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PubMed2000

Public health implications of dengue in personnel returning from East Timor.

In north Queensland the vector of dengue fever (Aedes aegypti) is present; hence any viraemic individual importing dengue has the potential to transmit the disease locally. In early 2000 approximately 2,000 personnel returned from East Timor to Townsville, north Queensland. Seven importations of dengue occurred and individual cases were viraemic for up to 6 days in Townsville. No subsequent local transmission occurred. There were 3 cases each of dengue type 2 and dengue type 3. One case could not be serotyped. A response, including mosquito control measures, was initiated in another 18 cases in which dengue fever was clinically suspected but which subsequently proved not to be dengue. The planning and processes undertaken to prevent local transmission of dengue in Townsville during an intense period are described.

Dengue↗
PubMed1983

Transovarial transmission of dengue viruses by mosquitoes: Aedes albopictus and Aedes aegypti.

Transovarial transmission of all four dengue serotypes was demonstrated in Aedes albopictus mosquitoes. The rates of such transmission varied with the serotype and strain of virus. In general, the highest rates were observed with strains of dengue type 1 and the lowest with dengue type 3. Surprisingly, despite the use of viral strains of the four dengue serotypes which gave the highest rates with Ae. albopictus, transovarial transmission was observed in Aedes aegypti only with dengue type 1, and then only at a relatively low rate. Five different strains of Ae. aegypti were employed, including one that was known to be relatively susceptible to oral infection with dengue viruses. The findings support the view that Ae. aegypti, while of major importance from the point of view of transmission of dengue to man, may be relatively unimportant in the overall natural history of dengue viruses.

Aedes↗
PubMed2006

Dengue fever in malaria endemic areas.

OBJECTIVE: To determine the clinical presentation and frequency of dengue fever in patients presenting with acute febrile illness. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Attock in collaboration with Armed Forces Institute of Pathology, Rawalpindi from November 2003 to October 2004. PATIENTS AND METHODS: Patients presenting with acute febrile illness were screened for clinical features of dengue fever (DF). Dengue specific IgM was performed in clinically suspected cases. In addition, peripheral smear for malarial parasites and complete blood counts were performed. RESULTS: Eight hundred patients with fever of less than 2 weeks duration were encountered. Twenty-two (2.75%) presented with the characteristic features of DF. Dengue specific IgM was detected in 11 patients (50%). Nine out of 11 (81.8%) dengue specific IgM positive patients were also positive for malarial parasites on peripheral smear. Out of 11 DF patients, 8 patients (78%) were cured and 3 (28%) died. CONCLUSION: Dengue fever should be suspected if patient presents with bleeding manifestations, retrobulbar headache, severe myalgias and/or thrombocytopenia. Malaria and dengue may co-exist; dengue should be excluded in clinically suspected cases by laboratory investigations. Furthermore, surveillance strategies, preventive measures and healthcare workers' education is critical for curtailing this problem.

Dengue↗
PubMed2001

Generation of IgM anti-platelet autoantibody in dengue patients.

Dengue virus infection causes a wide range of diseases from dengue fever to life-threatening dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS). The mechanisms involved in DHF/DSS pathogenesis remain unclear. Patient sera collected from an outbreak in southern Taiwan from November 1998 to January 1999 were studied. The presence of antibodies which cross-reacted with platelets could be detected in patient sera, and the isotype of these autoantibodies was IgM. The anti-platelet IgM levels were higher in DHF/DSS than in dengue fever patient sera in disease acute phase. These autoantibodies were still detectable in convalescent stage (1-3 weeks after acute phase) and even eight to nine months after illness. The platelet binding activity was not observed in other virus-infected patient sera tested. Further investigation showed that dengue patient sera caused platelet lysis in the presence of complement. The platelet cytotoxicity induced by DHF/DSS patient sera was higher than that by dengue fever sera. Dengue patient sera also inhibited platelet aggregation which, however, appeared to be not related to DHF/DSS development.

Acute Disease↗
PubMed2005

Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi.

