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Objective: To determine presence of inflammatory markers i.e. hyper-ferritinemia, elevated lactate dehydrogenase, and liver enzymes in dengue fever and their correlation with different classes of dengue severity, defined by new WHO classification. Study Design: Cross-sectional Analytical study. Setting: Medical Department of Dr. Ruth KM Pfau Civil Hospital Karachi. Period: October 2022 to March 2023. Methods: Conducted in confirmed cases of Dengue fever, after consent all patients were categorized in three i.e. D-W, D+W and SDF groups. Results: 120 patients were included in study. 24 suffered from Severe Dengue Fever (SDF) whereas 28 were in Dengue without warning signs (D-W) group and 68 were in Dengue with warning signs (D+W) group. We found a significant association between liver enzymes (SGPT and SGOT) and dengue severity. SGOT was significantly increased in cases with SDF as compared to D-W and D+W cases (p-value = 0.002). Similarly, ferritin was significantly increased in SDF cases compared to non-severe cohort (p-value <0.001). Using the area under the curve (AUC) of ROC curve, ferritin level (cutoff value of 800), produced a sensitivity of 75% for severe dengue fever. Mean length of stay in patients with non-severe dengue group was 3.63 days vs. 4.3 days in those with SDF (P value 0.002). Conclusion: As dengue is becoming a huge burden especially in developing countries, need to take proper measures to establish disease severity and according to severity resource allocation is cornerstone. Significant higher ferritin levels in severe dengue fever than other dengue groups, observed in our study, making serum ferritin a surrogate marker for dengue to predict the severity of dengue fever. [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) was discovered by P. M. Ashburn and Charles F. Craig in 1907. Evidence of dengue-like illness was observed before 1907 and DENV epidemics have been reported from different parts of the world since then, with increased morbidity rates every year. DENV typically causes a febrile illness that ranges from mild asymptomatic infection to fatal dengue haemorrhagic fever (DHF) and/or dengue shock syndrome (DSS). Host mechanisms through which mild infection progresses to the fatal forms are still unknown. Few factors have been associated to aid severe disease acquisition, DENV non-structural 1 (NS1) protein being one of them. NS1 is a highly conserved glycoprotein among the Flavivirus and is often used as a biomarker for dengue diagnosis. This review focuses on assessing the role of NS1 in severe dengue. In this review, hospital-based studies on the association of dengue NS1 with severe dengue from all over the world have been assessed and analysed and the majority of the studies positively correlate high NS1 levels with DHF/DSS acquisition. The review also discusses a few experimental studies on NS1 that have shown it contributes to dengue pathogenesis. This review assesses the role of NS1 and disease severity from hospital-based studies and aims to provide better insights on the kinetics and dynamics of DENV infection with respect to NS1 for a better understanding of the role of NS1 in dengue. [ABSTRACT FROM AUTHOR]

Dengue is a common arthropod-borne viral disease with a variable clinical spectrum, course, and outcome. We conducted a prospective observational study describing the clinical profile of patients hospitalized for dengue with warning signs during the 2019 epidemic. A total of 1349 patients with dengue, including 459 with warning signs, were seen. It predominantly affects the younger subset of both sexes. A higher proportion of females presented with either a platelet count less than 20,000/mm3 or a rapid fall in platelets. Bleeding manifestations of varying severity were observed in one-fifth of them. Severe bleeding was universal at a platelet count less than 10,000/mm3. Platelet transfusion was indicated in 17 (7.3%) males and 25 (11%) females, with females requiring it at a higher platelet count. While hepatic involvement was frequent, others such as myocarditis, encephalitis, and pancreatitis were infrequent. Coinfections observed included malaria, scrub typhus, and enteric fever. The case fatality rate for the patients with dengue and those with warning manifestations was 0.4% and 1.3%, respectively. Dengue epidemics often overwhelm health-care resources. Such epidemics can be successfully managed using a protocolized approach, modified as per the available resources. Platelet transfusions are lifesaving at a count less than 10,000/mm3. With meticulous supportive care, the case fatality rate can be reduced to less than 0.5%. [ABSTRACT FROM AUTHOR]

