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

10.20944/preprints202107.0618.v1 ◽

2021 ◽

Author(s):

Hisham A Imad ◽

Juthamas Phadungsombat ◽

Emi E Nakayama ◽

Lapakorn Chatapat ◽

Phimphan Pitusan ◽

...

Keyword(s):

Mosquito Species ◽

Dengue Infection ◽

Clinical Manifestations ◽

Warning Signs ◽

Rt Pcr ◽

Clinical Series ◽

Serotype 1 ◽

Ns1 Antigen ◽

The Mean ◽

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 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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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 Rare Case of Dengue Fever Complicated by Hepatitis and Pancreatitis: Expanded Dengue Syndrome

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44748.14195 ◽

2020 ◽

Author(s):

Tridip Kumar Das ◽

Sagar Kanta

Keyword(s):

Acute Hepatitis ◽

Rare Case ◽

Serum Amylase ◽

Liver Enzymes ◽

Clinical Manifestations ◽

Aedes Mosquito ◽

Pain Abdomen ◽

Ns1 Antigen ◽

Vector Borne ◽

Expanded Dengue Syndrome

Dengue is a vector borne disease which is one of the major public health problems caused by dengue virus which has 4 serotypes (DENV 1-4) and the vector being Aedes mosquito which has varied clinical manifestations. This report is about a previously healthy 32-year-old male patient that complained of fever, pain abdomen and jaundice for 1 week. On investigation, the patient tested positive for dengue NS1 antigen with raised liver enzymes. As the disease progressed, the pain of abdomen aggravated, radiating to the back and developed constipation with raised serum amylase and lipase. The patient was treated for both acute hepatitis and pancreatitis accordingly and responded to the treatment and gradually improved. Hence, it was thought that common dengue should be ruled out as a cause of Acute Hepatitis or Pancreatitis, depending on the incidence of dengue in that area.

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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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Inapparent dengue virus infection among students in Mandalay, Myanmar

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz071 ◽

2019 ◽

Author(s):

Aung Kyaw Kyaw ◽

Mya Myat Ngwe Tun ◽

Shine Thura Naing ◽

Thida ◽

Thein Thein Htwe ◽

...

Keyword(s):

Dengue Virus ◽

Clinical Manifestations ◽

Denv Infection ◽

Rt Pcr ◽

Serum Samples ◽

Cross Sectional ◽

Denv Serotypes ◽

Secondary Infections ◽

Serotype 1 ◽

History Of

AbstractBackgroundA school- and laboratory-based cross-sectional descriptive study was conducted to find out the burden of inapparent dengue virus (DENV) infection in Mandalay where DENV is endemic and there is circulation of all four DENV serotypes.MethodsA total of 420 students who had no history of fever and visited the hospital within 6 months were recruited from three monastic schools. Serum samples were collected and the DENV genome was checked by conventional one-step RT-PCR and anti-DENV IgM and IgG antibodies were determined. Inapparent dengue (DEN) infection is defined as individuals who were either RT-PCR-positive or anti-DENV IgM-positive with no clinical manifestations or mild symptoms, and which are not linked to a visit to a healthcare provider.ResultsAmong 420 students, 38 students (9.0%, 95% CI, 6.4 to 12.2) were confirmed as recent inapparent DEN infection. The DENV serotype-1 was detected in six students. Thirty-one out of 38 (81.6%) laboratory-confirmed inapparent DEN-infected students had primary infections and seven (18.4%) had secondary infections.ConclusionThis study explored the prevalence of inapparent DEN infection rate in urban monastic schools in Mandalay and showed that the rate of primary infection among inapparent DENV-infected children was high.

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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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Chikungunya Manifestations and Viremia in Patients Who Presented to the Fever Clinic at Bangkok Hospital for Tropical Diseases during the 2019 Outbreak in Thailand

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6010012 ◽

2021 ◽

Vol 6 (1) ◽

pp. 12

Author(s):

Hisham A Imad ◽

Juthamas Phadungsombat ◽

Emi E Nakayama ◽

Sajikapon Kludkleeb ◽

Wasin Matsee ◽

...