Dengue, an important human arboviral infection, is endemic in many parts of India. Outbreaks are now reported quite frequently from different parts of the country. We report here findings of serological investigation of serum samples received during a recent outbreak of dengue infection in Delhi from September to November 2003. Acute phase serum samples from suspected cases of dengue infection (including dengue fever, dengue haemorrhagic fever and dengue shock syndrome) of duration 5 days, were tested for dengue specific IgM antibodies by enzyme linked immuno sorbant assay (ELISA). Of the 874 serum samples tested, 456 (52.3% ) were positive for dengue specific IgM antibodies. The maximum number of positive cases was reported in October, peaking in second and third week. Patients in the age group of 21-30 yr accounted for 34.2 per cent of positive cases. This outbreak was less severe as compared to the previous 1996 outbreak and showed a shift towards an older age group.

Adolescent↗
PubMed2004

Prevalence of dengue virus in Aedes mosquitoes during dry season by semi-nested reverse transcriptase-polymerase chain reaction (semi-nested RT-PCR).

Dengue hemorrhagic fever remains a major health concern in Thailand. Much effort has focused on the prevention and control of the disease. Detection of dengue virus infection rate in mosquitoes would evaluate dengue control programs and predict the epidemics of dengue hemorrhagic fever. To determine dengue virus infection rate in mosquitoes by Semi-nested RT-PCR. A total of 400 mosquitoes were collected from Rom Kao Community representing a crowded community and another 9 non-crowded communities in Bangkok. Mosquitoes were then divided into 40 pools, each contained 10 mosquitoes. A total of 391 Aedes aegypti and 9 Aedes albopictus were screened for dengue virus. The mosquito infection rate in the Rom Klao community was 5% of the mosquito pool equal to that found in non-crowded communities. Both groups were found to have dengue virus serotype 3. The present study suggests a circulation of dengue virus serotype 3 in both crowded and non-crowed communities, the infection rates of which are indifferent during the dry season.

Aedes↗
PubMedDate not supplied

Profile of liver involvement in dengue virus infection.

BACKGROUND: Data are scarce on liver involvement in adult patients with dengue virus infection. METHODS: During a recent outbreak of dengue fever in Uttar Pradesh, India, we looked for evidence of liver dysfunction among patients with dengue fever. RESULTS: A total of 45 patients with dengue fever (age 7-65 [median 33] years; 29 men; 39 adults) were studied, including 23 with uncomplicated dengue fever, 15 with dengue haemorrhagic fever and 7 with dengue shock syndrome. The median platelet count was 34 x 10(9)/L (9-99 x 10(9)). Seven patients (15%) had jaundice, 11 (24%) hepatomegaly and 9 clinically detectable ascites; none had splenomegaly. Twelve patients (30%) had hyperbilirubinaemia. Serum alanine and aspartate aminotransferase activities were elevated in 43 patients (96%) each; 5-fold elevated levels were more frequent in severe disease. Hypoalbuminaemia was found in 31/41 patients (76%). Seven patients died, including 2 with acute liver failure. CONCLUSION: Our data show that liver injury is common in adult patients with dengue infection. Further studies are needed to determine the mechanism of liver injury in this disease.

Adolescent↗
PubMed2005

An outbreak of dengue fever in periurban slums of Chandigarh, India, with special reference to entomological and climatic factors.

BACKGROUND: Dengue viral infection is one of the most important public health problem in tropical countries. AIM: An outbreak of dengue fever was investigated in a periurban slum area of Chandigarh, India, during September to December, 2002. MATERIALS AND METHODS: Blood samples from 218 patients and 30 apparently healthy contacts were tested for dengue-specific immunoglobulin M (IgM) and IgG antibodies including 80 acute samples collected within 5 days of illness were subjected for virus isolation in newborn mice. The average temperature, rainfall, and humidity of the epidemic year were compared with the number of dengue cases. STATISTICAL ANALYSIS: statistical significance was found out using c2-test. RESULTS: A total of 76 cases were positive by either dengue IgM capture assay (n = 57) or virus isolation (n = 17) or both (n = 2). Fifteen of nineteen viral isolates subjected for typing by type-specific multiplex reverse transcription-polymerase chain reaction were found to be of dengue virus. High rainfall and humidity with the temperature range from 21 degrees C to 33 degrees C during the months of August and September might have favored the breeding of mosquitoes, thus leading to an increase in the number of dengue cases in October and November, 2002. CONCLUSION: The present outbreak thus emphasizes the need for continuous sero epidemiological and entomological surveillance for the timely implementation of effective dengue control programme.

