Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virus outbreak in Punjab, Pakistan

Humayoun, Malik Asif; Waseem, Tariq; Jawa, Ali; Hashmi, Mubashar; Akram, Javed

doi:10.1016/j.ijid.2009.10.008

Cited by 95 publications

(103 citation statements)

References 16 publications

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“…Contrary to our results, others reported three (DEN-1, 2 & 3) or all four serotypes of dengue virus from Pakistan (27,19,17,18). Humayoun and colleagues (19) has reported DEN4, DEN2, and DEN3 serotypes from Pakistan with predominant serotype DEN4. We were unable to detect a single patient infected by DEN-1 and DEN-4 serotypes from Pakistan during the current outbreak.…”

Section: Discussioncontrasting

confidence: 99%

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Dengue Virus Serotype 2 (DEN-2): the Causative Agent of 2011-Dengue Epidemic in Pakistan

Idrees¹,

Hussain²,

Rehman³

et al. 2012

Am. J. Biomed. Sci.

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Introduction: Dengue virus (DENV) is an arthropod-borne virus that belonged to the Flaviviridae viral family. Four known serotypes DEN-1 through DEN-4 do exist and circulate in diverse geographical regions of the world causing epidemics. The management of dengue patients, and especially dengue hemorrhagic fever (DHF)/Dengue shock syndrome (DSS) cases, has been a challenge in Pakistan now days. Method: We have carried out a comprehensive study of the current outbreaks of dengue virus infection on molecular level with the aim to find out the common serotype/s of DENV responsible for this outbreak using PCR, real-time PCR and nucleotide sequencing targeting the C-prM gene junction. For this purpose total 1129 serum samples received between from start of August till end of November 2011 from all the major hospitals of Lahore, Punjab at Division of Molecular Virology, National Centre of Excellence in Molecular Biology (CEMB) University of the Punjab Lahore were utilized for the DENV diagnosis and serotypes/genotypes analysis. Results: Male female ratio of the suspected dengue patients was 2.4:1. Their mean age were 31.14 + 16.03 (SD) years ranging from 9 months to 90 years. Out of these 1129 serum samples, total 930 (82.37%) were found infected with DENV. Out of the 930 DENV RNA positive samples, 893 (96.02%) had DEN-2 Am. J. Biomed. Sci. 2012, 4(4), 307-315; doi: 10.5099/aj120400307 © 2012 by NWPII. All rights reserved. 308 and 37 (3.97%) sample had concurrent infection with serotypes 2 and 3. Conclusion: Based on the results of this study we conclude that DEN-2 is the responsible genotype for the current dengue epidemic that started from the beginning of year 2011 and is continuing till now. The additional serotype detected in the current study was serotype 3 that remained in very low frequency in Pakistan for last several decades.

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Section: Discussioncontrasting

confidence: 99%

“…Sometimes all four dengue viruses are circulating simultaneously in areas where about 2/3 rd of the world's population lives and are infested with dengue vectors, mostly Aedes aegypti (12). At least seven dengue epidemics have been reported from Pakistan in last 20 years (13,14,15,16,17,18,19).…”

Section: Introductionmentioning

confidence: 99%

Dengue Virus Serotype 2 (DEN-2): the Causative Agent of 2011-Dengue Epidemic in Pakistan

Idrees¹,

Hussain²,

Rehman³

et al. 2012

Am. J. Biomed. Sci.

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“…Ocular manifestations in dengue, though rare, are not uncommon, with 20% having ocular pain [1] and 40.3% having subconjunctival hemorrhage, dilatation and tortuosity of retinal vessels and hard exudates [2]. Chorioretinitis, retinitis, retinal vasculitis and optic nerve involvement have been found to be associated with dengue [3].…”

