Chest Radiographic Presentation in Patients with Dengue Hemorrhagic Fever

Wang, Chin‐Chou; Wu, Chen-Hsuan; Liu, Jien-Wei; Lin, An‐Shen; Liu, Shih-Feng; Chung, Yoon Kyu; Su, Mu-Chun; Lee, Ing-Kit; Lin, Meng-Chih

doi:10.4269/ajtmh.2007.77.291

Cited by 19 publications

(24 citation statements)

References 22 publications

(26 reference statements)

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“…Wang et al [16] reported a similar percentage (54.7%) of abnormal chest radiographic findings in patients with dengue. Variable frequencies of PE, ranging from 16% [17] to 100% [18] of patients, have been reported in studies in which chest X-rays and sonography were used to evaluate dengue infection.…”

Section: Discussionmentioning

confidence: 73%

“…Variable frequencies of PE, ranging from 16% [17] to 100% [18] of patients, have been reported in studies in which chest X-rays and sonography were used to evaluate dengue infection. However, few studies have been performed in adults and most have used chest X-rays [16], [17]. Higher incidences of PE have been demonstrated in studies conducted in children and those using sonography [19], [20].…”

Section: Discussionmentioning

confidence: 99%

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Lung in Dengue: Computed Tomography Findings

et al. 2014

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BackgroundDengue is the most important mosquito-borne viral disease in the world. Dengue virus infection may be asymptomatic or lead to undifferentiated fever, dengue fever with or without warning signs, or severe dengue. Lower respiratory symptoms are unusual and lung-imaging data in patients with dengue are scarce.Methodology/Principal FindingsTo evaluate lung changes associated with dengue infection, we retrospectively analyzed 2,020 confirmed cases of dengue. Twenty-nine of these patients (11 females and 18 males aged 16–90 years) underwent chest computed tomography (CT), which yielded abnormal findings in 17 patients: 16 patients had pleural effusion (the sole finding in six patients) and 11 patients had pulmonary abnormalities. Lung parenchyma involvement ranged from subtle to moderate unilateral and bilateral abnormalities. The most common finding was ground-glass opacity in eight patients, followed by consolidation in six patients. Less common findings were airspace nodules (two patients), interlobular septal thickening (two patients), and peribronchovascular interstitial thickening (one patient). Lung histopathological findings in four fatal cases showed thickening of the alveolar septa, hemorrhage, and interstitial edema.Conclusions/SignificanceIn this largest series involving the use of chest CT to evaluate lung involvement in patients with dengue, CT findings of lower respiratory tract involvement were uncommon. When abnormalities were present, pleural effusion was the most frequent finding and lung involvement was often mild or moderate and bilateral. Extensive lung abnormalities are infrequent even in severe disease and when present should lead physicians to consider other diagnostic possibilities.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Lung in Dengue: Computed Tomography Findings

et al. 2014

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“…Nonetheless, the collective profile of host responses, such as tissue specificity of cytokine production in humans, remains unclear because of the difficulty of obtaining biopsy samples (57). Vascular leakage is a prominent feature of DHF/DSS in humans, which is characterized by increased hemoconcentration or fluid effusion in chest or abdominal cavities that is detectable by radiology or sonography (58)(59)(60)(61). Also, the notable pathology that causes mortality in the IC-inoculated mice is the fluid accumulation in the small intestine as a consequence of TNF-␣-induced vascular leakage.…”

Section: Discussionmentioning

confidence: 99%

Dengue Virus Infection with Highly Neutralizing Levels of Cross-Reactive Antibodies Causes Acute Lethal Small Intestinal Pathology without a High Level of Viremia in Mice

