Shock Syndrome Research Articles

Association of systemic vitamin D on the course of dengue virus infection in adults: a single-centre dengue cohort study at a large institution in Singapore.

Host immune responses may impact dengue severity in adults. Vitamin D has multiple immunomodulatory effects on innate and adaptive immunity. We evaluated the association between systemic 25-hydroxyvitamin D [25-(OH) D] and dengue disease severity in adults. We measured plasma for total 25-(OH) D levels with an electrochemiluminescence immunoassay using stored samples from participants with laboratory-confirmed dengue, who were prospectively enrolled in 2012-2016 at our institution. A total of 80 participants (median age 43 years) were enrolled in the study. Six participants had severe dengue based on the World Health Organization (WHO) 1997 criteria (i.e. dengue haemorrhagic fever/dengue shock syndrome) and another six had severe dengue based on the WHO 2009 criteria. Median 25-(OH) D at the acute phase of dengue was 6.175 (interquartile range 3.82-8.21, range 3.00-15.29) mcg/L in all participants. The 25-(OH) D showed an inverse linear trend with severe dengue manifestations based on the WHO 2009 criteria (adjusted risk ratio 0.72, 95% confidence interval 0.57-0.91, P < 0.01) after adjustment for age, gender and ethnicity. Limited studies have evaluated the role of systemic 25-(OH) D on dengue severity. Our study found low systemic 25-(OH) D was associated with increased dengue disease severity, particularly for severe bleeding that was not explained by thrombocytopenia. Further studies investigating the underlying immune mechanisms and effects on the vascular endothelium are needed.

Chest Pain in a Patient with Dengue Fever Resembling Acute Myocardial Infarction: A Case Report

Dengue is an arthropod-borne viral disease. Dengue fever may present with dengue hemorrhagic fever/dengue shock syndrome. Now a days some atypical and rare manifestations are noticed involving liver, central nervous system and heart. Here we reported a case of dengue fever in 25 years young man having high level of cardiac biomarkers and ECG changes mimicking myocardial infarction initially but later on further evaluation of the case confirmed as acute myocarditis due to dengue fever. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 99-102

PREVALENCE AND SPECTRUM OF OPHTHALMIC MANIFESTATIONS OF DENGUE: OUR EXPERIENCE IN A NORTH INDIAN TERTIARY CARE INSTITUTE

Objective: This article puts forward various ocular findings and its prevalence in hospitalized patients with confirmed Dengue serology. The aim is to spread awareness about these findings and call for complete eye examination in patients of dengue fever so that the ocular findings are not missed. Methods: This is a cross-sectional study, conducted on confirmed cases of 112 dengue patients in Dengue isolation ward in a tertiary care hospital, Government Medical College, Patiala, India, during and after the monsoon season. Results: Various fundus findings in dengue fever seen in our study are Dot blot hemorrhages, cotton wool spots, macular hemorrhages, macular edema, Roth spots, vascular sheathing, hard exudates, and sub-conjunctival hemorrhage. Cumulative prevalence of these findings was 9.82% in hospitalized patients of dengue fever. Blurring of vision was also a common symptom. Conclusion: Ocular findings do occur in dengue fever, along with other systemic manifestations such as fever, headache, myalgia, arthralgia, retro-orbital pain, hemorrhagic fever, and shock syndrome. Ocular examination should be undertaken in all patients with dengue fever so that these findings are not missed. Further studies are needed to ascertain its pathophysiology.

Dengue Hemorrhagic Fever and Non Immune Hemolytic Anemia: Two Recherché in Alliance

Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retro orbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported called expanded dengue syndrome. We report a 42 years old lady with atypical and rare presentation of dengue disease marked by non immune hemolysis following the critical phase of infection. Condition improved after conservative treatment. Hematological complications in dengue are now increasingly observed with the most common case is cytopenias and bleeding. Non immune hemolytic anemia in dengue is self-limiting in almost all cases. The main mechanism of hemolysis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for hematological complications in patients with dengue illness and should manage this accordingly.

