A Cluster of Dengue Cases in Travelers: A Clinical Series From Thailand

Dengue is an overlooked tropical disease for which billions of people are at risk. The disease, caused by a Flavivirus with four distinct serotypes, is transmitted primarily by urbanized Aedes mosquito species. The infection leads to a spectrum of clinical manifestations, with the majority being asymptomatic. Primary dengue and, to a greater extent, subsequent infection, mainly secondary dengue infection, are associated with increased severity. Increased global travel and recreational tourism expose naïve individuals to dengue, the most common arboviral infections in travelers. We describe a cluster of possible primary acute dengue infections in a group of 12 individuals who presented to Bangkok Hospital for Tropical Diseases in 2017. Infection was confirmed by dengue NS1 antigen and multiplex real-time RT-PCR. Nine individuals required hospitalization, and four developed dengue warning signs. The mean arterial pressure was significantly lower in the group with dengue warning signs. The period from the day of arrival in Thailand and the first day of symptoms was significantly shorter in adolescents with warning signs. Leukocytes, neutrophils, and platelets declined significantly at defervescence and were negatively correlated with day of illness. Six clinical isolates were identified as dengue serotype-1, with identical sequences suggesting that these patients were infected with the same virus.

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A Cluster of Dengue Cases in Travelers: A Clinical Series from Thailand

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030152 ◽

2021 ◽

Vol 6 (3) ◽

pp. 152

Author(s):

Hisham A. Imad ◽

Juthamas Phadungsombat ◽

Emi E. Nakayama ◽

Lapakorn Chatapat ◽

Phimphan Pisutsan ◽

...

Keyword(s):

Mosquito Species ◽

Clinical Manifestations ◽

Warning Signs ◽

Aedes Mosquito ◽

Rt Pcr ◽

Subsequent Infection ◽

Clinical Series ◽

Serotype 1 ◽

Ns1 Antigen ◽

Global Travel

Dengue is an overlooked tropical disease for which billions of people are at risk. The disease, caused by a Flavivirus with four distinct serotypes, is transmitted primarily by urban Aedes mosquito species. The infection leads to a spectrum of clinical manifestations, with the majority being asymptomatic. Primary dengue fever and, to a greater extent, a subsequent infection with a different serotype is associated with increased severity. Increased global travel and recreational tourism expose individuals naïve to the dengue viruses, the most common arboviral infections among travelers. We describe a cluster of possible primary acute dengue infections in a group of 12 individuals who presented to Bangkok Hospital for Tropical Diseases in 2017. Infection was confirmed by dengue NS1 antigen and multiplex real-time RT-PCR. Nine individuals required hospitalization, and four developed dengue warning signs. Leukocytes, neutrophils, and platelets declined towards defervescence and were negatively correlated with day of illness. Six clinical isolates were identified as dengue serotype-1, with 100% nucleotide identity suggesting that these patients were infected with the same virus.

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Case Report: Extrapulmonary Manifestations of COVID-19 and Dengue Coinfection

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0177 ◽

2021 ◽

Author(s):

José Manuel Reyes-Ruiz ◽

Rosa Campuzano-Vences ◽

Juan Fidel Osuna-Ramos ◽

Luis Adrián De Jesús-González ◽

María J. Pérez-Méndez ◽

...

Keyword(s):

Clinical Manifestations ◽

Serum Levels ◽

Rt Pcr ◽

Virus Serotype ◽

Serotype 1 ◽

Ns1 Antigen ◽

Control And Prevention ◽

Normal Chest ◽

Polymerase Chain ◽

Tomography Scan

The risk of coronavirus disease 2019 (COVID-19) and dengue coinfection is increased in tropical countries; however, the extrapulmonary clinical manifestations have not been fully characterized. We report a 42-year-old woman whose clinical manifestations began with fever, diarrhea, headache, chest pain, myalgia, odynophagia, and arthralgia. Despite mild respiratory symptoms and normal chest computed tomography scan results, she was diagnosed with real-time reverse-transcription polymerase chain reaction (RT-PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Because she had erythema and petechiae with a decreased platelet count, the dengue NS1 antigen and anti-dengue IgM/IgG test were performed, and the Centers for Disease Control and Prevention RT-PCR assay detected the dengue virus serotype 1 infection. Additionally, increased liver enzyme serum levels were found in the patient, who later developed hepatomegaly. Hence, the mechanism of hepatic pathology associated with SARS-CoV-2 and dengue coinfection needs further research.