Watanabe

Chan

Wang

et al. 2015

J Virol

107

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Severe dengue virus (DENV)-associated diseases can occur in patients who have preexisting DENV antibodies (Abs) through antibody-dependent enhancement (ADE) of infection. It is well established that during ADE, DENV-antibody immune complexes (ICs) infect Fc␥ receptor-bearing cells and increase the systemic viral burden that can be measured in the blood. For protection against infection with DENV serotypes 1 to 4, strongly neutralizing Abs must be elicited to overcome the effect of ADE. Clinical observations in infants who have maternal DENV Abs or recent phase II/III clinical trials with a leading tetravalent dengue vaccine suggested a lack of correlation between Ab neutralization and in vivo disease prevention. In addressing this gap in knowledge, we found that inoculation of ICs formed with serotype cross-reactive Abs that are more than 98% neutralized in vitro promotes high mortality in AG129 mice even though peak viremia was lower than that in direct virus infection. This suggests that the serum viremia level is not always correlated with disease severity. We further demonstrated that infection with the ICs resulted in increased vascular permeability, specifically in the small intestine, accompanied with increased tissue viral load and cytokine production, which can be suppressed by anti-tumor necrosis factor alpha (anti-TNF-␣) Abs. Flow cytometric analysis identified increased infection in CD11b int CD11c int/hi CD103 ؊ antigen-presenting cells by IC inoculation, suggesting that these infected cells may be responsible for the increase in TNF-␣ production and vascular permeability in the small intestine that lead to mortality in mice. Our findings may have important implications for the development of dengue therapeutics. IMPORTANCEWe examined the relationship between the neutralizing level of Abs at the time of infection and subsequent disease progression in a mouse model in order to understand why patients who are shown to have a neutralizing quantity of Abs still allow sufficient DENV replication to induce severe dengue manifestations, which sometimes do not correlate with viremia level. Strikingly, we found that high mortality was induced in AG129 mice by the increase in TNF-␣-induced vascular permeability accompanied by an increased viral load, specifically in the small intestine, even when the initial infection level is suppressed to less than 5% and the peak viremia level is not enhanced. This suggests that ADE overcomes the protective efficacy of Abs in a tissue-dependent manner that leads to severe small intestinal pathology. Our findings may serve to address the pathogenic role of Abs on severe dengue disease and also help to develop safe Ab-based therapeutic strategies. D engue virus (DENV) infection with any of the 4 related viral serotypes (DENV1 to DENV4) causes a variety of clinical manifestations, ranging from self-limiting febrile illness, known as dengue fever (DF), to the life-threatening severe diseases, such as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), charac...

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“…Like others, we used the IgM assay as one of our confirmatory tests for dengue. [9][10][11][12][13][14][15] The likelihood of cross-reactivity was low, because other flaviviruses (yellow fever, Japanese encephalitis, tick-borne encephalitis, and West Nile fever) are not endemic in our setting. Also, IgM antibodies are specific, even in Japanese encephalitis and yellow fever vaccinees.…”

Section: Methodsmentioning

confidence: 99%

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

See¹,

Phua²,

Yip³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. We aim to construct a diagnostic model for bacterial coinfection in dengue patients (Dengue Dual Infection Score [DDIS]); 2,065 adult dengue patients (mean age = 41.9 ± 17.2 years, 58.4% male, 83 patients with bacterial coinfection) seen at a university hospital from January of 2005 to February of 2010 were studied. The DDIS was created by assigning one point to each of five risk factors for bacterial coinfection: pulse rate 90 beats/minute, total white cell count 6 + 10 9 /L, hematocrit 40%, serum sodium 135 mmol/L, and serum urea 5 mmol/L. The DDIS identified bacterial coinfection (derivation set area under the curve = 0.793, 95% confidence interval = 0.732-0.854; validation set area under the curve = 0.761, 95% confidence interval = 0.637-0.886). A DDIS of 4 had a specificity of 94.4%, whereas a DDIS of 1 had a sensitivity of 94.4% for bacterial coinfection. The DDIS can help to select dengue patients for early bacterial cultures and empirical antibiotics.

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Chest Radiographic Presentation in Patients with Dengue Hemorrhagic Fever

Cited by 19 publications

References 22 publications

Lung in Dengue: Computed Tomography Findings

Lung in Dengue: Computed Tomography Findings

Dengue Virus Infection with Highly Neutralizing Levels of Cross-Reactive Antibodies Causes Acute Lethal Small Intestinal Pathology without a High Level of Viremia in Mice

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

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