Fever, Rash, Cytopenia, and Disseminated Intravascular Coagulation in a 6-year-old.

Fever, Rash, Cytopenia, and Disseminated Intravascular Coagulation in a 6-year-old.

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.

Clinical characteristic of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, Bali

Background: Mosquito-borne diseases are one of the most significant public health risks globally, and dengue fever seems to be one of the most important arboviral diseases in humans. In humans, dengue viruses are the supreme agents that cause dengue fever (DF) and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Following that, the virus's presence, sufficient numbers of susceptible populations, and mosquito vectors are required to transmit dengue infection. This study aimed to identify the clinical characteristics of dengue fever and dengue hemorrhagic fever among patients at Sanglah Hospital, Denpasar, BaliMethod: The study is a descriptive retrospective study design. The data was collected from the medical records of patients diagnosed with dengue and dengue hemorrhagic fever in Sanglah Hospital, Denpasar, Bali, from June 2015- June 2016. We took 50 patients according to sample size calculation by randomized sampling technic. Data were analyzed descriptively.Result: The study found the age range from 5 to 53 years old. The mean age for DF and DHF were 11 and 31, respectively. Secondly, the proportion of gender in this research was male by 21 (42%) and 29 (58%) female. Further to this, Denpasar showed the maximum number of cases between all the nine regencies. Both DF and DHF cases recorded the highest total cases in April 2016.Conclusion: Expected clinical characteristics prior knowledge and prognosticators of DF and DHF development will be able to provide data to detect persons who are higher risk category and provide adequate time to clinicians to lessen dengue related morbidity and mortality

Clinical importance of determination of procalcitonin in diagnosis of sepsis

The review presents an assessment of the dynamics of the change in procalcitonin as the main marker of bacterial inflammation in patients with the syndrome of systemic inflammatory reaction, sepsis and septic shock, clarification of the practical and predictive significance of PCT in patients with an identified and not identified focus of infection.

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

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

Clinical profile and outcomes of dengue fever during monsoon season at a tertiary care hospital in South India

Background: Dengue is a mosquito-borne infectious disease of the tropical and subtropical countries which is rapidly becoming a global burden. It is caused by any of the four serotypes of dengue virus. Dengue disease presentation varies from mild fever with myalgia and fatigability to severe conditions of dengue haemorrhagic fever and shock syndrome. This study describes the clinical features, laboratory parameters and outcomes of the dengue fever patients during the monsoon season in a tertiary care hospital.Methods: This is retrospective, single centre study carried out at Yenepoya medical college and hospital (YMCH), Mangalore a coastal town in southern India. All patients who were adults (aged&gt;16 years), positive for rapid (NS1 antigen) test or dengue IgM Elisa and admitted from 1-5-2019 to 31-9-2019 (monsoon season) were included in this study. Data was collected from the medical records of YMCH.Results: The male to female ratio of patients in this study was about 4:1. About 70.1% belonged to the age group between 16-35 years. The predominant symptoms on admission were fever, headache, myalgia, nausea and vomiting, abdominal pain, loose stools, bleeding manifestations and skin rashes. Average days of hospitalization are 5.88 days (SD 2.94). Thrombocytopenia leukopenia raised hematocrit and transaminases are the commonly observed laboratory findings. Ascites, pleural effusion, gall bladder wall edema, sepsis, bradycardia, hypotension, ARDS, and acute kidney injury are the complications observed during the illness. Mortality rate in this study is 1.9%.Conclusions: As seen in this study dengue fever is predominantly affecting the younger age group. The early confirmation of diagnosis, identifying the warning signs and prompt supportive management will help in preventing the further complications and in reducing the mortality. Increased public awareness and vector control measures are important factors to be taken into consideration in the prevention of dengue.

