In most cases, especially in children younger than 15 years, the patient is asymptomatic or has a mild undifferentiated febrile illness lasting 57 days. Dengue is a mosquitoborne disease caused by any one of four closely related dengue viruses. May 03, 2019 dengue viral infections frequently are not apparent. We too have found that dengue ns1 stimulates il10 production from monocytes, which in turn could lead to suppression of dengue virus specific. This video aims to describe the mode of replication of dengue virus and the pathophysiology of dengue. Dengue pathogenesis, clinical manifestation, lab diagnosis. The 2009 world health organization who revised classification system defines two major entities, dengue and severe dengue, in place of the more complex dengue fever dengue hemorrhagic fever categories previously recommended although the revised classification is more easily applicable for clinical and epidemiological purposes, debate.
The characteristic feature of dhf is increased capillary permeability leading to extensive plasma leakage in serous cavities resulting in shock. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Doctor hari shankar explains death due to dengue fever. Dengue vaccine is used in all the endemic countries currently f. Dengue chapter 4 2020 yellow book travelers health cdc. Recent evidence has provided further information of neutralizing versus enhancing monoclonal antibodies and their target epitopes on the. In a small proportion of cases, the virus causes increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation dic known as dengue hemorrhagic fever dhf. Recent findings the pathogenesis of severe dengue is thought to be immunemediated due to the timing of the clinical manifestations and higher incidence in secondary infections with a heterologous serotype.
Dec 08, 2017 dengue pathogenesis, clinical manifestation, lab diagnosis and treatment pathogenesis of dengue. The clinical manifestations of dengue are the expression of a constellation of host and viral factors, some acquired, others intrinsic to the individual. Dengue infection is caused by any of four dengue virus serotypes. Learn more dengue clinical case management elearning pathophysiology of severe dengue. Treat the symptoms of dengue and see your healthcare provider. Guidelines for diagnosis, treatment, prevention and control. The clinical manifestations range from asymptomatic infection to undiffer. Role of ns1 antibodies in the pathogenesis of acute secondary. There have been multiple epidemics of dengue fever in the us in the 18th to early 20th centuries. Plasma leakage and intrinsic coagulopathy are the pathological hall marks in dengue haemorrhagic fever dhf.
They are rna viruses that belong to the flavivirus genusflaviviridae family, which also includes the yellow fever virus, west nile virus, japanese encephalitis virus, zika virus, and the st louis encephalitis virus. Symptoms typically begin three to fourteen days after infection. If you think you have dengue pdf icon pdf 1 page see a healthcare provider if you develop a fever or have symptoms of dengue. Here we investigate the immunoglobulin responses of patients with dengue fever df and.
This severe syndrome, which recently has also been identified. Once you are infected with one of the dengue viruses, you will develop immunity to that. Dengue fever is one of the major health problems in india. Beginning in the 1950s, at the time when four different denvs were discovered, a lethal variant of dengue emerged. Dengue viruses occur as four antigenically related but distinct serotypes transmitted to humans by aedes aegypti mosquitoes. The clinical manifestations range from asymptomatic infection to undifferentiated fever, dengue fever and dengue hemorrhagi. Dengue is an important differential diagnosis of fever in children presenting to firstlevel health facilities in tropical asia and latin america. Dengue fever is a mosquitoborne tropical disease caused by the dengue virus. Pathophysiology and management of dengue hemorrhagic fever. Since the second edition of dengue haemorrhagic fever.
Dengue virus denv infections of humans were long thought to be selflimited and of low mortality. Since the last major pandemic in 1998, epidemics have recurred in much of the area. Dengue viral infections postgraduate medical journal. Dengue viral infections are one of the most important mosquito borne diseases in the world. Dengue virus produces a mild acute febrile illness, dengue fever df and a severe illness, dengue hemorrhagic fever dhf.
This would help determine the immune correlates of severe clinical disease and protection. Dengue is not included in the generic integrated management of childhood illness imci algorithm, but due to its importance, it was incorporated in several asian and latin american imci adaptations. Dengue feverdengue hemorrhagic fever dengue feverdengue hemorrhagic fever bruce r. Infection with any of the denv serotypes may be asymptomatic in the majority of cases or may result in. Dengue fever global prevalence, dengue pathogenesis, dengue infection diagnosis introduction dengue fever abreak bone fever a spanish word dengue means fastidious or careful. Natural course the clinical course of illness passes through 3 phases.