Adolescent↗
PubMedDate not supplied

Dengue fever with acute liver failure.

A virus belonging to the Flaviviridae group causes dengue haemorrhagic fever. Dengue presenting as acute liver failure is rare. Dengue is endemic in India. The last epidemic of dengue occurred in Delhi in 2003. During this epidemic, 2185 confirmed cases of dengue were reported. Dengue virus serotypes 2 and 3 were responsible for this epidemic. A 19-yr-old male presented to our hospital with the complaints of fever for 12 days, during this epidemic. He was diagnosed as having dengue shock syndrome, stage IV with acute liver failure. He had primary dengue infection. He made complete recovery with supportive management.

Adult↗
PubMed2006

Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients.

Dengue virus infection can cause mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Cytokines are believed to be involved in the pathogenesis of dengue infection. However, the role of the pro-inflammatory cytokine macrophage migration inhibitory factor (MIF) in dengue infection is unclear. In this study, serum levels of MIF in adult dengue patients with different disease severity and clinical outcome were determined and compared with the levels of other cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-10, and interferon gamma (IFN-gamma), in the same patients. Serum levels of MIF, IL-6, and IL-10, but not IFN-gamma or TNF-alpha, were higher in all DHF patients who died than in DHF survivors and DF patients. We conclude that in addition to IL-6 and IL-10, elevated levels of serum MIF are a potential predictor of disease severity and clinical outcome in dengue patients.

Adult↗
PubMed2006

[Abnormal clinical manifestations of dengue hemorrhagic fever in children].

INTRODUCTION: Recently, dengue hemorrhagic fever with unusual neurological and hepatic manifestations has been reported in children, with a concomitant increase in morbidity and mortality. OBJECTIVE: To describe unusual clinical manifestations of dengue hemorrhagic fever in children. MATERIALS AND METHODS: These manifestations were systematically scrutinized in dengue cases occurring between 1992-2004 in the Pediatrics Department of the University Hospital of Santander, Bucaramanga, Colombia. Case reports were examined of 913 patients with clinical symptoms of dengue hemorrhagic fever. They were classified according to standard criteria for dengue hemorrhagic fever and grouped according to the main organs or systems that were affected. Clinical presentation, laboratory results and medical evolution were summarized. RESULTS: Of the 913 cases, 168 showed abnormal clinical manifestations; these were predominant in male school age children and associated mainly with grades III and IV of dengue hemorrhagic fever. The most frequent manifestations were as follows: hepatitis--53 cases (27%), neurological alterations--49 (25%), renal impairment--14 (7%), cardiac involvement--15 (8%), pulmonary alterations--18 (9%), alithiasic cholecistitis--18 (9%), haemophagocitic syndrome--5 (2.5%), pancreatitis--2 (1%), and acute abdominal pain--21 (11%). Ten patients died. CONCLUSIONS: The results were compared with data from other endemoepidemic countries of dengue. The significance and importance of abnormal dengue were explored, as well as the difficult retrospective diagnoses. Hepatic and neurological manifestations were recognized as frequently involved in elevated morbidity and mortality. Physicians working in endemic zones should be aware of them in order to recognize them.

Adult↗
PubMed1986

Characterization with monoclonal antibodies of human lymphocytes active in natural killing and antibody-dependent cell-mediated cytotoxicity of dengue virus-infected cells.

Non-immune human peripheral blood lymphocytes (PBL) lyse dengue virus-infected cells to a greater degree than uninfected cells. In the present study, the PBL active in lysing dengue virus-infected Raji cells are characterized using monoclonal antibodies and are compared to lymphocytes that lyse K562 cells. Leu11+ cells lyse dengue virus-infected cells and K562 cells. Leu11- cells lyse dengue virus-infected cells, but not K562 cells. In the Leu11+ fraction, Leu11+ Leu7- cells are more active than Leu11+ Leu7+ cells in lysing dengue virus-infected cells. T3+ cells also lyse dengue virus-infected cells, but they do not lyse K562 cells. T3- cells lyse both target cells. These results, along with the observation that Leu11+ cells and T3+ cells are different subsets of PBL, indicate that the PBL that are active in lysing dengue virus-infected cells are heterogeneous and are contained in Leu11+ and T3+ subsets. Leu11+ cells are more active than T3+ cells. Leu11+ cells are active in lysing dengue virus-infected cells by antibody-dependent cell-mediated cytotoxicity, whereas T3+ cells are not active.

