Clinical management of patientswith viral haemorrhagic fever. Who, comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever, 2011. Pathophysiology of severe dengue centers for disease. The incidence of dengue has increased dramatically in recent decades, with estimates of 40%50% of the worlds. This disease used to be called breakbone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. Dengue is emerging as one of the most abundant vectorborne disease globally. Dengue infectious diseases merck manuals professional edition. Also called break bone fever caused by dengue virus and characterised by fever myalgia and arthralgia and bone pains. The latter may progress to hypovolemic shock dengue shock syndrome dss. Symptoms typically begin three to fourteen days after infection.
They may range from subclinical infection to dengue fever, dengue hemorrhagic fever dhf, and eventually dengue shock syndrome dss. It can be lifethreatening, and are caused by four closely related virus serotypes of the genus flavivirus, family flaviviridae. Besides fever, the disease is characterized by an extreme pain in and stiffness of the joints. May 03, 2019 a child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation dic, as this severely ill pediatric icu patient did. The pathophysiology of the severe forms of dengue may be related to sequential infection with different serotypes, variations in virus virulence, interaction of the virus with environmental and host factors or a combination of these factors. The clinical picture and the pathogenesis of the severe disease are explained. Dc, pan american health organization, 1997 document.
Health experts have known about dengue fever for more than 200 years. The role of ns1specific antibodies in the pathogenesis of dengue virus infection is poorly understood. Bleeding diathesis in dengue hemorrhagic fever dhf is caused by a combination of plasma leakage, vasculopathy, thrombocytopenia, platelet dysfunction, and coagulopathy. Dengue fever vaccine, symptoms, treatment, prevention. Viral hemorrhagic fever diagnostics clinical infectious. Hematology parameters in areas endemic for dengue hemorrhagic fever indicated that platelet counts of of ns1specific antibodies in the pathogenesis of dengue virus infection is poorly understood. 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. Viral virulence, infection enhancing antibodies, cytokines and chemical mediators in the setting of intense immune activation are the key players implicated in the pathogenesis of dhf. Dengue fever is transmitted by the bite of an aedes mosquito infected with a dengue virus. Crystalloid fluid resuscitation and standard dic treatment are critical to the childs survival. The severity of the pain led to the term breakbone fever to describe dengue. Mechanism of dengue virus entry into cells revealed. The mosquito becomes infected when it bites a person with dengue virus in their blood.
To help with recovery, health care experts recommend. Predicting outcome from dengue bmc medicine full text. Pathogenesis of dengue haemorrhagic fever and its impact on. Dengue is a viral disease transmitted by some types of mosquitoes. A prospective nested casecontrol study of dengue in infants. Pdf autoimmune pathogenesis in dengue virus infection. Dengue virus denv infections of humans were long thought to be selflimited and of low mortality. Spak spak dengue virus family flaviviridae genus flavivirus enveloped, single strand rna viruses genomic rna 11 kb and encodes 3 structural proteins. Dengue is a potentially fatal acute febrile illness caused by infection with any of four dengue viruses denv1, 2, 3, and 4. The death of health workers is often the first sign that a vhf outbreak has begun, and early.
Dengue fever is common in tropical areas, so take extra precautions if you travel somewhere with this type of climate. An epidemic of dengue 1 virus denv1 occurred in french polynesia in 2001, 4 years after a denv2 epidemic that ended in 1997. Pdf dengue fever, also known as breakbone fever, is a mosquitoborne infectious tropical. The clinical spectrum of the disease ranges from dengue fever to dengue hemorrhagic fever and dengue shock syndrome. Pathophysiology and management of dengue hemorrhagic fever ampaiwan chuansumrit md department of pediatrics, faculty of medicine, ramathibodi hospital, mahidol university, bangkok, thailand. How do i view different file formats pdf, doc, ppt, mpeg on this site. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. There are four dengue virus denv types denv1, denv2, denv3, and denv4, all of which are capable of inducing severe disease dengue hemorrhagic fever dhfdengue shock syndrome dss. A viral hemorrhagic fever is a possible cause of the plague of athens during the peloponnesian war.
Around the time the fever begins to subside usually 37 days after symptom onset, the patient may develop warning signs of severe disease. As most clinical symptoms of severe dengue infection only. Burke, evidence that maternal dengue antibodies are important in the development of dengue hemorrhagic fever in infants, american journal of tropical medicine and hygiene, vol. Dengue fever and dengue hemorrhagic fever dhf are acute febrile diseases transmitted by mosquitoes, which occur in the tropics. Antibodydependent enhancement of disease and severe dengue.