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A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105144 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5144

Author(s):

Mar Muñoz-Chápuli Gutiérrez ◽

Ana Durán-Vila ◽

Javier Ruiz-Labarta ◽

Pilar Payá-Martínez ◽

Pilar Pintado Recarte ◽

...

Keyword(s):

Clinical Manifestations ◽

Specific Treatment ◽

Rt Pcr ◽

Good Adherence ◽

Major Morbidity ◽

Reference Hospital ◽

The Mean ◽

Discharge From Hospital ◽

Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

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Increased levels of pentraxins protein and cytokines bear good association in patients with severe dengue infection

Scientific Reports ◽

10.1038/s41598-020-80144-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Goutam Patra ◽

Bibhuti Saha ◽

Sumi Mukhopadhyay

Keyword(s):

Dengue Infection ◽

Clinical Manifestations ◽

Blood Parameters ◽

Warning Signs ◽

Severe Dengue ◽

Disease Manifestation ◽

Mild Disease ◽

Tnf Α ◽

The Status ◽

The Tropics

AbstractDengue is an arboviral infection with high rates of morbidity and mortality throughout the tropics and sub-tropics. This work studied the status of pentraxin (CRP/SAP) protein, ferritin, TNF-α and IL-1β levels in Dengue patients of different pathophysiological manifestations. Accordingly, clinically confirmed Dengue cases (n = 97) were enrolled and subsequently blood parameters were studied by Haematology cell counter and Biochemistry Autoanalyser. CRP, SAP, ferritin, TNF-α and IL-1β ELISA were done in all the samples by using standard ELISA kits. Statistical Analysis was done in all the experiments. The levels of CRP (p < 0.0001), SAP (p < 0.0001), ferritin (p < 0.0001), TNF-α (p < 0.0001) and IL-1β (p < 0.0001) were high in patients with Severe Dengue as compared to Dengue without warning signs. High levels of SGOT, SGPT and decreased platelet counts were found in severe patients as compared to Healthy donor. CRP/SAP as well as TNF-α/IL-1β were independently associated with both dengue severity and overall disease manifestation. Statistically significant increased CRP, SAP, ferritin, TNF-α and IL-1β titres were correlated in patients with severe clinical manifestations as compared to mild disease forms of dengue. Elevated levels of pentraxin, TNF-α/IL-1β in blood during dengue infection could act as an early predictor in Severe Dengue infection.

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Epidemiological and Clinical Features of Dengue Infection in Adults in the 2017 Outbreak in Vietnam

BioMed Research International ◽

10.1155/2019/3085827 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Bui Vu Huy ◽

Le Nguyen Minh Hoa ◽

Dang Thi Thuy ◽

Nguyen Van Kinh ◽

Ta Thi Dieu Ngan ◽

...

Keyword(s):

