The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Kuender D Yang - One of the best experts on this subject based on the ideXlab platform.
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acute myocarditis in Dengue Hemorrhagic Fever a case report and review of cardiac complications in Dengue affected patients
International Journal of Infectious Diseases, 2010Co-Authors: Ingkit Lee, Jienwei Liu, Wen Huei Lee, Kuender D YangAbstract:We report a case of Dengue Hemorrhagic Fever (DHF) complicated by acute myocarditis and review the literature. A 65-year-old woman experienced DHF due to Dengue virus serotype 3, complicated with acute myocarditis and acute pulmonary edema. Clinically this masqueraded as acute myocardial infarction, with an electrocardiographically depressed ST segment in precordial leads and elevated serum cardiac-specific troponin I level. Under supportive management, the patient recovered 3 days later. A total of 18 pertinent articles involving 339 Dengue-affected patients with cardiac complications were found by PubMed search. Clinical manifestations of cardiac complications varied considerably, from self-limiting tachy-brady arrhythmia to severe myocardial damage, leading to hypotension and pulmonary edema. Although rare, a fatal outcome was reported in some cases of Dengue with cardiac complications. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for cardiac complications in patients with Dengue illness and should manage this accordingly.
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combination of ctla 4 and tgfβ1 gene polymorphisms associated with Dengue Hemorrhagic Fever and virus load in a Dengue 2 outbreak
Clinical Immunology, 2009Co-Authors: Rongfu Chen, Jienwei Liu, Lin Wang, Jenchieh Chang, Jiintsuey Cheng, Hau Chuang, Ichun Lin, Kuender D YangAbstract:Abstract The pathogenesis of Dengue Hemorrhagic Fever (DHF) has been considered to be massive immune activation of T cells. Abnormal expression of the immune regulatory molecules, CTLA-4 and TGFβ1, leads to disturbances of regulatory T cell immune response. We investigate the contribution of CTLA-4 and TGFβ1 in DHF by analyzing them for association with virus load in blood and polymorphisms of CTLA-4 +49A/G, and TGFβ1 −509C/T in a DEN-2 outbreak. The increased frequency of the TGFβ1 −509 CC genotype in patients with DHF was compared to those with Dengue Fever (OR = 1.9, p = 0.034). Moreover, the presence of the CTLA-4 +49 G allele and TGFβ1 −509 CC genotype increased the susceptibility to risk of DHF (OR = 2.1, p = 0.028) and significantly higher virus load (p = 0.013). This finding suggests that a combination of CTLA-4 and TGFβ1 polymorphisms is associated with the susceptibility of DHF and higher virus load.
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clinical characteristics risk factors and outcomes in adults experiencing Dengue Hemorrhagic Fever complicated with acute renal failure
American Journal of Tropical Medicine and Hygiene, 2009Co-Authors: Ingkit Lee, Jienwei Liu, Kuender D YangAbstract:In a retrospective study, acute renal failure (ARF) was found in 10 (3.3%) among 304 hospitalized adults with Dengue Hemorrhagic Fever (DHF), and 6 (60%) of the 10 patients with ARF died, whereas all 294 patients without ARF (controls) survived (P < 0.001). Compared with the controls, DHF patients with ARF were found to be significantly older (P = 0.002) and male predominant (P < 0.001) and to have higher frequency of previous stroke (P = 0.005), chronic renal insufficiency (P = 0.046), Dengue shock syndrome (DSS; P < 0.001), gastrointestinal bleeding (P < 0.001), and concurrent bacteremia (P = 0.009), lower hemoglobin (P = 0.003) and serum albumin levels (P = 0.003), and higher incidences of prolonged prothrombin time (P < 0.001), elevated aspartate aminotransferase (P < 0.001), and alanine aminotransferase levels (P < 0.001). Multivariate analysis showed DSS (odd ratio = 220.0; P < 0.001) was an independent risk factor for development of ARF in DHF patients. The high fatality rate in DHF patients complicated with ARF in our series underscore the importance of clinicians' alertness to this potentially fatal complication so that initiation of timely appropriate treatment is possible.