Beginning in the 1950s, at the time when four different denvs were discovered, a lethal variant of dengue emerged. Dengue fever and dengue hemorrhagic fever dhf are acute febrile diseases transmitted by mosquitoes, which occur in the tropics it can be lifethreatening, and are caused by four closely related virus serotypes of the genus flavivirus, family flaviviridae it is also known as breakbone fever, since it can be extremely painful dengue is transmitted to humans by the aedes. Endothelial nitric oxide pathways in the pathophysiology of. Other countries approved its use in adults up to age 45 in endemic areas. We also discuss the viral, individual, and environmental factors that determine. National center for emerging and zoonotic infectious diseases. The initial, and currently only, outbreak of lujo virus in septemberoctober 2008 left 45 patients dead. Dengue is a febrile illness caused by a flavivirus transmitted by aedes aegypti or aedes albopictus mosquitoes while taking a blood meal. Dengue and its severe forms, namely, dengue haemorrhagic fever dhf and dengue shock syndrome dss, caused by four serotypes of dengue virus denv, have become a major public health concern that is straining the health systems of both developing and developed countries. May 03, 2019 classic dengue fever is marked by rapid onset of high fever, headache, retroorbital pain, diffuse body pain both muscle and bone, weakness, vomiting, sore throat, altered taste sensation, and a centrifugal maculopapular rash, among other manifestations. Plasma leakage and intrinsic coagulopathy are the pathological hall marks in dengue haemorrhagic fever dhf. Since the second edition of dengue haemorrhagic fever. Dengue fever is a mosquitoborne tropical disease caused by the dengue virus. In a small proportion of cases, the disease develops into severe dengue, also.
Dengue is a mosquitoborne disease caused by a flavivirus. Dengue fever usually results in abrupt onset of high fever, headache, myalgias, arthralgias, and generalized lymphadenopathy, followed by a rash that appears with a 2nd temperature rise after an afebrile period. Dengue chapter 4 2020 yellow book travelers health cdc. Dengue is a highly endemic infectious disease of the tropical countries and is rapidly becoming a global burden. Dengue is an acute infectious disease of viral etiology characterized by biphasic fever, headache,pain in various parts of the body, prostration. Dengue chapter 4 2020 yellow book travelers health. Dengue fever is a disease spread by the aedes aegypti mosquito and caused by one of four dengue viruses that are closely related. The dengue virus responsible for the disease belongs to class of flavivirus fami. Treatment of acute dengue fever is supportive, with either oral or intravenous rehydration for mild or. Learn more dengue clinical case management elearning pathophysiology of severe dengue. These severe manifestations, including a unique plasma leakage syndrome, a coagulopathy sometimes. Evaluation of the ns1 rapid test and the who dengue classification schemes for use as bedside diagnosis of acute dengue fever in adults. Several studies document raised serum transaminase.
In november 2009, the world health organization who issued a new guideline that classifies symptomatic cases as dengue or severe dengue. There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. Dengue 1 virus and dengue hemorrhagic fever, french. Symptoms include a high fever, headaches, joint and muscle pain, vomiting, and a rash. Dengue fever is a mosquitoborne infection that causes severe flulike symptoms and can be fatal.
Today, dengue is the most frequent arbovirus infection with more than 100 million cases annually throughout the world, including up to 0. Dengue is a major public health problem worldwide, where an estimated 400 million denv infections and 100 million clinically apparent dengue cases occurred in 2010. Pathophysiology and management of dengue hemorrhagic fever. Dengue is a highly endemic infectious disease of the tropical countries and is. Nov 25, 2015 dengue virus denv infections of humans were long thought to be selflimited and of low mortality. Respiratory symptoms, such as cough, sore throat, and rhinorrhea, can occur. Prevention is possible in children ages 916 with a labconfirmed previous dengue infection with a vaccine, dengvaxia, approved by the fda in the u. Endothelial nitric oxide pathways in the pathophysiology. Dengue hemorrhagic fever and dengue shock syndrome some patients with dengue fever go on to develop dengue hemorrhagic fever dhf, a severe and sometimes fatal form of the disease. It is caused by any of the 4 serotypes of dengue virus and is transmitted within humans through female aedes mosquitoes.