Antibodies, Monoclonal↗
PubMed1994

Ecology and control of dengue vector mosquitoes in Taiwan.

Due to rapid urbanization, industrialization and social changes in recent years, the use of packing materials and tires has dramatically increased in the Taiwan area. What is more is that some parts of southern Taiwan are short of water resources and water preservation with huge containers becomes part of custom in those areas. Storage water containers, waste vessels and tires are good habitats for Aedes. Meanwhile, some persons traveling to dengue endemic countries bring the dengue disease back to Taiwan. Surveys taken since 1988 show that dengue occurs mainly in the urban and coastal areas where Aedes aegypti is prevalent. This species is the most important, if not the only, vector of dengue in Taiwan. It appears that the types of Aedes breeding have changed quickly. In dengue fever epidemic areas, the most popular breeding sites are ornamental containers (38.8%), storage water containers (30.1%), discarded containers (25.4%), receptacles (3.3%) and water collection in the basement (2.2%). In dengue fever epidemic areas, those building basements, huge water containers, waste vessels and waste tires in open fields are most difficult to clean up and manage and become the most popular Aedes habitats. We established a waste recycling system and promoted a breeding site reduction campaign for waste management, including the application of Temephos in containers to kill larvae. For the drinking water management, fish were released in water containers to prevent larval breeding. It should be mentioned that with the integrated pest control and regular inspections of Aedes larvae in Taiwan the density figures 1, 2-5, and 6 or above for Aedes aegypti were 38.7%, 42.9%, and 18.4%, respectively, in 1988, and in 1993 were 90.8%, 9.2% and 0%. The incidence of dengue fever cases has 98% decreased since 1988. In 1990 and 1993, there was no indigenous cases. We have concluded that integrated pest control is the best and most effective method for dengue fever control, including solid waste and drinking water management.

Aedes↗
PubMed1994

[Dengue: an disease imported from the Indian subcontinent].

BACKGROUND: The febrile syndrome is one of the most frequent diseases in travellers with transient clinical pictures, not being reported on many ocassions. In Spain no cases of dengue fever has been published so far. METHODS: A prospective clinical study was carried out in travellers from endemic zones with serologic diagnosis for dengue viruses being performed: IgM/IgG by hemagglutination inhibition and ELISA enhancement. RESULTS: Six cases of dengue are described in Spanish travellers (4 tourists and 2 workers) from the Indian subcontinent (1989-1992). Serologic diagnosis: IgM/IgG by hemagglutination inhibition and ELISA enhancement was carried out. Five cases presented with classical dengue fever picture and 1 with hemorrhagic dengue. In all cases, fever and thrombopenia were reported. The clinical picture was self-limited in 2 patients, complicated with post-dengue syndrome in 3 cases and with fatal outcome in 1. CONCLUSIONS: Dengue fever should be included in the differential diagnosis of febrile syndrome in travellers coming from endemic zones. The authors present the first cases of imported dengue in Spain.

Adult↗
PubMed1997

[Surveillance and active search of suspected cases of hemorrhagic dengue in Ribeirão Preto, São Paulo].