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confidence: 99%

Panophthalmitis in dengue fever

Sowbhagya

2012

Indian Pediatr

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CORRESPONDENCEWe report a rare case of panophthalmitis in dengue fever. A 6 year old girl presented with 5 days fever and rash on the lower extremities, flushed face and myalgia. Examination revealed fever of 38ºC, erythematous rash, and flushed face. Investigations revealed leucopenia and thrombocytopenia. Dengue serology was positive (both IgM and IgG). Ultrasound showed ascitis and right pleural effusion. Next morning, she complained of severe pain in the left eye. On examination, right eye was normal. Vision in the left eye was 6/18. Fundus examination revealed focal leaks of exudates from venous ends of retinal vessels at superior quadrant. By evening, the left eye was swollen, with intolerable pain and vomiting. Examination revealed shallow anterior chamber, intense ciliary congestion, cloudy cornea; percluding evaluation of underlying details. Vision was reduced to perception of light. Intraocular pressure was increased. A diagnosis of acute angle-closure glaucoma was suspected and was treated accordingly. By next morning, there was gross loss of vision, proptosis and corneal clouding. Anterior chamber showed organized disc of exudates. Panophthalmitis was suspected and ultrasound was done which revealed thickening of choroid, sclera and exudation of vitreous. MRI confirmed the diagnosis and showed diffuse inflammatory thickening of the left ocular coats with hazy vitreous, peri-ocular extensions of the inflammatory process involving both pre and post septal soft tissues, retro-orbital fat and peri-optic neural sheath showed inflammatory changes.Ocular manifestations in dengue, though rare, are not uncommon, with 20% having ocular pain [1] and 40.3% having subconjunctival hemorrhage, dilatation and tortuosity of retinal vessels and hard exudates [2]. Chorioretinitis, retinitis, retinal vasculitis and optic nerve involvement have been found to be associated with dengue [3]. Anti-IgM dengue antibody was found to be positive in 18% of patients with multifocal retinitis [4]. The triad of eye flashes, floaters and blurring of vision was highly predictive for the development of retinal hemorrhages [5]. The pathogenesis of panophthalmitis is not known. It could be the part of immunologic and inflammatory response to the dengue virus infection. The child recovered, with visual loss of left eye.Ocular manifestations in dengue are rare, but can be as serious as panophthalmitis in this child. So a systematic ophthalmic examination in patients with dengue fever, especially with ocular symptoms, is mandatory.

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“…Dengue NS1 antigen and Dengue specific IgA antibody based assays have been shown to be useful during early febrile days. [5][6][7][8][9][10][11][12][13][14][15][16][17] ELISA and ICT based NS1 assay have been used as a diagnostic tool during febrile phase till defervescence (1 -9 days of fever onset) however, due to presence of virus -IgG immunocomplexs this assay has shown to be less sensitive in secondary infection as compared to primary infections 18,19 and may give false negative results in dengue endemic and hyperendemic areas. Studies comparing sensitives and specificities of IgA and NS1 reported dengue IgA to be more sensitive during early febrile phase of both primary and secondary dengue infection.…”

Section: -416mentioning

confidence: 99%

“…Karachi, and Lahore witnessed major out breaks. [6][7] During seasonal outbreaks large proportion of suspected dengue cases are referred to tertiary care hospitals in both public and private sectors. It has been found difficult to accommodate uncomplicated suspected dengue fever (DF) cases especially in public sector.…”

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Dengue Rapid Diagnostic Tests; Evaluation of Utility in a Tertiary Care Hospital

Kidwai

Ara

Ghaznawi

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the point of care role of dengue IgA and Dengue IgM / IgG rapid diagnostic tests (RDTs) in a tertiary care setting in terms of day of onset of illness at presentation and frequency of positive RDTs in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Study Design: Cross-sectional study. Setting: Abbasi Shaheed Hospital, Karachi. Period: August-2014 to January-2016. Method: Patients aged 13years and above with acute febrile illness, fulfilling the WHO case definition criteria of probable DF and DHF were included. Two immunochromatograpic (ICT) based RDTs, Assure dengue IgA and Panbio Dengue Duo Cassette (IgM / IgG) were used. Dengue IgA was employed in all patients from day 2 of illness whereas IgM / IgG was employed after day 4 of onset of fever. Result: Among 174 probable cases, 108 (62%) presented between 2 -5 days of onset of fever, among whom 87 (80.5%) were found to be dengue IgA positive. Sixty-nine (39.65%) patients had DHF, among whom 97.1% were seropositive for IgA. Of 118 patients presented after 4 days of onset of illness, 59.3% were positive by IgM / IgG rapid assay. Conclusion: Considering the higher frequency of secondary dengue and DHF in dengue endemic-hyperendemic regions, IgA based ICT might be a helpful diagnostic assay for early diagnosis of dengue infection.

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Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virus outbreak in Punjab, Pakistan

Cited by 95 publications

References 16 publications

Dengue Virus Serotype 2 (DEN-2): the Causative Agent of 2011-Dengue Epidemic in Pakistan

Dengue Virus Serotype 2 (DEN-2): the Causative Agent of 2011-Dengue Epidemic in Pakistan

Panophthalmitis in dengue fever

Dengue Rapid Diagnostic Tests; Evaluation of Utility in a Tertiary Care Hospital

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