Dengue fever is a mosquitoborne viral illness found throughout the. The role of ns1specific antibodies in the pathogenesis of dengue virus infection is poorly understood. Dengue infection is caused by 4 antigenically distinct dengue virus serotypes. Pathogenesis people bitten by aedes aegypti mosquito are diagnosed with high fever and severe joint pain that are the common symptoms of dengue fever 16. We expand specifically on the role of the dermis in dengue virus infection, the contribution of cellular and humoral immune responses to pathogenesis and immunity, ns1 and. Mar 19, 20 clinical manifestations of dengue and dengue hemorrhagic fever undifferentiated fever classic dengue fever dengue hemorrhagic fever dengue shock syndrome 14. The most widelycited hypothesis for the pathogenesis of severe dengue is antibodydependent enhancement ade. Severe dengue most commonly occurs among patients with secondary denv infections and infants with primary infections. Classic dengue fever primarily occurs in nonimmune, nonindigenous adults and children and is typically selflimiting. Nov 25, 2015 dengue virus denv infections of humans were long thought to be selflimited and of low mortality. Individual risk factors for dengue hemorrhagic fever dengue shock syndrome. Generally, dengue is classified as a blood infection and the main reaction of the human body to dengue. Spak spak dengue virus family flaviviridae genus flavivirus.
As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of dengue, there is a. Description of the clinical picture of dengue hemorrhagic feverdengue shock syndrome dhfdss in adults. As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of dengue, there is a critical need for adequate tropism assays, animal models, and human autopsy data. Dengue fever is a mosquitoborne viral disease caused by 1 of 4 closely related but antigenically distinct serotypes of dengue virus, serotypes denv1 through den4. Recent advances in dengue pathogenesis and clinical. Pathogenesis of dengue haemorrhagic fever and its impact. Age and sex both are affected since dengue is a universal infection season aedes aegypti is more commonly found in tropical and subtropical countries. However, relatively little is known about these receptors. Blood pressure can drop to dangerous levels, causing shock and, in some cases, death. The infection is endemic in more than 100 countries, particularly the south east asia region, western pacific region, and the americas. Feb 16, 2018 if severe, dengue fever can damage the lungs, liver or heart.
The presence of fever, itchy rash, and headache the dengue triad is characteristic of dengue. Infection may be asymptomatic or present with a broad range of clinical manifestations including a mild febrile illness to a lifethreatening shock syndrome. Pathogenesis of dengue haemorrhagic fever and its impact on. Attempts to explain the pathogenesis of dengue in all its complexity must consider all the clinical, immunological, pathological, and epidemiological features of denv infection.
Interaction with specific receptors at the cell surface is one of the first events in the pathogenesis of dengue virus. Generally, dengue is classified as a blood infection and the main reaction of the human body to dengue virus. Jul 03, 2006 the pathogenic mechanisms of dengue hemorrhagic fever and dengue shock syndrome dhfdss caused by dengue virus dv infection remain unresolved. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever vii dengue fever is the fastest emerging arboviral infection spread by aedes mosquitoes with major public health consequences in over 100 tropical and subtropical countries in southeast asia, the western pacific and south and central america. These viruses generally cause a benign syndrome, dengue fever, in the american and african tropics, and a severe syndrome, dengue hemorrhagic fever dengue shock syndrome dhfdss, in southeast asian children. Dengue, dengue haemorrhagic fever and dengue shock. Dengue fever is a disease caused by a family of viruses transmitted by infected mosquitoes. Focusing on the pathogenesis of dengue, a pattern of acute viral infection can be seen. From 1975 through 2009, symptomatic dengue virus infections were classified according to the who guidelines as dengue fever, dengue hemorrhagic fever dhf, and dengue shock syndrome the most severe form of dhf. The case definition was changed to the 2009 clinical classification after reports that the case. Febrile phase critical phase convalescent phase 25. Normally selflimiting, patients recover in 710 days in 114,000 primary infections. Denv infection results in a broad spectrum of clinical symptoms, ranging from mild fever to dengue hemorrhagic fever dhf, the latter of which.
Febrile phase the onset of dengue fever is usually with sudden rise in temperature which may be biphasic, lasting 58 days and commonly associated with. Pdf autoimmune pathogenesis in dengue virus infection. Dengue is an important cause of childhood and adult morbidity in asian and latin american countries and its geographic footprint is growing. Dengue fever primary infection asymptomatic or acute febrile illness with severe headache, back and limb pain and rash.