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clinical and laboratory characteristics and risk factors for fatality in elderly patients with Dengue Hemorrhagic Fever
American Journal of Tropical Medicine and Hygiene, 2008Co-Authors: Ingkit Lee, Jienwei Liu, Kuender D YangAbstract:To better understand the clinical and laboratory characteristics and to identify risk factor(s) for fatality in elderly patients with Dengue Hemorrhagic Fever (DHF), 66 elderly (age > or = 65 years) and 241 non-elderly adults (age, 19-64 years) with DHF were retrospectively analyzed. Compared with non-elderly adults, elderly individuals had significantly lower incidences of Fever (P = 0.002), abdominal pain (P = 0.003), bone pain (P < 0.001), and skin rashes (P = 0.002); higher frequencies of concurrent bacteremia (P = 0.049), gastrointestinal bleeding (P = 0.044), acute renal failure (P = 0.001), and pleural effusion (P < 0.010); higher incidence of prolonged prothrombin time (P = 0.025); lower mean hemoglobin level (P < 0.001); longer hospitalization (P = 0.049); and a higher fatality rate (P = 0.006). Five elderly patients with DHF died. When compared with non-fatal elderly patients with DHF, a significant higher frequency in men (P = 0.019), those with chronic obstructive pulmonary disease (P = 0.008), those with Dengue shock syndrome (DSS; P < 0.001), and those with acute renal failure (P < 0.001) was found in the elderly counterparts that died. Multivariate analysis showed that only DSS (odd ratio = 77.33, P = 0.001) was an independent risk factor for fatality in elderly patients.
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Dengue Hemorrhagic Fever patients with acute abdomen clinical experience of 14 cases
American Journal of Tropical Medicine and Hygiene, 2006Co-Authors: Boonsiang Khor, Jienwei Liu, Ingkit Lee, Kuender D YangAbstract:Among 328 patients with Dengue Hemorrhagic Fever/Dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure-related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a Dengue-endemic setting.
Duane J. Gubler - One of the best experts on this subject based on the ideXlab platform.
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chymase level is a predictive biomarker of Dengue Hemorrhagic Fever in pediatric and adult patients
The Journal of Infectious Diseases, 2017Co-Authors: Hasitha Tissera, Duane J. Gubler, Abhay P S Rathore, Wei Yee Leong, Brian L Pike, Tyler E Warkentien, Farouk S Farouk, Ayesa Syenina, Eng Eong Ooi, Annelies WildersmithAbstract:Background. Most patients with Dengue experience mild disease, Dengue Fever (DF), while few develop the life-threatening diseases Dengue Hemorrhagic Fever (DHF) or Dengue shock syndrome (DSS). No l ...
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epidemiology of Dengue in sri lanka before and after the emergence of epidemic Dengue Hemorrhagic Fever
American Journal of Tropical Medicine and Hygiene, 2002Co-Authors: William B Messer, Duane J. Gubler, Tissa U Vitarana, Kamalanayani Sivananthan, Jayanthi Elvtigala, L D Preethimala, R Ramesh, Nalini Withana, Aravinda M De SilvaAbstract:Before 1989, Dengue epidemiology in Sri Lanka was characterized by frequent transmission of all four Dengue serotypes but a low incidence of Dengue Hemorrhagic Fever (DHF). After 1989, cases of DHF dramatically increased. Here we present the results of epidemiologic studies conducted in Colombo, Sri Lanka before and after epidemic emergence of DHF in 1989. We compared the proportion of Dengue cases among people with Fever attending clinics from 1980 to 1984 and in 1997 and 1998 to determine if an increase in Dengue transmission was associated with more DHF cases being reported. We also compared the relative distribution of Dengue virus serotypes circulating in Colombo before and after the emergence of DHF. We detected no significant differences in Dengue as a proportion of Fever cases or in serotype distribution between the pre and post-DHF periods. We conclude that an increase in virus transmission or a change in circulating serotypes does not explain the epidemic emergence of DHF in Sri Lanka.