Background: In acute dengue fever, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are often elevated. The World Health Organization (WHO) established AST or ALT 1000 units/litre (U/L) as a criterion for severe dengue in its 2009 dengue guidelines. The goal of this study was to determine the clinical significance and prognostic value of AST or ALT as a marker in the diagnosis of dengue fever, dengue hemorrhagic fever (DHF) and severe dengue. Materials and methods: This was a prospective single centre observational study conducted for a period of 12 months carried out in the Department of General Medicine, Malla Reddy Hospitals, Hyderabad. A total 150 adult patients were included and for management. The WHO grading system was used to triage the patients as group A, group B and group C according to WHO. Amongst them group A were sent home and followed up daily; group B were admitted in wards and group C were admitted to ICU in need of any emergency treatment. Study population constituted group B and C. Patients were managed and observed from time to time with review examinations to assess improvement or derangement in patient condition. Results: Out of the serologically confirmed dengue cases, 90(60%) were male and 60(40%) were females, in which NS1 antigen positive were 133 (88.7%) and specific dengue IgM antibodies were 36 (24%). 79 (53%) had dengue fever, 63 (42%) had dengue fever with warning signs, and 8 (5.3%) suffered from severe dengue. Hepatic dysfunction was seen very commonly in all the dengue cases. Extent of ALT and AST elevation revealed good correlation with each other. Levels of ALT and AST increased significantly with increasing severity of DF, i.e., the levels of AST and ALT were significantly more in dengue with warning signs and severe dengue when compared with dengue fever without warning signs. The finding was of great clinical significance as this indicated that higher values of AST, ALT, were seen in patients with severe disease. So, we can say that grossly deranged LFT's can point towards severe form of dengue, and deranged transaminases can be used as a prognostic factor. Conclusion: The levels of serum aminotransferase (AST and ALT) are markedly elevated in all three kinds of dengue infection, and they are strongly related to the severity of the infection. In all forms of dengue infection, serum aspartate aminotransferase (AST) levels were considerably higher than alanine aminotransferase (ALT) levels. There is a direct association when used as a prognostic marker. More is the derangement in serum transaminase level; more is the chance of the disease being severe. The number of days spent in the hospital increased as the level of transaminases became more abnormal. [ABSTRACT FROM AUTHOR]

Dengue, commonly referred to as 'breakbone fever,' is a mosquito-borne arboviral infection transmitted by Aedes aegypti , featuring an average incubation period of approximately seven days. Key cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor (TNF)-α, and interleukin (IL)-10 are pivotal in the pathogenesis of dengue. Travelers are particularly susceptible to contracting dengue fever, with disease severity often associated with CD8+ T cell response. Without proper hospitalization during severe cases like dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), mortality rates can escalate to 50%. Dengue fever can lead to various complications, including neurological manifestations such as encephalopathy, encephalitis, cerebral venous thrombosis, myelitis, posterior reversible encephalopathy syndrome, strokes (both ischemic and hemorrhagic), immune-mediated neurological syndromes (such as mononeuropathy, acute transverse myelitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis), and neuromuscular complications. Treatment protocols typically involve assessing disease activity using composite indices, pursuing treatment objectives, and administering intravenous fluids according to symptomatology. Given the absence of specific antiviral treatment for dengue, supportive care, particularly hydration, remains paramount during the early stages. It is crucial to recognize that dengue viruses may contribute to the development of neurological disorders, particularly in regions where dengue is endemic. Furthermore, there is a necessity for well-defined criteria for specific neurological complications. Primary prevention strategies primarily revolve around vector control measures, which play a critical role in curtailing the spread of dengue., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Patel et al.)

Abstract Background Currently, several assays can diagnose acute dengue infection. However, none of these assays can predict the severity of the disease. Biomarkers that predicts the likelihood that a dengue patient will develop a severe form of the disease could permit more efficient patient triage and allows better supportive care for the individual in need, especially during dengue outbreaks. Methods We measured 20 plasma markers i.e. IFN-γ, IL-10, granzyme-B, CX3CL1, IP-10, RANTES, CXCL8, CXCL6, VCAM, ICAM, VEGF, HGF, sCD25, IL-18, LBP, sCD14, sCD163, MIF, MCP-1 and MIP-1β in 141 dengue patients in over 230 specimens and correlate the levels of these plasma markers with the development of dengue without warning signs (DWS−), dengue with warning signs (DWS+) and severe dengue (SD). Results Our results show that the elevation of plasma levels of IL-18 at both febrile and defervescence phase was significantly associated with DWS+ and SD; whilst increase of sCD14 and LBP at febrile phase were associated with severity of dengue disease. By using receiver operating characteristic (ROC) analysis, the IL-18, LBP and sCD14 were significantly predicted the development of more severe form of dengue disease (DWS+/SD) (AUC = 0.768, P

Objective: To classify suspected dengue into dengue, dengue with warning signs and severe dengue, based on clinical features as per the revised WHO guidelines with special emphasis on serology.Methods: It was a prospective cross-sectional study for five years from 2011-2016 in a tertiary care medical college hospital in Bangalore. All cases of fever of three to five days duration with symptoms like dengue were enrolled for the study. They were categorized into three groups as per the Revised WHO 2012 criteria. Laboratory parameters, serology, ultrasound abdomen and X-ray were done in almost all patients. Data was analysed by SPSS software, version 16, and different groups were compared with Chi square test.Results: Five hundred sixty eight children were diagnosed to have dengue fever; 4.2% of the sample belonged to infancy. Majority were in the age group of 5-10 y (42.6%). Fever and flushing were present in majority of the children. Gastrointestinal bleed was more commonly seen in the severe dengue group. Dengue nonstructural protein antigen (NS1Ag) was positive in 78%, immunoglobulin M (IgM) in 15.8% and immunoglobulin G (IgG) in 14.6%. Children with IgG had more complications, though not statistically significant. Mortality was reported in 1.2%. Dengue serology helped to confirm the diagnosis, however did not help in patient management.Conclusions: There is a considerable overlap in the symptomatology of dengue with warning signs and severe dengue. More studies are required on the severity and type of response to treatment in infants and obese adoloscents with severe dengue. [ABSTRACT FROM AUTHOR]

Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets. Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.