Prognosis factors for dengue shock syndrome in children

Background: Varied clinical manifestations, complex pathogenesis, and different viral serotypes make it difficult to predict the course of dengue disease. Many studies have been conducted on the prognostic factors for the occurrence of dengue shock syndrome (SSD), but all use the 2017 World Health Organization (WHO) guidelines. Aim: This study aims to determine the prognostic factors for the occurrence of SSD based on WHO guidelines in 2011. Method: Retrospective study using medical record data of pediatric patients aged 0 to &lt;18 years with a diagnosis of dengue fever dengue (DHF), SSD, and expanded dengue syndrome (EDS) that meet WHO criteria in 2011 at the reputable database from 2017 to December 2020. Independent variables, namely gender, age, nutritional status, secondary dengue infection, leukopenia, abdominal pain, gastrointestinal bleeding, hepatomegaly, and plasma leakage. Shock is the dependent variable. Multivariate analysis using logistic regression analysis. Results: Subjects who met the study criteria were 145 patients, 52 (35.8%) of whom had SSD. Five of 52 SSD patients went into shock during hospitalization. The bivariate analysis yielded significant factors including, malnutrition, overnutrition and obesity, gastrointestinal bleeding, hemoconcentration, ascites, leukocytes 5,000 mm 3, encephalopathy, enzyme elevation heart, and overload. The results of multivariate analysis showed that hemoconcentration variables and elevated liver enzymes were factors of SSD Prognosis. Conclusion: Hemoconcentration and elevated liver enzymes are prognostic factors for SSD.

Association between Body Mass Index and Type of Infection on the Severity of Dengue Infection in Bengkulu City, Indonesia

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dengue virus infection is a serious global health problem. The incidence has increased rapidly within the last 50 years. The clinical manifestations vary from Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), to Dengue Shock Syndrome (SSD). Some of the influencing factors are the Body Mass Index (BMI) and the type of dengue infection. The study aimed to determine the association between BMI and type of infection on the severity of dengue infection in adulthood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study used a cross-sectional design with a total sample of 39 patients diagnosed with dengue infection and fulfilling the inclusion criteria. The sampling technique was consecutive sampling. The data analysis used was the Spearman correlation test. Data collection was conducted by distributing research form which cover sample characteristics, BMI values, clinical manifestations, types of infection and the severity of dengue infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The total of subject obtained was 37 respondents (23 male and 14 female). The average BMI value was 24.65 ± 5.08. The most common clinical manifestations were fever (100%), nausea/vomiting (91.8%), headache (89.1%), myalgia (89.1%), and arthralgia (72.9%). Most cases of dengue infection were in the normal BMI group and the highest degree of severity was DD. There was a significant relationship with a fairly strong correlation value between BMI and dengue severity (p=0.003; r=0.478). However, there was no significant relationship between the type of infection (p=0.987; r=0.03) with the level of dengue severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Knowing the risk factors as predictors of dengue severity is very necessary in order to handle dengue infection quickly and accurately.&lt;/p&gt;

Revisiting the dengue epidemic of 2011 in Paraguay: molecular epidemiology of dengue virus in the Asuncion metropolitan area

BackgroundDengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen.MethodsThis was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis.ResultsDengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages.ConclusionsWe have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.

