotypes, especially in tropical regions. The disease has disseminated in over 100 countries and has become a global threat, mainly affecting young individuals. Detecting the dengue virus in clinical samples has a significant role in diagnosing, treating, epidemiology, surveillance, predicting outbreaks etc. To accomplish this, RT-PCR technology has become a practical way out. Although PCR has reached its cutting edge with its improved versions being available, the conventional form of it has still retained the standard for generating more accurate and reliable results cost-effectively. In the present study, the conventional RT-PCR protocol was normalized for detecting dengue viral RNA in infected clinical residual serum samples by adopting a few previous protocols with required modifications. This procedure, with necessary precautions considered particularly for residual samples, resulted in obtaining expected amplicon bands in three samples. Additionally, Sanger sequencing of the amplicons and NCBI nucleotide BLAST analysis of obtained sequences assured the RT-PCR outcomes. The benefits of using clinical residual samples in dengue research encouraged us to make the PCR protocol suitable for such samples by tackling their limitations.

Updates in the Management of Dengue Shock Syndrome: A Comprehensive Review.

Dengue is a very serious public health problem that can manifest a wide range of symptoms from asymptomatic to fatal conditions, such as dengue shock syndrome (DSS). It is a life-threatening mosquito-borne viral infection widely spread in tropical areas. Dengue virus transmission occurs from an infected Aedes mosquito to humans. Various factors are responsible for the occurrence of the disease, such as viral load, age of the host, immune status of the host, and genetic variability. Dengue infection occurs in three phases: febrile, critical, and recovery. The febrile phase lasts for seven daysand manifests symptoms such as high-grade fever, headache, arthralgia, and backache, andin some cases, the upper respiratory tract and gastrointestinal tract are also involved. Severe dengue is characterized by endothelial dysfunction that causes vascular permeability and plasma leakage. The fundamental mechanisms of these immune pathologies are not yet known. Dengue manifests various complications such as dengue encephalopathy, encephalitis, stroke, ocular involvement, acute transverse myelitis, myalgia, and cerebellar syndrome, but the most commonly seen is liver involvement. Dengue is managed supportively because there are no proven curative treatments. The cornerstone of care during the critical period of dengue is prudent fluid resuscitation. The first fluid of preference is a crystalloid. Prophylactic transfusion of platelets is not advised. The occurrence of four antigenically different dengue virus serotypes, each able to elicit a cross-reactive and disease-enhancing antibody response against the other three serotypes, has made the creation of the dengue vaccine a difficult undertaking. The development of a dengue vaccine has faced significant challenges due to a lack of the best animal models and a variety of immunological conditions in people, particularly in endemic locations. Dengvaxia is a live attenuated vaccine, which was developed by Sanofi. It is made up of four chimeric vaccine viruses produced by Vero cells.

Dengue Fever in India - A Review

Dengue fever is generally a mosquito borne viral infection which is transmitted from female Aedes Aegypti mosquito to human or infected human to mosquito, this virus is classified into five serotypes. Presenting features may range from asymptomatic to symptomatic (High grade fever, vomiting, hemorrhage, joint pain, headache ..etc.) Early and accurate diagnosis is critical to reduce mortality. Hematological tests includes RBC count, WBC count and Platelet count. We can protect ourselves from mosquito bites by using mosquito nets treated with Permethrin and getting rid of mosquito breeding sites. It is important to see a doctor when the symptoms become severe. Keywords: ,,, ,

Anaesthetic management of pregnant patients with severe dengue fever for emergency caesarean section - A case series and review

: Dengue, a mosquito-borne viral infection, can lead to severe complications like dengue shock syndrome and severe thrombocytopenia. Pregnant patients with dengue present unique anaesthetic challenges. In this case series, we present the anaesthetic management of four pregnant patients with dengue who required emergency caesarean delivery.: All patients had severe thrombocytopenia and required platelet transfusions. Two patients developed respiratory distress and pulmonary edema in the perioperative period. One patient had severe liver function abnormalities along with thrombocytopenia, complicating the diagnosis. All patients received intensive care unit (ICU) management. None of the neonates tested positive for dengue.: The pathophysiological changes of pregnancy and dengue infection complicate the anaesthetic management of critically ill dengue patients. Thrombocytopenia and abnormal immune response lead to acute vascular permeability, plasma leakage, circulatory insufficiency, and polyserositis. Abnormal liver function tests and thrombocytopenia must be differentiated from HELLP syndrome. Over-transfusion of fluids due to shock can lead to pulmonary edema.: Pregnant patients with dengue fever pose a high risk of maternal and foetal mortality and morbidity. Successful anaesthetic management requires judicious transfusion of blood products and fluids based on the disease's complications and stage of illness. General anaesthesia is safe in these patients.