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epidemic Dengue Dengue Hemorrhagic Fever as a public health social and economic problem in the 21st century
Trends in Microbiology, 2002Co-Authors: Duane J. GublerAbstract:Dengue Fever/Dengue Hemorrhagic Fever is now one of the most important public health problems in tropical developing countries and also has major economic and societal consequences.
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Dengue and Dengue Hemorrhagic Fever in Latin America and the Caribbean.
Infectious disease clinics of North America, 2000Co-Authors: Raúl E. Istúriz, Duane J. Gubler, José Brea Del CastilloAbstract:Four serotypes of Dengue viruses produce Dengue Fever, Dengue Hemorrhagic Fever, and Dengue shock syndrome. They are the most important arbovirus infections of humans, in terms of both morbidity and mortality, constituting one of the most rapidly expanding and re-emerging infectious disease problems in Latin America. In less than 20 years, the region has transformed itself from hypoendemic to hyperendemic, while serotype circulation in most countries has gone from none or single to multiple. Changes in endemicity have coincided with the emergence and increasing incidence of the severer forms of Dengue infection. This article reviews the clinical presentations of these diseases. Health care providers who see patients in or returning from areas of Latin America, the Caribbean, and other tropical areas must consider Dengue in the differential diagnosis of patients presenting with compatible symptoms, and must be knowledgeable in the current management of this important disease.
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impact of Dengue Dengue Hemorrhagic Fever on the developing world
Advances in Virus Research, 1999Co-Authors: Duane J. Gubler, Martin MeltzerAbstract:Publisher Summary This chapter focuses on the changing epidemiology of Dengue/Dengue Hemorrhagic Fever (DEN/DHF), estimates the global growth in the number of cases of DEN/DHF from 1955 to 1996, and uses these incidence data to estimate the global economic impact of this disease. Epidemic DEN/DHF has emerged as a global public health problem in the tropics in the past 20 years. This has been caused by the expanding geographic distribution of both the viruses and the principal mosquito vectors as a result of global demographic and societal changes. During this period, most tropical urban centers of the world have become hyperendemic, thus increasing the risk of epidemic transmission and the emergence of DHF. Despite this dramatic emergence of a new Hemorrhagic disease, few estimates of the economic impact of DEN/DHF have been attempted. The lack of estimates of the economic impact of endemic DEN/DHF is important, because such estimates are needed by policy planners to help allocate limited resources for research, prevention, and control activities. Different model for evaluating the effect of the impact of DEN/DHF is provided in this chapter.
Jienwei Liu - One of the best experts on this subject based on the ideXlab platform.
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acute myocarditis in Dengue Hemorrhagic Fever a case report and review of cardiac complications in Dengue affected patients
International Journal of Infectious Diseases, 2010Co-Authors: Ingkit Lee, Jienwei Liu, Wen Huei Lee, Kuender D YangAbstract:We report a case of Dengue Hemorrhagic Fever (DHF) complicated by acute myocarditis and review the literature. A 65-year-old woman experienced DHF due to Dengue virus serotype 3, complicated with acute myocarditis and acute pulmonary edema. Clinically this masqueraded as acute myocardial infarction, with an electrocardiographically depressed ST segment in precordial leads and elevated serum cardiac-specific troponin I level. Under supportive management, the patient recovered 3 days later. A total of 18 pertinent articles involving 339 Dengue-affected patients with cardiac complications were found by PubMed search. Clinical manifestations of cardiac complications varied considerably, from self-limiting tachy-brady arrhythmia to severe myocardial damage, leading to hypotension and pulmonary edema. Although rare, a fatal outcome was reported in some cases of Dengue with cardiac complications. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for cardiac complications in patients with Dengue illness and should manage this accordingly.