Diversity of Dengue Virus Serotypes in Dhaka City: From 2017 to 2021

This is a retrospective observational study aimed to search the alteration of circulating dengue virus (DENV) serotypes in Dhaka City for five consecutive years (2017-2021) along with disease outcome.&#x0D; Methods: Routine dengue NS1 or PCR positive dengue samples from patients who visited Evercare Hospital Dhaka (ex. Apollo Hospitals Dhaka) were selected for serotype determination by serotype specific real time reverse transcriptase PCR (RT-PCR).&#x0D; Results: In 2017, predominant serotype was DENV-2 (91.3%) with less than 5% of DENV-1 and DENV-3 among 161 cases. In 2018, among127 cases, DENV-2 was the predominant serotype (40.95%) followed by DENV-3 (33.07%) and DENV-1 (25.98%). In 2019, predominance of DENV-2 was totally replaced by DENV-3 (91.86%) and DENV-1 (8.14%). In 2021, only DENV-3 serotype was detected among 178 samples. Regarding serotype association with disease outcome, more severe cases (Dengue Hemorrhagic Fever/Dengue Shock Syndrome) were observed from 2019 with notable shifting of serotype dominance to DENV-3 from DENV-2 in previous years. In our cohort, the prevailing age group was 1-20 years which is analogous with many studies in Asia.&#x0D; Conclusion: Dominance of DENV serotype shifted to DENV-3 in 2019 from prolonged persistence of DENV-2 and DENV-1. Continuous surveillance for circulating DENV serotype is needed for preparedness of potential outbreaks and occurrence of severe cases.&#x0D; Bangladesh J Med Microbiol 2021; 15 (2): 23-29

Perspective of Immunopathogenesis and Immunotherapies for Kawasaki Disease.

Kawasaki Disease (KD) is an acute inflammatory illness that mostly occurs in children below 5 years of age, with intractable fever, mucocutaneous lesions, lymphadenopathy, and lesions of the coronary artery (CAL). KD is sharing clinical symptoms with systemic inflammatory syndrome in children (MIS-C) which is related to COVID-19. Certain genes are identified to be associated with KD, but the findings usually differ between countries and races. Human Leukocyte Antigen (HLA) allele types and toll-like receptor (TLR) expression are also correlated to KD. The acute hyperinflammation in KD is mediated by an imbalance between augmented T helper 17 (Th17)/Th1 responses with high levels of interleukin (IL)-6, IL-10, IL-17A, IFN-γ, and IP-10, in contrast to reduced Th2/Treg responses with lower IL-4, IL-5, FoxP3, and TGF-β expression. KD has varying phenotypic variations regarding age, gender, intravenous immunoglobulin (IVIG) resistance, macrophage activation and shock syndrome. The signs of macrophage activation syndrome (MAS) can be interpreted as hyperferritinemia and thrombocytopenia contradictory to thrombocytosis in typical KD; the signs of KD with shock syndrome (KDSS) can be interpreted as overproduction of nitric oxide (NO) and coagulopathy. For over five decades, IVIG and aspirin are the standard treatment for KD. However, some KD patients are refractory to IVIG required additional medications against inflammation. Further studies are proposed to delineate the immunopathogenesis of IVIG-resistance and KDSS, to identify high risk patients with genetic susceptibility, and to develop an ideal treatment regimen, such as by providing idiotypic immunoglobulins to curb cytokine storms, NO overproduction, and the epigenetic induction of Treg function.

Forms of drug allergy and various variants of its manifestation

Lately, the problem of drug allergy is becoming more and more urgent, which is a consequence of the wide availability of drugs and the widespread use of counterfeit drugs. According to some authors, the incidence of drug allergy reaches 60%. This pathological reaction is the result of the patient's individual intolerance to one or another medication, and is not inherently its side effect. In some cases, the ingestion of a minimum dose of a drug into the body is sufficient for a severe reaction to develop. Theoretically, any drug can cause an allergy, but there is a group of certain medications, to the ingestion of which an allergic reaction develops most often - these include antibiotics of the penicillin series, sulfonamides, analgesics, some antihypertensive drugs, B vitamins. An allergic reaction can develop with lightning speed, or it can manifest itself within a day. The most common forms of drug allergy include urticaria, Quincke's edema, and itchy rash (toxidermia). The most formidable manifestations of drug allergy are anaphylactic shock and Lyell's syndrome, which manifests itself in the form of total damage to the skin and mucous membranes.

