Pathogenesis of severe dengue infection

Malavige, GN; Ogg, Graham S.

doi:10.4038/cmj.v57i3.4701

Cited by 20 publications

(20 citation statements)

References 39 publications

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“…One factor that is thought to cause the dreaded shock syndrome is antibody-dependent enhancement, resulting in increased viral replication;3,9,10 however, many other virus and host factors are thought to contribute 11–13. Much of the evidence points to severe manifestations of dengue having an immunological basis,9,14–16 rather than being due to direct tissue damage by the virus. Variations in virulence in the infecting strain may contribute, and higher viral loads correlate with disease severity 17,18.…”

Section: Pathogenesis Of Denguementioning

confidence: 99%

Corticosteroids in the treatment of dengue shock syndrome

Rajapakse¹,

Rodrigo²,

Maduranga³

et al. 2014

IDR

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Dengue infection causes significant morbidity and mortality in over 100 countries worldwide, and its incidence is on the rise. The pathophysiological basis for the development of severe dengue, characterized by plasma leakage and the “shock syndrome” are poorly understood. No specific treatment or vaccine is available, and careful monitoring and judicious administration of fluids forms the mainstay of management at present. It is postulated that vascular endothelial dysfunction, induced by cytokine and chemical mediators, is an important mechanism of plasma leakage. Although corticosteroids are potent modulators of the immune system, their role in pharmacological doses in modulating the purported immunological effects that take place in severe dengue has been a subject of controversy. The key evidence related to the role of corticosteroids for various manifestations of dengue are reviewed here. In summary, there is currently no high-quality evidence supporting the beneficial effects of corticosteroids for treatment of shock, prevention of serious complications, or increasing platelet counts. Non-randomized trials of corticosteroids given as rescue medication for severe shock have shown possible benefit. Nonetheless, the evidence base is small, and good-quality trials are lacking. We reiterate the need for well-designed and adequately powered randomized controlled trials of corticosteroids for the treatment of dengue shock.

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Section: Pathogenesis Of Denguementioning

confidence: 99%

Corticosteroids in the treatment of dengue shock syndrome

Rajapakse¹,

Rodrigo²,

Maduranga³

et al. 2014

IDR

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“…The immunologic damage described in the literature consists of perifollicular and intrafollicular Such a pathogenic mechanism has been confirmed for dengue haemorrhagic fever, in which the most severe features, despite its viral aetiology, are caused by autoimmune mechanisms triggered by episodes of reinfection, 27 and has also been suggested for autoimmune diseases such as type 1 diabetes. 28,29 In our study, this reinfection/re-exposure mechanism would explain the development of cases of alopecia areata in older patients (who had probably been infected by enterovirus in the past) following the outbreak of HFMD in preschool-age children.…”

Section: Discussionmentioning

confidence: 84%

Posible relación entre alopecia areata e infecciones por enterovirus

Barreiro

Pelegrín

Val

et al. 2014

Rev Pediatr Aten Primaria

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Posible relación entre alopecia areata e infecciones por enterovirus Introducción: la alopecia areata es una enfermedad autoinmune de etiología desconocida que se asocia a otras enfermedades autoinmunes. La enfermedad mano-pie-boca es una infección viral frecuente en la edad pediátrica, causada por diferentes serotipos de enterovirus y que en ocasiones asocia onicomadesis. El presente estudio pretende comprobar un incremento de los casos de alopecia areata tras un brote de enfermedad mano-pie-boca en nuestro entorno. Material y métodos: identificación de los pacientes menores de 14 años diagnosticados de enfermedadmano-pie-boca y/o alopecia areata en un área de salud entre el 1 de enero de 2011 y el 31 de diciembre de 2012. Revisión de historias clínicas, recogiendo fecha de nacimiento y diagnóstico, edad al diagnóstico y características clínicas. Resultados: se encontraron 49 pacientes diagnosticados de enfermedad mano-pie-boca y siete diagnosticados de alopecia areata. Se confirmó un brote de enfermedad mano-pie-boca con 42 casos en un periodo de ocho semanas. Se observó un incremento posterior de los casos de alopecia areata (cuatro casos en las cuatro semanas siguientes, frente a tres casos a lo largo de los 11 meses previos y ninguno durante el año anterior). Conclusiones: tras un brote de enfermedad mano-pie-boca se observó un incremento del número de casos de alopecia areata. Este hecho, unido a la asociación de la alopecia areata con otras enfermedades autoinmunes y a la relación encontrada entre infecciones por enterovirus y procesos autoinmunes como la diabetes mellitus tipo 1, plantea una posible relación causal entre infecciones por enterovirus y alopecia areata, así como un posible componente de autoinmunidad en la onicomadesis asociada a la enfermedad mano-pie-boca.

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“…Cytokines released in this process cause endothelial dysfunction leading to increased vascular permeability, thus causing vascular 'leak', the hallmark of DHF, resulting in pleural effusion, ascites and shock [5].…”

Section: Objectivementioning

confidence: 99%