Dengue causes illness that can range from a mild fever to a severe, even fatal condition. Nov 02, 2018 dengue fever is a mosquitoborne infection that causes severe flulike symptoms and can be fatal. Pathophysiology plasma leakage denvinfected cells release inflammatory mediators, immune complexes are formed, and the complement cascade is activated resulting in increased vascular permeability and hemorrhagic manifestations that characterize severe dengue. Nutritional status of children with dengue hemorrhagic fever. Clinical findings include nausea, vomiting, rash, aches and pains, a positive tourniquet test, leukopenia. Dengue dengue hemorrhagic hemorrhagic fever fever pathogenesis and pathophysiology alan alan r.
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. There are four dengue virus denv types denv1, denv2, denv3, and denv4, all of which are capable of inducing severe disease dengue hemorrhagic fever dhf dengue shock syndrome dss. Role of ns1 antibodies in the pathogenesis of acute. Department of health and human services centers for. Dengue disease varies from mild fever to severe conditions of dengue hemorrhagic fever and shock syndrome. Complication of dengue fever can give rise to a more severe. A viral hemorrhagic fever is an alternate theory of the cause of the black death and the plague of justinian. 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. There is no treatment for dengue fever, and about 40 percent of the worlds population is at risk. Mar 12, 2020 dengue is an infection caused by a virus. Concerning the natural history of dengue, as previously mentioned, an incubation period of 58 days followed by the onset of a highpeak. It is transmitted by mosquitoes of the genus aedes, which are widely distributed in subtropical and tropical areas of the world see the image below.
Dengue begins abruptly after an incubation period of 57 days range, 310 days, and the course follows 3 phases. Dengue presents the most uptodate overview of the field, encompassing various aspects of epidemiology, virus research, clinical management of the disease, pathogenesis, vector control and diagnosis. Clinical implications and treatment of dengue core. It is also known as breakbone fever, since it can be extremely painful. Clinical manifestations of dengue in relation to dengue. The viruses that cause dengue fever are related to those that. Origins of the word dengue not clear some believe that it is derived from the swahili phrase kadinga pepo. The pathology of dengue hemorrhagic fever sciencedirect.
The who regional office for southeast asia publish dengue. Dengue fever has emerged as a global public health problem in the recent decades. Surveillance data from hospitalized casepatients showed that casepatients with dengue hemorrhagic fever dhf exhibited a bimodal age distribution with 1 peak among infants 610 months of age and a second peak at 411 years of age. Nov 22, 2008 this feature is not available right now. Dengue fever is a virus transmitted to humans through bites from the aedes mosquito, a daybiting mosquito. Dengue fever, an infectious tropical disease caused by a mosquitoborne virus, afflicts millions of people each year, causing fever, headache, muscle and joint pains and a characteristic skin rash. Dengue fever is a mosquitoborne viral disease caused by 1 of 4 closely related but antigenically distinct serotypes of dengue virus, serotypes denv. Dengue hemorrhagic feverdengue shock syndrome dhfdss initially observed in southeast asia now has spread throughout the world. Future trials investigating endothelial modulating therapies should consider either administering the drug earlier day 1 or targeting patients with evidence of early endothelial dysfunction.
Attempts to explain the pathogenesis of dengue in all its complexity must consider all the clinical, immunological. Here we investigate the immunoglobulin responses of patients with dengue fever df and. Dengue is the most common and important arthropodborne viral arboviral illness in humans. Complication of dengue fever can give rise to a more severe form, called dengue hemorrhagic fever. A recent trial of lovastatin in adult dengue given within 72 hours of fever did not have an impact on any clinical outcomes. Concerning the natural history of dengue, as previously mentioned, an incubation period of 58 days followed by the onset of a highpeak fever, headache, malaise and myalgia with a rash.
Pathogenesis of dengue haemorrhagic fever and its impact. Although the majority of infections are asymptomatic or result in only a brief systemic viral illness, a small proportion of patients develop potentially fatal complications. Author summary the study highlights interesting relationship between viral factors and clinical manifestation of dengue disease during an outbreak. Dengue hemorrhagic fever dengue shock syndrome dhfdss initially observed in southeast asia now has spread throughout the world. Dengue and dengue haemorrhagic fever world health organization.
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