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combination of ctla 4 and tgfβ1 gene polymorphisms associated with Dengue Hemorrhagic Fever and virus load in a Dengue 2 outbreak
Clinical Immunology, 2009Co-Authors: Rongfu Chen, Jienwei Liu, Lin Wang, Jenchieh Chang, Jiintsuey Cheng, Hau Chuang, Ichun Lin, Kuender D YangAbstract:Abstract The pathogenesis of Dengue Hemorrhagic Fever (DHF) has been considered to be massive immune activation of T cells. Abnormal expression of the immune regulatory molecules, CTLA-4 and TGFβ1, leads to disturbances of regulatory T cell immune response. We investigate the contribution of CTLA-4 and TGFβ1 in DHF by analyzing them for association with virus load in blood and polymorphisms of CTLA-4 +49A/G, and TGFβ1 −509C/T in a DEN-2 outbreak. The increased frequency of the TGFβ1 −509 CC genotype in patients with DHF was compared to those with Dengue Fever (OR = 1.9, p = 0.034). Moreover, the presence of the CTLA-4 +49 G allele and TGFβ1 −509 CC genotype increased the susceptibility to risk of DHF (OR = 2.1, p = 0.028) and significantly higher virus load (p = 0.013). This finding suggests that a combination of CTLA-4 and TGFβ1 polymorphisms is associated with the susceptibility of DHF and higher virus load.
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clinical characteristics risk factors and outcomes in adults experiencing Dengue Hemorrhagic Fever complicated with acute renal failure
American Journal of Tropical Medicine and Hygiene, 2009Co-Authors: Ingkit Lee, Jienwei Liu, Kuender D YangAbstract:In a retrospective study, acute renal failure (ARF) was found in 10 (3.3%) among 304 hospitalized adults with Dengue Hemorrhagic Fever (DHF), and 6 (60%) of the 10 patients with ARF died, whereas all 294 patients without ARF (controls) survived (P < 0.001). Compared with the controls, DHF patients with ARF were found to be significantly older (P = 0.002) and male predominant (P < 0.001) and to have higher frequency of previous stroke (P = 0.005), chronic renal insufficiency (P = 0.046), Dengue shock syndrome (DSS; P < 0.001), gastrointestinal bleeding (P < 0.001), and concurrent bacteremia (P = 0.009), lower hemoglobin (P = 0.003) and serum albumin levels (P = 0.003), and higher incidences of prolonged prothrombin time (P < 0.001), elevated aspartate aminotransferase (P < 0.001), and alanine aminotransferase levels (P < 0.001). Multivariate analysis showed DSS (odd ratio = 220.0; P < 0.001) was an independent risk factor for development of ARF in DHF patients. The high fatality rate in DHF patients complicated with ARF in our series underscore the importance of clinicians' alertness to this potentially fatal complication so that initiation of timely appropriate treatment is possible.
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clinical and laboratory characteristics and risk factors for fatality in elderly patients with Dengue Hemorrhagic Fever
American Journal of Tropical Medicine and Hygiene, 2008Co-Authors: Ingkit Lee, Jienwei Liu, Kuender D YangAbstract:To better understand the clinical and laboratory characteristics and to identify risk factor(s) for fatality in elderly patients with Dengue Hemorrhagic Fever (DHF), 66 elderly (age > or = 65 years) and 241 non-elderly adults (age, 19-64 years) with DHF were retrospectively analyzed. Compared with non-elderly adults, elderly individuals had significantly lower incidences of Fever (P = 0.002), abdominal pain (P = 0.003), bone pain (P < 0.001), and skin rashes (P = 0.002); higher frequencies of concurrent bacteremia (P = 0.049), gastrointestinal bleeding (P = 0.044), acute renal failure (P = 0.001), and pleural effusion (P < 0.010); higher incidence of prolonged prothrombin time (P = 0.025); lower mean hemoglobin level (P < 0.001); longer hospitalization (P = 0.049); and a higher fatality rate (P = 0.006). Five elderly patients with DHF died. When compared with non-fatal elderly patients with DHF, a significant higher frequency in men (P = 0.019), those with chronic obstructive pulmonary disease (P = 0.008), those with Dengue shock syndrome (DSS; P < 0.001), and those with acute renal failure (P < 0.001) was found in the elderly counterparts that died. Multivariate analysis showed that only DSS (odd ratio = 77.33, P = 0.001) was an independent risk factor for fatality in elderly patients.