Dengue begins abruptly after an incubation period of 57 days range, 310 days, and the course follows 3 phases. Dengue virus after entering in the body invades the local macrophages and multiply there. They may range from subclinical infection to dengue fever, dengue hemorrhagic fever dhf, and eventually dengue shock syndrome dss. Annually, 100 million cases of dengue fever and half a million cases of dhf occur worldwide. The dengue virus nonstructural1 protein ns1 generates antibodies to common epitopes on human blood clotting, integrinadhesin proteins and binds to human endothelial cells.
Although dengue is a very old disease but recently an alarming increase has been seen in the geographic range, along with the severity of infection 17. Pathogenesis of dengue fever and dhf dengue fever develops from dengue virus infection following a mosquito bite. The pathogenesis of dengue is likely to be a complex interplay of host immunity and genetic predisposition combined with certain viral virulence factors. Apr 03, 2016 this video aims to describe the mode of replication of dengue virus and the pathophysiology of dengue. Clinical and serologic study of cuban children with dengue hemorrhagic feverdengue shock syndrome dhfdss. After an absence of 56 years, dengue fever has reemerged in us states such as texas and hawaii. Dengue is a febrile illness caused by infection with one of four dengue viruses denv transmitted by aedes aegypti or aedes albopictus mosquitoes during the taking of a blood meal.
Dengue hemorrhagic feverdengue shock syndrome dhfdss initially observed in southeast asia now has spread throughout the world. The supportive care in dengue includes fluid replacement and close monitoring of platelet and hct c. Molecular mechanism of pathogenesis of dengue virus. As both cell tropism and tissue tropism of denv are considered major determinants in the pathogenesis of dengue. Dengue hemorrhagic fever can occur when someone is bitten by a mosquito or exposed to blood infected with the dengue virus. Dengue hemorrhagic fever dengue shock syndrome dhfdss initially observed in southeast asia now has spread throughout the world. Pathogenesis of dengue viral infections sri lankan journal of. Although dhf can develop in patients with a first episode of dengue infection. Pathogenesis and pathophysiology of dengue hemorrhagic fever.
Pathophysiology and pathogenesis of dengue haemorrhagic fever. They may be asymptomatic or may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever dhf, or dengue shock syndrome. Infection with one dengue serotype confers lifelong homotypic immunity and a brief period of partial heterotypic immunity 2 years, but each individual can eventually be infected by all. Ninety percent of dhf subjects are children less than 15. Take acetaminophen also known as paracetamol outside of the united states to control fever. Although infection with the dengue virus denv is associated with a self. Antibodydependent enhancement of disease and severe dengue. Dengue is caused by infection with one of four dengue virus serotypes, i. Role of ns1 antibodies in the pathogenesis of acute. Dengue chapter 4 2020 yellow book travelers health. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen lymph nodes lymphadenopathy, and rash. Jan 27, 2016 the 1986 dengue fever outbreak in puerto rico. Attempts to explain the pathogenesis of dengue in all its complexity must consider all the.
Although dengue is a very old disease but recently an alarming increase has been seen in the geographic range, along with the severity of. Dengue pathogenesis, clinical manifestation, lab diagnosis and treatment pathogenesis of dengue. Dengue viral infections frequently are not apparent. Cellular receptors in human monocytes and mouse neural cells are main target for the viral infection.
Although the exact mechanisms are not clear, ade is the process in. Dengue fever is a benign, acute febrile syndrome occurring in tropical regions. Pdf pathogenesis and pathophysiology of dengue hemorrhagic. Infected local cells then migrate from site of infection to lymph nodes, where monocytes and macrophages are recruited, which become targets of infection. Dengue dengue hemorrhagic hemorrhagic fever fever pathogenesis and pathophysiology alan alan r. The pathogenesis of dengue request pdf researchgate. Patients with dhfdss are characterized by several manifestations, including severe thrombocytopenia, vascular leakage, and hepatomegaly. Dengue vaccine is given to new born babies as preventive method g. Pathogenesis of severe dengue infection international journal of. Much remains to be learned about the pathogenesis of the different manifestations of dengue virus denv infections in humans. Dengue fever is a globally important arboviral infection transmitted by the aedes genus of mosquito primarily a aegypti, but also a albopictus, found in tropical and subtropical regions. Pathogenesis of vascular leak in dengue virus infection. Progress towards understanding the pathogenesis of dengue. Undifferentiated fevermay be the most common manifestation ofdengueprospective study found that 87% of patientsinfected were either asymptomatic or only mildlysymptomaticother prospective.
1091 17 1105 747 225 312 229 747 620 1293 1513 771 29 780 1160 1109 524 558 1163 1541 1491 637 446 280 549 342 1474 878 793 739 259 595 846 1454 946 992 1454 108 611 753 294 121 717 582 326 1071 1355 249