A clinical-epidemiological case study was carried out to evaluate a surveillance and active search system for suspect cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) during a dengue epidemic in the Ribeirão Preto municipality, State of São Paulo, Brazil, between November 1990 and March 199. This was the first dengue epidemic ever recorded in this region. Although dengue is a growing public health problem in Brazil, and DHF/DSS has been reported to be evolving in the Americas, health officials have shown a passive attitude towards the disease, partly due to lack of experience. Reporting dengue occurrences, both of isolated cases and of epidemics, is essential to reduce mortality. The data analyzed were collected through the official epidemiological surveillance system during the 1990-1991 epidemic. Out of 2,521 confirmed cases of dengue, 34 cases of febrile acute illness with hemorrhagic manifestations were identified as possible cases of DHF/DSS, as well as two deaths associated to dengue. From these 36 cases, 12 cases were confirmed by laboratory exams as dengue with hemorrhagic manifestations. Examinations of clinical and laboratory data, and results of the autopsies suggested that the two deaths were cases of primary DHF/DSS. The difficulty of the health system in establishing the clinical suspicion of DHF/DSS was confirmed in the study. This resulted in delayed and inadequate clinical procedure. The present study also confirmed the need for a permanent active epidemiological surveillance system for the early identification of DHF/DSS suspect cases thus enabling quick and adequate control actions.

Adolescent↗
PubMedDate not supplied

Retrospective study on dengue fatal cases.

Immunohistochemical procedure (avidin biotin peroxidase complex) was applied in formalin-fixed and paraffin-embedded tissues obtained from 5 fatal cases of dengue infection associated with encephalopathy. Dengue virus antigen was demonstrated in the cytoplasm of phagocytic mononuclear cells from liver, spleen, and lung. Moreover, dengue viral antigens were here, to our knowledge, first demonstrated in the central nervous system (CNS) and numerous immunolabelled cells were found in brain sections from 3 cases. Extended immunohistochemical studies carried out in 1 case showed virus-positive cells mostly located within Virchow Robin space of medium size and small veins, infiltrating the white and grey matter, and often situated close to neurons displaying apparent cytopathic features. Furthermore, immunostaining for CD68 antigens demonstrated that most CD68+ macrophages and dengue antigen-positive cells share similar morphology and localization, suggesting a unique identity for at least part of these cells. Since in dengue fever, virus replicates mostly in cells of macrophage lineage, our results seem to indicate that infiltration of virus-infected macrophages could be one of the pathways by which viruses enter the brain in dengue encephalitis. Whether bone marrow-derived infected macrophages and viral-free particles induce CSN lesions through immune, metabolic, and/or direct viral-induced mechanisms will be essential to better understand the pathogenesis and provide new therapeutic strategies for dengue-associated encephalitis. As the evidence of tissue damage was nonspecific, the detection of virus antigen by immunoperoxidase technique appeared to be highly reliable for dengue diagnosis.

Adolescent↗
PubMed1997

Prevalence of infection with dengue virus among international travelers.

BACKGROUND: Dengue has been recognized as a potential hazard to tourists. A prospective, controlled study in the outpatient clinic of a German infectious disease clinic was conducted to assess the prevalence of dengue virus infection among international travelers. METHODS: Serum samples from 130 patients with signs or recent history clinically compatible with dengue (fever, headache, muscle and joint pain, or rash), 95 matched controls with diarrhea, and 26 patients who never visited a country endemic for dengue were investigated. RESULTS: Nine (6.9%) of the 130 patients with compatible symptoms and 1 (1%) of the 95 controls with diarrhea developed rising antibody titers against dengue virus. Of these 10 patients with probable dengue infection, 6 had been to Thailand, 2 to Malaysia, and 1 each to Indonesia and Brazil. CONCLUSIONS: Infection with dengue virus appears to be a realistic threat to travelers to Southeast Asia. Symptoms commonly associated with dengue, such as fever, myalgia, arthralgia, and vomiting, can be helpful for diagnosis when present, but the absence of typical symptoms does not exclude infection.

Acute Disease↗
PubMed1997

Dengue virus infection--the Malaysian experience.

Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The case fatality rate varied from a high of 10.43% in 1985 when dengue type 3 was the predominant type to a low of 1.29% when dengue type 1 predominated. Severe disease patterns have been observed with dengue 2 and 3 serotypes in the country. The clinical spectrum has also been changing and multisystem involvement with more severe manifestations are being seen. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye's syndrome. Dengue type 3 has been isolated from liver biopsy specimens. Neurological manifestations can very from irritability, convulsions, coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluids recently strongly suggests that dengue viruses can be neurovirulent. Adult respiratory distress syndrome was seen in three children admitted with shock. Deaths were more frequent in children in the early period but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.

Adult↗