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Dengue Hemorrhagic Fever patients with acute abdomen clinical experience of 14 cases
American Journal of Tropical Medicine and Hygiene, 2006Co-Authors: Boonsiang Khor, Jienwei Liu, Ingkit Lee, Kuender D YangAbstract:Among 328 patients with Dengue Hemorrhagic Fever/Dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure-related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a Dengue-endemic setting.
Gary G Clark - One of the best experts on this subject based on the ideXlab platform.
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the Dengue and Dengue Hemorrhagic Fever epidemic in puerto rico 1994 1995
American Journal of Tropical Medicine and Hygiene, 2001Co-Authors: Jose G Rigauperez, A V Vorndam, Gary G ClarkAbstract:From June 1, 1994 to May 31, 1995 a total of 24,700 cases of Dengue (7.01/1,000 population) were reported to the laboratory-based surveillance system in Puerto Rico (1991-1994, annual average: 2.55/1,000). Dengue virus 2 predominated. The earliest indicator of epidemic activity was the virus isolation rate in May 1994 (14.0% versus 5.7% average). The male-to-female ratio among cases was 1:1.1; 65.4% were younger than 30 years (the 10 to 19 year age group had the highest incidence, 11.8/1,000). At least 5,687 cases (23.0%) showed a Hemorrhagic manifestation; 4,662 (18.9%) were hospitalized, and 40 died (0.2%; 10 laboratory-positive). Two cases documented by laboratory were transmitted by unusual routes--intrapartum and through a bone marrow transplant. Among 2,004 hospitalized cases reported by infection control nurses, 139 (6.9%) fulfilled the criteria for Dengue Hemorrhagic Fever (DHF) and another 13 cases (0.6%) had Dengue shock syndrome. This epidemic produced the largest number of hospitalizations, DHF cases, and deaths from any Dengue epidemic in Puerto Rico. Severity did not change throughout the year. Surveillance capabilities were maintained by temporary, simplified reporting methods, none of which could be recommended as the single method of choice for surveillance; each must be used (on site, or as a service available from a reference laboratory) at the right time in the epidemic cycle. The utility of comparisons of current and previous data underscores the value of long-term surveillance. Our analysis was unable to document whether significantly increased transmission occurred more often in cities where the water supply was rationed or where the local landfill was closed.
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Dengue Dengue Hemorrhagic Fever the emergence of a global health problem
Emerging Infectious Diseases, 1995Co-Authors: Duane J. Gubler, Gary G ClarkAbstract:Dengue and Dengue Hemorrhagic Fever (DHF) are caused by one of four closely related but antigenically distinct virus serotypes (DEN-1 DEN-2 DEN- 3 and DEN-4) of the genus Flavivirus. Infection with one of these serotypes does not provide cross-protective immunity so persons living in a Dengueendemic area can have four Dengue infections during their lifetimes. Dengue is primarily an urban disease of the tropics and the viruses that cause it are maintained in a cycle that involves humans and Aedes aegypti a domestic day-biting mosquito that prefers to feed on humans. Infection with a Dengue virus serotype can produce a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal Hemorrhagic disease. Important risk factors for DHF include the strain and serotype of the virus involved as well as the age immune status and genetic predisposition of the patient. The first reported epidemics of Dengue Fever occurred in 1779-1780 in Asia Africa and North America; the near simultaneous occurrence of outbreaks on three continents indicates that these viruses and their mosquito vector have had a worldwide distribution in the tropics for more than 200 years. During most of this time Dengue Fever was considered a benign nonfatal disease of visitors to the tropics. Generally there were long intervals (10-40 years) between major epidemics mainly because the viruses and their mosquito vector could only be transported between population centers by sailing vessels. (excerpt)
Alan L Rothman - One of the best experts on this subject based on the ideXlab platform.
