Dengue viral infection (DVI) is a debilitating arthropod-borne disease that has been rapidly spread in several regions of the world in recent years. The spectrum of disease varies from mild self-limiting illness to dengue fever (DF) to more severe and fulminating forms, i.e., dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS),and expanded dengue syndrome (EDS). The pathogenesis of EDS is not clear amid lack of studies on animal models. In the absence of in vitro experiments, disease spectrum is difficult to be elucidated and mimicked for humans.Recent advances on research on atypical complications of EDS demonstrate the involvement of other major organs such as the kidney, lung, heart, and central nervous system. Histopathological findings demonstrate the presence of hemorrhage, edema, and inflammatory infiltrates in these organs.The spectrum of Dengue viral infection varies from mild self-limiting illness to dengue fever to more severe and fulminating forms, i.e., dengue hemorrhagic fever, dengue shock syndrome, and expanded dengue syndrome. Apart from the classical presentation, dengue infection can result in a myriad of unusual clinical manifestations, which are grouped under the title expanded dengue syndrome. These findings urge more focused and comprehensive investigations to explore such relationships so that high-risk patients could be identified immediately during their presentation to the hospitals.Keywords: Expanded dengue syndrome, Pathogenesis, Organ-specific manifestation
Background: CD4+ T cells deficiency generally occurs in human immunodeficiency virus (HIV) patients, leading to some infections such as pulmonary and extrapulmonary tuberculosis. A rare case of decreased CD4+ T cells is idiopathic CD4+ T cell lymphocytopenia, a rare and unexplained immunodeficiency syndrome with no evidence of HIV infection. In this case report, we are reporting a patient with CD4+ T cells deficiency, pulmonary tuberculosis, pleuritis tuberculosis, and meningitis with HIV test negative.
Case Presentation: A 58-year-old male was referred to the Emergency Department of Dr. Soetomo General Hospital with a gradual decrease of consciousness following six days of hospitalization at a private hospital. During hospitalization, one liter of fluid was evacuated from the right lung and analyzed, revealing tuberculosis infection. History of diabetes, hypertension, stroke, hepatitis, and cardiovascular disease was denied. The patient also never had chemotherapy or radiation treatment. Based on history taking, physical examination, and laboratory results, this patient has been diagnosed new case of pulmonary tuberculosis with deficiency CD4+ T cells and altered consciousness et causes meningitis tuberculosis with pleurisy tuberculosis. After 32 days of hospitalization with anti-mycobacterium therapy, the patient was improved and was discharged.
Conclusion: This case highlights the challenges of having the definitive cause of CD4+ T cells deficiency either active tuberculosis infection or idiopathic CD4+ lymphocytopenia. Therefore, serial analyses of CD4+ T cells are advised on the patient during the treatment with anti-tuberculosis drug.
Background Malaria and dengue are the most prevalent vector-borne diseases worldwide. Both diseases are endemic in similar tropical regions. Each infection has a specific mosquito vector. Hence, overlapping of the habitat cannot be easily available. In co-infection, the clinical features were more like dengue mono-infection than malaria mono-infection. Therefore, clinically, it is difficult to diagnose co-infection dengue and malaria. Case Illustration A 42-yo Javanese man, presented with 10-days of fever that was clinically and serologically consistent with symptoms of vivax malaria. Plasmodium vivax was found in the form of ring, trophozoite and schizonts stage at the thick blood smear examination with parasitemia index 84.410 parasite/µl. In the course of the disease, patients were found to have a mixed infection with Plasmodium ovale. The patients also experience complications of spontaneous bleeding, thrombocytopenia and worsening respiratory conditions leading to acute respiratory distress syndrome (ARDS) which increases suspicion of co-infection with dengue virus. Laboratory tests to enforce dengue infection are carried out with the results obtained positive IgG and IgM that indicate recurrent infections. The patient is then given the management of severe malaria and expanded dengue syndrome according to the Indonesia Ministry of Health of guideline. On the 11 th day of hospitalizations, the patients showed a significant cure rate and continuing ambulatory therapy with Primaquine 15 mg oral until day 14 th . Conclusion The incidence of heavy bleeding in malaria patients is very low. Thus, malaria patients who experience unclear fever patterns and heavy bleeding should be systematically investigated for suspicion of dengue virus co-infection.
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