plasma leakage
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2022 ◽  
Vol 16 (1) ◽  
pp. e0010051
Author(s):  
Rahajeng N. Tunjungputri ◽  
Silvita Fitri Riswari ◽  
Setyo G. Pramudo ◽  
Lydia Kuntjoro ◽  
Bachti Alisjahbana ◽  
...  

Background Thrombocytopenia, bleeding and plasma leakage are major complications of dengue. Activation of endogenous sialidases with desialylation of platelets and endothelial cells may underlie these complications. We aimed to assess the effects of the neuraminidase inhibitor oseltamivir on platelet recovery and plasma leakage in dengue. Methods We performed a phase 2, double-blind, multicenter, randomized trial in adult dengue patients with thrombocytopenia (<70,000/μl) and a duration of illness ≤ 6 days. Oseltamivir phosphate 75mg BID or placebo were given for a maximum of five days. Primary outcomes were the time to platelet recovery (≥ 100,000/μl) or discharge from hospital and the course of measures of plasma leakage. Results A total of 70 patients were enrolled; the primary outcome could be assessed in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n = 9) were similar in the oseltamivir and placebo group (3.0 days [95% confidence interval, 2.7 to 3.3] vs. 2.9 days [2.5 to 3.3], P = 0.055). The kinetics of platelet count and parameters of plasma leakage (gall bladder thickness, hematocrit, plasma albumin, syndecan-1) were also similar between the groups. Discussion In this trial, adjunctive therapy with oseltamivir phosphate had no effect on platelet recovery or plasma leakage parameters. Trial registration ISRCTN35227717.


Viruses ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 90
Author(s):  
Esther Dawen Yu ◽  
Hao Wang ◽  
Ricardo da Silva Antunes ◽  
Yuan Tian ◽  
Rashmi Tippalagama ◽  
...  

According to the WHO 2009 classification, dengue with warning signs is at the risk of developing severe form of dengue disease. One of the most important warning signs is plasma leakage, which can be a serious complication associated with higher morbidity and mortality. We report that the frequency of CD4+CD8+ double-positive (DP) T cells is significantly increased in patients at risk of developing plasma leakage. Transcriptomic analysis demonstrated that CD4+CD8+ DP cells were distinct from CD4+ Single Positive (SP) T cells but co-clustered with CD8+ SP cells, indicating a largely similar transcriptional profile. Twenty significant differentially expressed (DE) genes were identified between CD4+CD8+ DP and CD8+ SP cells. These genes encode OX40 and CCR4 proteins as well as other molecules associated with cell signaling on the cell surface (NT5E, MXRA8, and PTPRK). While comparing the profile of gene expression in CD4+CD8+ DP cells from patients with and without warning signs of plasma leakage, similar expression profile was observed, implying a role of CD4+CD8+ DP cells in plasma leakage through a quantitative increase rather than functional alteration. This study provided novel insight into the host immune response during the acute febrile phase of DENV infection and the role of CD4+CD8+ DP T cells in the pathogenesis of plasma leakage.


2021 ◽  
Vol 12 ◽  
Author(s):  
Baranca Buijsers ◽  
Fadel Muhammad Garishah ◽  
Silvita Fitri Riswari ◽  
Rosalie M. van Ast ◽  
Setyo Gundi Pramudo ◽  
...  

BackgroundEndothelial hyper-permeability with plasma leakage and thrombocytopenia are predominant features of severe dengue virus infection. It is well established that heparanase, the endothelial glycocalyx degrading enzyme, plays a major role in various diseases with vascular leakage. It is yet to be elucidated whether heparanase activity plays a major role in dengue-associated plasma leakage. Moreover, the major source of heparanase secretion and activation in dengue remains elusive. Since a relatively high amount of heparanase is stored in platelets, we postulate that heparanase released by activated platelets contributes to the increased plasma heparanase activity during dengue virus infection.MethodsHeparanase activity (plasma and urine), and heparan sulfate and syndecan-1 (plasma levels) were measured in dengue patients with thrombocytopenia in acute phase (n=30), during course of disease (n=10) and in convalescent phase (n=25). Associations with clinical parameters and plasma leakage markers were explored. Platelets from healthy donors were stimulated with dengue non-structural protein-1, DENV2 virus and thrombin to evaluate heparanase release and activity ex vivo.ResultsHeparanase activity was elevated in acute dengue and normalized during convalescence. Similarly, glycocalyx components, such as heparan sulfate and syndecan-1, were increased in acute dengue and restored during convalescence. Increased heparanase activity correlated with the endothelial dysfunction markers heparan sulfate and syndecan-1, as well as clinical markers of plasma leakage such as ascites, hematocrit concentration and gall-bladder wall thickening. Notably, platelet number inversely correlated with heparanase activity. Ex vivo incubation of platelets with thrombin and live DENV2 virus, but not dengue virus-2-derived non-structural protein 1 induced heparanase release from platelets.ConclusionTaken together, our findings suggest that the increase of heparanase activity in dengue patients is associated with endothelial glycocalyx degradation and plasma leakage. Furthermore, thrombin or DENV2 activated platelets may be considered as a potential source of heparanase.