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Dengue Hemorrhagic Fever the sensitivity and specificity of the world health organization definition for identification of severe cases of Dengue in thailand 1994 2005
Clinical Infectious Diseases, 2010Co-Authors: Anon Srikiatkhachorn, Sharone Green, Ananda Nisalak, David W Vaughn, Timothy P Endy, Robert V Gibbons, Daniel H Libraty, Stephen J Thomas, Francis A Ennis, Alan L RothmanAbstract:Background Dengue virus infection causes a spectrum of clinical manifestations, usually classified according to the World Health Organization (WHO) guidelines into Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). Its ability to categorize severe Dengue illness has recently been questioned.
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immunopathological mechanisms in Dengue and Dengue Hemorrhagic Fever
Current Opinion in Infectious Diseases, 2006Co-Authors: Sharone Green, Alan L RothmanAbstract:Purpose of reviewThe continued emergence of Dengue virus infection and its severe disease manifestation, Dengue Hemorrhagic Fever, is a growing public health problem. The majority of severe infections occur upon secondary encounters with heterologous Dengue virus serotypes, suggesting an immune-medi
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high circulating levels of the Dengue virus nonstructural protein ns1 early in Dengue illness correlate with the development of Dengue Hemorrhagic Fever
The Journal of Infectious Diseases, 2002Co-Authors: Daniel H Libraty, Sharone Green, Ananda Nisalak, David W Vaughn, Timothy P Endy, Francis A Ennis, Siripen Kalayanarooj, Paul R Young, Darren Pickering, Alan L RothmanAbstract:Infection with any 1 of 4 Dengue viruses produces a spectrum of clinical illness ranging from a mild undifferentiated febrile illness to Dengue Fever (DF) to Dengue Hemorrhagic Fever (DHF), a potentially life-threatening disease. The morbidity and mortality of DHF can be reduced by early hospitalization and careful supportive care. To determine its usefulness as a predictor of DHF, plasma levels of the secreted Dengue virus nonstructural protein NS1 (sNS1) were measured daily in 32 children with Dengue-2 virus infections participating in a prospective, hospital-based study. Free sNS1 levels in plasma correlated with viremia levels and were higher in patients with DHF than in those with DF. An elevated free sNS1 level (> or =600 ng/mL) within 72 h of illness onset identified patients at risk for developing DHF.
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early cd69 expression on peripheral blood lymphocytes from children with Dengue Hemorrhagic Fever
The Journal of Infectious Diseases, 1999Co-Authors: Sharone Green, Alan L Rothman, Ananda Nisalak, Suchitra Nimmannitya, David W Vaughn, Ichiro Kurane, Sathit Pichyangkul, Siripen Kalayanarooj, Francis A EnnisAbstract:Recent reports have demonstrated immune activation in Dengue Hemorrhagic Fever (DHF) by cytokine and soluble receptor detection in blood. The goal of this study was to determine which cell types are activated and likely to be responsible for cytokine production. Whole blood specimens from 51 Thai children presenting within 72 h of Fever onset and with detectable plasma Dengue viral RNA were studied by flow cytometry. Absolute CD4 T cell, CD8 T cell, NK cell, and gd T cell counts were decreased in children with DHF compared with those with Dengue Fever (DF) early in the course of illness. The percent of cells expressing CD69 was increased on CD8 T cells and NK cells in children who developed DHF more than in those with DF. These data directly demonstrate that cellular immune activation is present early in acute Dengue and is related to disease severity.