Elderly Patients ◽

Dengue Fever ◽

Clinical Features ◽

Dengue Infection ◽

Clinical Manifestations ◽

Warning Signs ◽

Severe Dengue ◽

Severe Bleeding ◽

Cross Sectional ◽

Number Of Patients

Purpose. The clinical features and laboratory results of dengue-infected adult patients admitted to the hospital during the 2017 outbreak were analyzed in this study. Method. This is a cross-sectional study. 2922 patients aged 18 years or more with dengue fever in National Hospital for Tropical Diseases (NHTD) in the North and Hospital for Tropical Disease (HTD) in the South of Vietnam were recruited in this study. Result. Patients were admitted in the hospital around the year and concentrated from August to December, in 53/63 (84.0%) provinces in Vietnam, and patients in all ages were affected. The number of patients with dengue fever was 1675 (57.3%), dengue with warning signs 914 (31.3%), and severe dengue 333 (11.4%), respectively. Among patients with severe dengue, severe plasma leakage and dengue shock account for 238 (8.1%), severe organ impairment 73 (2.5%), and severe bleeding 22 (0.75%). The rate of mortality was 0.8%, and the outcome of dengue patients is worse in the elderly and people with underlying diseases. Conclusion. The 2017 dengue outbreak occurred in a larger scale than in the previous years in terms of time, location, and number of patients. More elderly patients were infected by dengue in this outbreak, and this may contribute to the mortality rate. Clinical manifestations of dengue patients in Southern Vietnam are more typical than the northern, but the rate of severe dengue is not different. The mortality risk and underlying conditions associated with dengue-infected elderly patients are worthy of further investigations in the future.

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NS-1 antigen positive Dengue Infection and molecular characterization of Dengue Viruses in a private Medical College Hospitalin Dhaka, Bangladesh

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v17i4.38334 ◽

2018 ◽

Vol 17 (4) ◽

pp. 669-673

Author(s):

Mahmuda Siddiqua ◽

Ahmed Nawsher Alam ◽

AKM Muraduzzaman ◽

Tahmina Shirin

Keyword(s):

Virus Infection ◽

Dengue Virus ◽

Dengue Infection ◽

Medical Science ◽

Cost Effective ◽

Rt Pcr ◽

Dengue Virus Infection ◽

Medical College ◽

Virus Serotype ◽

Ns1 Antigen

Introduction: Detection of dengue virus infection as soon as possible is critical for management of dengue virus infected patients. Immuno-chromatographic (ICT) tests are easy, cost effective method for dengue virus antigen detection.The sensitivity and specificity of ICT should compare with a gold standard test like RT-PCR. Aim of this study was to compare two test methods (ICT and RT-PCR), observe dengue serotype and seasonal impact on dengue infection.Methodology & result: The patients of Ibn Sina Medical College Hospital from October 2015 to October 2017 were tested for dengue NS1 antigen by ICT method. Out of 3201 sample tested 32.39% were found positive and 89 of which were re-tested for RT-PCR for comparison. Eighty eight of 89 NS1 positive cases showed positive by RT-PCR method giving an accuracy of 98.87%. Among the RT-PCR positive cases 45 were further analyzed for serotype. DEN-1, DEN-2 or both DEN- 1 and DEN-2 were found in 21, 23 and 1cases respectively. No cases of DEN-3 or DEN-4 were detected.Conclusion: This study showed that easily available and cost effective dengue NS1 antigen detection method (ICT) is as effective as molecular test (RT-PCR). DEN-1 and DEN-2 serotype were prevalent during last few years in Bangladesh. Continuous monitoring of dengue virus serotype is important for prevention and control of sudden epidemic by other serotype. Alert to be more during post monsoon when the peak of dengue virus infection was observed.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.669-673

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Estimating the annual dengue force of infection from the age of reporting primary infections across urban centres in endemic countries

BMC Medicine ◽

10.1186/s12916-021-02101-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Joseph R. Biggs ◽

Ava Kristy Sy ◽

Katharine Sherratt ◽

Oliver J. Brady ◽

Adam J. Kucharski ◽

...