Keyword(s):

Chikungunya Virus ◽

Clinical Manifestations ◽

Clinical Findings ◽

Acute Stage ◽

Tropical Diseases ◽

Healthy Individuals ◽

Rt Pcr ◽

Viral Loads ◽

The Family ◽

Systemic Symptoms

Chikungunya virus is an Alphavirus belonging to the family Togaviridae that is transmitted to humans by an infected Aedes mosquito. Patients develop fever, inflammatory arthritis, and rash during the acute stage of infection. Although the illness is self-limiting, atypical and severe cases are not uncommon, and 60% may develop chronic symptoms that persist for months or even for longer durations. Having a distinct periodical epidemiologic outbreak pattern, chikungunya virus reappeared in Thailand in December 2018. Here, we describe a cohort of acute chikungunya patients who had presented to the Bangkok Hospital for Tropical Diseases during October 2019. Infection was detected by a novel antigen kit and subsequently confirmed by real-time RT-PCR using serum collected at presentation to the Fever Clinic. Other possible acute febrile illnesses such as influenza, dengue, and malaria were excluded. We explored the sequence of clinical manifestations at presentation during the acute phase and associated the viral load with the clinical findings. Most of the patients were healthy individuals in their forties. Fever and arthralgia were the predominant clinical manifestations found in this patient cohort, with a small proportion of patients with systemic symptoms. Higher viral loads were associated with arthralgia, and arthralgia with the involvement of the large joints was more common in female patients.

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Clinicohaematological profile of dengue in children: a hospital based study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172662 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1340 ◽

Cited By ~ 1

Author(s):

Irshad Abdul Majeed ◽

K. Shreedhara Avabratha ◽

Lokesha R. Gowda ◽

Sadia Syeda

Keyword(s):

Dengue Fever ◽

Early Recognition ◽

Tertiary Care ◽

Clinical Manifestations ◽

Haematological Parameters ◽

Severe Dengue ◽

Clinical Feature ◽

Igm Elisa ◽

Ns1 Antigen ◽

Atypical Presentations

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. The aim of this study is to document varied clinical manifestations and haematological parameters of dengue patients in a tertiary care centre.Methods: A total 130 cases of any of NS1 antigen, IgM card test positive or IgM ELISA positive dengue patients were included in this observational study. Clinical and haematological parameters were noted and analysed statistically.Results: Most common clinical feature was fever (100%) followed by headache (51.5%). Atypical features like seizures due to encephalitis was seen in a child with dengue. Seizure were present in 1.5% of cases, two children died due to severe dengue with shock and multi organ failure. In our study 26.92% of patients had thrombocytopenia. The mean Hb was 12.86 g/dl and platelet count was 104202/mm3.Conclusions: Fever and headache are the main features of dengue. However, one should be aware of different atypical presentations of dengue fever to diagnose and intervene timely. Early recognition of complication and timely intervention are required in the management of dengue cases.

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Alphaviruses

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.070512_update_001 ◽

2010 ◽

pp. 557-561

Author(s):

E.E. Ooi ◽

L.R. Petersen ◽

D.J. Gubler

Keyword(s):

Mosquito Species ◽

Clinical Manifestations ◽

Febrile Illness ◽

Domestic Animals ◽

Human Infection ◽

Tissue Samples ◽

The Family ◽

Polymerase Chain ◽

Complex Transmission ◽

Diagnosis Of Infection

There are 29 registered alphaviruses belonging to the family Togaviridae, 16 of which are known to cause human infection. They are RNA viruses with global geographical distribution and complex transmission cycles between wild or domestic animals or birds and one or more mosquito species; humans are infected by mosquito bites. They cause a spectrum of clinical manifestations ranging from nonspecific febrile illness to acute encephalitis and death. Diagnosis of infection is made serologically by detection of IgM and IgG antibodies, virus isolation, and polymerase chain reaction, or by immunohistochemistry on tissue samples....

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