2021 ◽  
Vol 8 (12) ◽  
pp. 28-33
Author(s):  
Rishad Ahmed

Objective: The main objective of the present study was to observe the electrocardiogram (ECG) changes in dengue fever and to find correlation with subclinical cardiac involvement. Methods: This was an observational, prospective, non-randomized study. High grade fever for one to five days diagnosed as dengue infection later confirmed by dengue tests (NS1, IgG and IgM ELISA) were included in this study. Prior to the commencement of the study informed consent was taken from all the participants. With 12 lead ECG taken during the febrile phase of dengue fever randomly selected serologically confirmed cases of dengue fever were evaluated at an interval of 24 hrs. for a total of five days. On the day of admission when the patient was afebrile, echocardiography was done. Plasma leakage was diagnosed by presence of any one of four: subcutaneous oedema (pedal oedema, facial puffiness) or pleural effusion or pericardial effusion or ascites. Result: A total 80 patients who were admitted to hospital during study periods due to symptoms of dengue fever and IgM dengue positive status were included in this study. Among this total population of 80 patients (N=80) 48 were male and 32 were female. Out of these, majority were diagnosed as DF 52 (65%), 23 (29%) were diagnosed as DHF and rest only 5 (6%) were diagnosed as DSS. Total 54 patients were found to have normal ECG among which 35 were having dengue fever, 16 were having DHF and 3 were having DSS. Total 2 patients were diagnosed to have left ventricular hypertrophy among which one had dengue fever and rest two had DHF. ST depression was observed in total 7 patients in which 5 were had dengue fever and 2 were had DHF. Relative bradycardia was found in 14, tall t waves in 2 and ventricular ectopics in 1 patient (table 2). Abnormal ECG findings were compared using Chi-square test and were found to be statistically significant (P < 0.05) in dengue fever and DHF. There was statistically significant correlation between ECG abnormalities and abdominal pain and mucosal bleed. The presence of plasma leakage were observed among 77 (96.3%) patients. Proportion of echocardiography abnormalities were higher among patients with plasma leak 6 (30%) as compared to without plasma leak 9 (15%), this difference was not found to be statistically significant Conclusion: In all type of Dengue infections incidence of cardiac involvement was quite high. Due to the overlapping clinical manifestations such as capillary leak associated with DENV infection, tachycardia, pulmonary edema, and hypotension as well as due to the low index of clinical suspicion cardiac involvement in dengue fever is often underdiagnosed. Keywords: Cardiac manifestation, dengue infection, echocardiography, electrocardiography.


2021 ◽  
Vol 33 (1) ◽  
pp. 104-108
Author(s):  
Homayra Tahseen Hossain ◽  
Refaya Tasnim ◽  
Halima Khatun ◽  
Nawsabah Noor ◽  
Mahbub Mayukh Rishad ◽  
...  

During COVID-19 pandemic, the increasing incidence of dengue in Monsoon season has become a further threat especially in the dengue endemic countries of Southeast Asia like Bangladesh. Co-infection of dengue with COVID-19 has created a number of practical challenges to combat the diseases simultaneously, especially at a time when healthcare resources are already exhausted tackling the COVID pandemic. We are presenting the case report of a 14 year old girl who suffered from both RT-PCR positive COVID -19 infection & NS1 positive Dengue. She was managed in a Private Hospital of Dhaka as Dengue fever Group C (due to severe plasma leakage) with severe COVID-19 infection (as required oxygen therapy). She had a critical course of illness, having continued fever, cough, breathlessness, desaturation along with thrombocytopenia & plasma leakage. However, to our great satisfaction, the patient was ultimately improved & could be discharged in a happy face. Bangladesh J Medicine July 2022; 33(1) : 104-108


2021 ◽  
Vol 9 (5) ◽  
pp. 580-590
Author(s):  
Vaishnavi Sundar ◽  
◽  
Shalini Ramasamy ◽  
Sanjana Vimal ◽  
Anupam Dutta ◽  
...  

Substance P (SP) is a neuropeptide that has its place in the tachykinin family and helps in the transmission of neurogenic signals. SP is also a neuromodulator that plays a crucial part in pain during inflammatory processes. It is produced by the capsaicin-sensitive unmyelinated C fibers sensory neurons by the central and peripheral nervous systems. Substance P is known as a critical primary responder to most of the extreme stimuli, i.e., specifically those with the ability to destabilize the biological integrity. Hence, SP can be considered as an instantaneous system for defense, stress, healing, etc. SP is known to perform a vital role in neurogenic inflammation and the pathophysiology of acute pancreatitis. Out of these, neurogenic inflammation is responsible for acute interstitial pancreatitis as a result of oedema. SP binds itself to the G-protein coupled neurokinin-1 receptor and causes plasma leakage, cell proliferation, and invasion resulting in pancreatic cancer. SP along with comparable neuropeptides seems to be crucial targets with the capability of satisfying several unfulfilled medical requisites. This review article mainly focuses on compiling the available evidence to show that SP could be a novel therapeutic target for pancreatic diseases, and more exploration into the SP signaling pathways is the call of the hour.