Keyword(s):

Case Reports ◽

Dengue Infection ◽

Laboratory Data ◽

The Philippines ◽

Warning Signs ◽

Transmission Intensity ◽

Dengue Case ◽

Force Of Infection ◽

Regression Modelling ◽

The Mean

Abstract Background Stratifying dengue risk within endemic countries is crucial for allocating limited control interventions. Current methods of monitoring dengue transmission intensity rely on potentially inaccurate incidence estimates. We investigated whether incidence or alternate metrics obtained from standard, or laboratory, surveillance operations represent accurate surrogate indicators of the burden of dengue and can be used to monitor the force of infection (FOI) across urban centres. Methods Among those who reported and resided in 13 cities across the Philippines, we collected epidemiological data from all dengue case reports between 2014 and 2017 (N 80,043) and additional laboratory data from a cross-section of sampled case reports (N 11,906) between 2014 and 2018. At the city level, we estimated the aggregated annual FOI from age-accumulated IgG among the non-dengue reporting population using catalytic modelling. We compared city-aggregated FOI estimates to aggregated incidence and the mean age of clinically and laboratory diagnosed dengue cases using Pearson’s Correlation coefficient and generated predicted FOI estimates using regression modelling. Results We observed spatial heterogeneity in the dengue average annual FOI across sampled cities, ranging from 0.054 [0.036–0.081] to 0.249 [0.223–0.279]. Compared to FOI estimates, the mean age of primary dengue infections had the strongest association (ρ −0.848, p value<0.001) followed by the mean age of those reporting with warning signs (ρ −0.642, p value 0.018). Using regression modelling, we estimated the predicted annual dengue FOI across urban centres from the age of those reporting with primary infections and revealed prominent spatio-temporal heterogeneity in transmission intensity. Conclusions We show the mean age of those reporting with their first dengue infection or those reporting with warning signs of dengue represent superior indicators of the dengue FOI compared to crude incidence across urban centres. Our work provides a framework for national dengue surveillance to routinely monitor transmission and target control interventions to populations most in need.

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The clinical characteristics and outcome of children hospitalized with dengue in Barbados, an English Caribbean country

The Journal of Infection in Developing Countries ◽

10.3855/jidc.5566 ◽

2015 ◽

Vol 9 (04) ◽

pp. 394-401 ◽

Cited By ~ 3

Author(s):

Alok Kumar ◽

Marquita Gittens-St. Hilair ◽

Vincent Jason ◽

Christian Ugwuagu ◽

Kandamaran Krishnamurthy

Keyword(s):

Case Fatality Rate ◽

Dengue Infection ◽

Clinical Manifestations ◽

Case Fatality ◽

Population Based ◽

Warning Signs ◽

Severe Dengue ◽

Fatality Rate ◽

Case Files ◽

Dengue With Warning Signs

Introduction: Although dengue is endemic in all English-speaking Caribbean countries, there are no published studies on the clinical presentations and outcomes of children hospitalized with dengue from this region. This study aims to assess the clinical charcteristics and the outcome in children hospitalized with dengue. Methods: This was a population-based prospective study of all the children hospitalized with confirmed dengue in 2009 in Barbados. All children suspected to have dengue were routinely screened for dengue infection and underwent routine blood tests. Relevant data was extracted from their case files at the time of their discharge from the hospital. Results: Of the 199 children who were hospitalized with suspected dengue, 115 (58%) were confirmed. The overall incidence rate of dengue among children that required hospitalization was 2.1/1,000 children. Besides the typical clinical features of dengue, 64 children hospitalized with confirmed dengue also presented with gastrointestinal manifestations (56%), 39 with respiratory manifestations (51%), 11 with hepatic manifestations (10%), 8 with neurologic manifestations (7%), and 7 with cardiovascular manifestations (6%). Twenty (17.4%) children hospitalized with confirmed dengue met the criteria for the diagnosis of severe dengue. The other 82.6% had uncomplicated or non-severe (53.9% had dengue and 28.7% had dengue with warning signs) forms of dengue. The case fatality rate in this series was 1.7%. Conclusions: Less than a third of all the children with confirmed dengue required hospitalization. Atypical clinical manifestations were common, and only a minority of these children had severe dengue. Overall, the case fatality rate for dengue in this select population of children hospitalized with dengue was low.