Improving the therapy of generalized forms of Meningococcal infection in children using extracorporeal hemocorrection

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

BackgroundKlebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis.MethodsThis retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups, KPLA with sepsis and KPLA without sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings were analyzed.ResultsA total of 135 patients with KPLA were analyzed. The mean age of patients was 60.9 ± 12.7 years, and the percentage of men was 59.3%. Among them, 37/135 (27.4%) of patients had sepsis and the mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction compared to KPLA patients without sepsis (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently therapeutic strategy. Furthermore, the incidences of sepsis shock and acute respiratory distress syndrome were higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. In addition, KPLA patients with sepsis showed respiratory symptoms in 11 patients, endophthalmitis in 4 patients, and meningitis in 1 patient.ConclusionOur findings emphasize that KPLA patients combined with or without sepsis have different clinical features, but KPLA patients with sepsis have higher rates of complications and metastatic infections. Taken together, further surveillance and control of septic spread is essential for KPLA patients.

Dynamic thromboembolic left ventricular outflow tract obstruction after aggressive procoagulant treatment in hemorrhagic shock: a case report

BackgroundIn cases of hypertrophic obstructive cardiomyopathy (HOCM), the systolic anterior motion of the mitral valve apparatus results in an obstruction of the left ventricular outflow tract (LVOT), which is known as the SAM [systolic anterior motion] phenomenon. Hypothetically, a pathological obstruction of the LVOT of a different etiology would result in a comparable hemodynamic instability, which would be refractory to inotrope therapy, and may be detectable through echocardiography.Case presentationWe observed a severely impaired left ventricular function due to a combination of a thrombotic LVOT obstruction and distinctive mitral regurgitation in a 56-year-old Caucasian, female patient after massive transfusion with aggressive procoagulant therapy. Initially, the patient had to be resuscitated due to cardiac arrest after a long-distance flight. The resuscitation attempts in combination with lysis therapy due to suspected pulmonary artery embolism were initially successful but resulted in traumatic liver injury, hemorrhagic shock and subsequent acute respiratory distress syndrome (ARDS). Oxygenation was stabilized with veno-venous extracorporeal membrane oxygenation (ECMO), but the hemodynamic situation deteriorated further. Transesophageal echocardiography (TEE) showed a massive, dynamic LVOT obstruction. Two thrombi were attached to the anterior leaflet of the mitral valve, resulting in a predominantly systolic obstruction. Unfortunately, the patient died of multiple-organ failure despite another round of lysis therapy and escalation of the ECMO circuit to a veno-venoarterial cannulation for hemodynamic support.ConclusionMassive transfusion with aggressive procoagulant therapy resulted in mitral valve leaflet thrombosis with dynamic, predominantly systolic LVOT obstruction, comparable to the SAM phenomenon. The pathology was only detectable with a TEE investigation.

Intra-Serotype Polyprotein Variation and its Effect on Antigenicity of Dengue Virus

Dengue virus is a mosquito-borne human pathogen, causing disease that ranges from mild febrile illness to life-threatening hemorrhage fever/ shock syndrome. The altered antigenicity and virulence in the dengue virus, resulting from the accumulation and fixation of the favorable mutations in the genome, is the cause of concern nowadays. The present study focuses on the comparative study of polyproteins of viral strains within each dengue serotype to understand the trend of intra-serotype polyprotein variation and its effect on the antigenicity. Polyprotein sequences of viral strains in each serotype were investigated using multivariate statistical analysis, phylogenetic analysis and multiple sequence alignment methods. Epitope prediction was done by Bepipred-1.0 server and experimental epitope data were extracted from Immune Epitope Database with BLAST search. The study reveals that the polyproteins of viral strains of a serotype have variable amino acid composition that corresponds to the geographical regions of origin. This compositional variation has occurred due to the presence of polymorphic residues at different positions along the polyprotein sequence. The polymorphic residues have also been identified at epitope regions of structural proteins as well as NS1 of viral strains, possessing dissimilar physicochemical properties and occupy surface accessible positions. These positions on epitopes with polymorphic, dissimilar and surface accessible residues might act as putative sites for generation of antigenic variation among viral strains of a serotype of different geographical origin. Thus, these polymorphic residue positions on epitopes might be considered as putative target for development of drug or vaccine, in future.