Author(s):  
Saurabh Rajkumar Jain ◽  
Jitendra D. Lakhani ◽  
Pramod R. Jha

Here we are presenting a case of dengue fever presented with an atypical symptom of “oculogyric crisis” with features of multi organ dysfunction syndrome. Increased vascular permeability, plasma leakage, haemorrhagic manifestations, and thrombocytopenia are charecteristics of dengue fever.  A 19 year old male patient, with no co-morbidity came to Dhiraj hospital with chief complaints of  fever which was high grade & intermittent, it is associated with chills & rigours for 5 days. Also complain of abdominal pain over epigastric region, dull aching non radiating associated with decreased appetite since 5 days. Dengue infection has a wide range of clinical features. Neurological complications can occur in any spectrum of dengue infection.  The diagnosis of oculogyric crisis is majorly clinical and it requires a focused detailed history and detailed physical examination to find out possible triggers for the crisis and to rule out other reasons for abnormal eye movements.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaturaka Rodrigo ◽  
Chathurani Sigera ◽  
Deepika Fernando ◽  
Senaka Rajapakse

AbstractPlasma leakage is a precursor to life-threatening complications of dengue, but this group is poorly defined and not often reported in literature. Patients with Dengue haemorrhagic fever (DHF) as defined in the 1997 World Health Organization classification are often reported, and they all have plasma leakage, but some patients with plasma leakage do not meet the definition of DHF. The study aims to estimate the frequency of plasma leakage and DHF (as a surrogate of plasma leakage) in dengue and its variations based on virus serotype, geography, patient gender and pre-existing immunity to dengue. PUBMED, Scopus, EMBASE, CINAHL and Web of Science were searched for prospective observational studies reporting on plasma leakage or DHF. Quality of data was assessed using the NIH quality assessment tool for cohort studies. Forty-three studies that recruited 15,794 confirmed dengue patients were eligible. Cumulative frequency of plasma leakage was 36.8% (15 studies, 1642/4462, 95% CI 35.4–38.2%), but surprisingly the estimated cumulative frequency of DHF was higher (45.7%, 32 studies, 4758/10417, 95% CI 44.7–46.6%), indicating that current medical literature over-reports DHF or under-reports plasma leakage. Therefore, a reliable estimate for the proportion of dengue patients developing plasma leakage cannot be derived from existing medical literature even after applying rigorous inclusion criteria to select homogenous studies. Plasma leakage is an important marker of “at-risk” dengue patients and standardizing its definition, diagnosis and reporting should be a priority in research and global policy.


2021 ◽  
Vol 7 (1) ◽  
pp. 1-3
Author(s):  
Fransisco Aditia Sembiring Meliala ◽  
Johan Christian Silaen ◽  
Novita Hasiani Simanjuntak

Background: Dengue virus infection is a global health problem. Dengue Hemorrhagic Fever (DHF) has become a global attention because of children death due to plasma leakage. Plasma leakage is a symptom of critical phase in children that occurs on the 3rd to 5th day. Neutrophil lymphocyte (NL) ratio and platelet count change can be seen in critical phase of plasma leakage which can help process of patient’s therapy. Objective: This study aimed to compare the NL ratio and platelets count on plasma leakage in children with DHF. Methods: This study was an analytical study with cross-sectional design. The sample was children with DHF at RSUD Dr.Pirngadi Medan. The data of this study were analyzed by computer software, used an unpaired t test with p <0.05. Results: This study found that the most age of DHF was 6-10 years old, most gender are male and DHF grade 1. Unpaired t test found the average difference between NL ratio and platelet with value of p = 0.043 (p<0.05). Conclusion: Plasma leakage average on NL ratio is higher than plasma leakage average on platelets that occurs in children with DHF at RSUD Dr.Pirngadi Medan.


2021 ◽  
Vol 3 (2) ◽  
pp. 01-15
Author(s):  
Makarius Tel Aviv C. Dela Cru ◽  
Benie T. Constantino IH

Dengue virus is the most common mosquito borne viral disease in humans, and poses a major challenge to global public health services. Infection can be caused by any of the 4 DENV serotypes, transmitted by female Aedes aegypti mosquitoes. Presenting features may vary from a mild self-limiting febrile illness to life-threatening symptoms of bleeding, organ impairment, and plasma leakage leading to shock. Early diagnosis and monitoring are critical to reduce mortality, especially in the context of the COVID-19 pandemic. Laboratory tests, such as the serological detection of either antigen or antibodies are useful in the diagnosis. Currently, although a vaccine for DENV is available, it remains a challenge to develop an effective vaccine against 4 discrete serotypes and antiviral drugs effective in reducing morbidity or improving disease outcome.


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