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Liver function tests to predict the severity of dengue fever in serologically positive children below 18 years of age

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190069 ◽

2019 ◽

Vol 6 (2) ◽

pp. 358

Author(s):

Yashwanth Raju H. N. ◽

Rajendra Kumar ◽

Sudha Rudrappa

Keyword(s):

Serum Albumin ◽

Dengue Fever ◽

Hepatic Dysfunction ◽

Dengue Infection ◽

Liver Function Tests ◽

Relevant Information ◽

Warning Signs ◽

Severe Dengue ◽

Cross Sectional ◽

The Mean

Background: Dengue fever presents with a diverse clinical spectrum. Although liver is not a major target organ, hepatic dysfunction is a well-recognized feature. In this study authors attempted to study the pattern of hepatic involvement in children with dengue and its association with disease severity.Methods: This was a cross sectional study conducted at Cheluvamba hospital during the period of 1 year. Children <18 years of age with dengue Ns1 Ag and IgM positive were included in this study. After obtaining informed consent, a pre-structured proforma was used to record the relevant information from each subject. After detailed clinical examination and haematological investigation children were categorized into three groups as dengue fever with no warning signs (DNWS), dengue fever with warning signs (DWWS) and severe dengue fever (SDF) according to WHO classification. Statistical analysis was done to know the strength of association between different clinical and biochemical variables and outcome of the disease.Results: The mean age of the study population was 8.65 years with male preponderance. The mean total bilirubin, serum albumin, SGOT, SGPT, ALP, PT and INR were 0.76 mg/dl, 3.8g/dl, 233.18U/L, 118.15U/L, 200.65 U/L, 12.9s and 1.09 respectively. The mean SGOT was significantly higher than SGPT. The degree of deranged LFTs was significantly more in SDF group than DNWS and DWWS groups. Serum albumin was significantly decreased in children with SDF group correlating with disease severity, prognosis and outcome.Conclusions: Hepatic dysfunction was present in all forms of dengue infection, with SGOT rising significantly more than SGPT. All biochemical liver parameters were significantly deranged in patients with severe dengue fever indicating prolonged illness and poor prognosis.

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Six Cases of Zika/Dengue Coinfection in a Brazilian Cohort, 2015–2019

Viruses ◽

10.3390/v12101201 ◽

2020 ◽

Vol 12 (10) ◽

pp. 1201

Author(s):

Claudio Siqueira ◽

Valéria Féres ◽

Livia Coutinho ◽

Isabela Junqueira ◽

Luziane Bento ◽

...

Keyword(s):

Real Time ◽

Clinical Outcomes ◽

Acute Infection ◽

Warning Signs ◽

Surveillance Systems ◽

Rt Pcr ◽

Zikv Infection ◽

Central Brazil ◽

Ns1 Antigen ◽

Coinfected Patient

Brazil is one of the countries which has been most affected by dengue epidemics. This scenario became more challenging with the emergence of Zika virus after 2014. The cocirculation of dengue and Zika viruses makes their diagnosis and treatment a challenge for health professionals, especially due to their similar clinical outcomes. From 2015 to 2019, we followed a cohort of 2017 participants in Goiania, Goias, Central Brazil. Febrile cases were monitored weekly, and after identification of fever, the physician performed a home visit for clinical evaluation and collection of blood/urine for diagnosis of acute dengue/Zika infection in suspected cases. Dengue acute infection was investigated by NS1 antigen and real time RT-PCR and seroconversion of anti-dengue IgM. ZIKV infection was confirmed by real time RT-PCR. Six cases of Zika/dengue coinfection among participants were reported. The clinical outcomes were suggestive for both DENV and ZIKV infection. No coinfected patient had neurological clinical manifestation, warning signs or need for hospitalization. A continuous specific laboratory confirmation for both dengue and Zika viruses should be enforced as part of the surveillance systems even in the presence of very suggestive cases of dengue fever, minimizing the risk of a late detection of ZIKV circulation.

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