Rishi Desai, MD, MPH

Dengue virus

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DENGUE VIRUS osms.it/dengue-virus PATHOLOGY & CAUSES ▪ Viral disease, mosquito transmission ▫ Characterized by febrile illness ▫ AKA break-bone fever ▪ Four serotypes ▫ DENV-1 through DENV-4 ▫ IgG response to speciﬁc type → lifetime immunity ▫ Limited, transient cross-protectivity across viral types ▪ Vector ▫ Primarily Aedes aegypti and A. albopictus Pathogenesis ▪ Aedes mosquito bite → dengue virus skin introduction → local infection, response → dissemination → viremia (2–6 days later) → circulating leukocyte infection (especially) monocytes → viral replication, release → fever  RISK FACTORS  ▪ Endemic area residence ▪ Recent travel  COMPLICATIONS Severe dengue ▪ AKA dengue hemorrhagic fever ▪ Viremia → local hemorrhage → systemic hemorrhage → hemodynamic collapse → shock ▫ Dengue shock syndrome (rare complication—DENV-2 confers highest risk) ▪ Direct bone marrow infection → hematopoietic stem cell infection → ↓ megakaryocyte differentiation (among all other cell lines) → ↓ platelets formed ▫ ↓ Circulating lifetime: virus-antibody complex → circulating platelet adherence → complement destruction  392 OSMOSIS.ORG  ▪  ▪  ▪  ▪  of virus-antibody complex → adherent platelet destruction Capillary leak ▫ Direct effect: viral endothelial cell infection → cellular dysfunction → tight junction widening → capillary leak ▫ Indirect: virus-infected monocytes, dendritic cells, mast cells → TNFalpha, IFN-gamma, IL-2, IL-8, vascular endothelial growth factor release, complement activation → ↑ capillary permeability Molecular mimicry ▫ Viral E protein antibody response → plasminogen cross-reaction → inefﬁcient coagulation cascade → hemorrhage Liver failure ▫ Direct viral infection → Kupffer cells, hepatocytes → apoptosis → hepatocellular necrosis, Councilman bodies ▫ Sever disease → shock → liver hypoperfusion → hepatocellular injury, death Central nervous system (CNS) involvement ▫ Rare, direct viral infection of brain parenchyma  SIGNS & SYMPTOMS ▪ High-grade fever (> 38.5°C/101.3°F) ▪ Generalized pain ▫ Abdominal pain/tenderness, headache, joint pain, muscle pain, eye/retro-orbital pain ▪ Nausea/vomiting ▪ Mucosal bleeding ▪ Rash Severe symptoms and signs ▪ Severe bleeding ▪ Fluid accumulation → respiratory distress ▫ Ascites, pleural effusion   

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Protein synthesis inhibitors: Aminoglycosides

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Cell wall synthesis inhibitors: Cephalosporins

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Laboratory value
Serum chemistries	Result
Hemoglobin	9.8 g/dL
Hematocrit	30 %
Leukocyte count	2000 /mm3
Platelet count	50,000 /mm3
AST	170 U/L
ALT	200 U/L
Serum creatinine	1.4 mg/dL

Dengue virus

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Dengue virus

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