Background: Currently, several assays can diagnose acute dengue infection. However, none of these assays can predict the severity of the disease. Biomarkers that predicts the likelihood that a dengue patient will develop a severe form of the disease could permit more efficient patient triage and allows better supportive care for the individual in need, especially during dengue outbreaks.Methods: We measured 20 plasma markers i.e. IFN-γ, IL-10, granzyme-B, CX3CL1, IP-10, RANTES, CXCL8, CXCL6, VCAM, ICAM, VEGF, HGF, sCD25, IL-18, LBP, sCD14, sCD163, MIF, MCP-1 and MIP-1β in 141 dengue patients in over 230 specimens and correlate the levels of these plasma markers with the development of dengue without warning signs (DWS-), dengue with warning signs (DWS+) and severe dengue (SD).Results: Our results show that the elevation of plasma levels of IL-18 at both febrile and defervescence phase was significantly associated with DWS+ and SD; whilst increase of sCD14 and LBP at febrile phase were associated with severity of dengue disease. By using receiver operating characteristic (ROC) analysis, the IL-18, LBP and sCD14 were significantly predicted the development of more severe form of dengue disease (DWS+/SD) (AUC = 0.768, P < 0.0001; AUC = 0.819, P < 0.0001 and AUC = 0.647, P = 0.014 respectively). Furthermore, we also found that the levels of VEGF were directly correlated and sCD14 was inversely correlated with platelet count, suggesting that the endothelial activation and microbial translocation may played a role in pathogenesis of dengue disease.Conclusions: Given that the elevation IL-18, LBP and sCD14 among patients with severe form of dengue disease, our findings suggest a pathogenic role for an aberrant inflammasome and monocyte activation in the development of severe form of dengue disease. [ABSTRACT FROM AUTHOR]

Introduction: Dengue viral infection has become a significant public health concern with increased recognition of atypical manifestations apart from the classical clinical features. Appropriate, timely diagnosis and risk stratification for severe disease are crucial in the optimal management of this illness. The study outlines the evolving clinical spectrum of dengue with special emphasis on unusual manifestations. Methodology: A prospective hospital based study was conducted over a period of two years (June-2013 to May-2014). Data of 186 IgM dengue antibody-confirmed hospitalised cases was collected, compiled and analysed. Atypical manifestations in dengue fever were noted and analyzed. Result: The dengue infection was affecting mostly the younger age group with male preponderance. Most common symptoms apart from fever and headache were gastrointestinal symptoms like abdominal pain, vomiting and diarrhoea. Liver injury was almost universally present in the form of transaminitis. Atypical features were seen in 38.17% cases. Platelet count did not correlate exactly with severity of bleeding. Overall recovery rate was good. 4 (2.15%) patients succumbed to multiorgan failure and shock. Conclusion: Dengue illness may have a non-specific and varied presentation, thus mandating its screening in febrile illness especially during the post-monsoon period. An understanding of the course of disease progression, recognition of the warning signs during the different phases of the disease will enable primary care physicians to manage dengue fever in an appropriate and timely manner to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background Dengue fever, more prevalent in Asia, is a highly neglected vector-borne disease. It has a varied presentation ranging from common fever to atypical presentation as encephalitis. This study aimed to analyze the demographic and clinical profile of dengue patients admitted to a tertiary care center in Tamilnadu. Methodology This retrospective study was performed by collecting patient data from the medical records department for the years 2012 to 2014. A total of 150 patients with 50 patients from each year were selected. The patient's demographic data, clinical profile, management, and outcome were noted. Patients were divided into three groups as per the World Health Organization's 2009 classification. Results Most dengue cases occurred from October to December (70.7%). The number of male and female patients was almost equal (77 [51.3%] and 73 [48.7%], respectively). The middle-aged group (21-40 years) was commonly affected (54%). The mean age was 29 ± 13.20 years. Fever was the most common symptom (100%), followed by lethargy (81.3%) and myalgia (60.7%). Overall, 10% of patients had comorbidities such as diabetes, hypertension, and ischemic heart disease. Moreover, 22.7% of patients had dengue with warning signs, and severe dengue was seen in 19.3% of patients. A significant difference was noted in the total count, comorbidities, serositis, and the duration of hospitalization between the groups. No mortality was recorded in the study population. Conclusions Dengue is very common in the middle-aged group. Patients with severe dengue had significant leucopenia, several comorbidities, and serositis. The mortality can be reduced to <1% and even zero in severe dengue according to our study with close monitoring and supportive care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Jisamerin et al.)

Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding., Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets., Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.