Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

A Case Report of Ischemic Stroke in an Adult Patient of Dengue Fever with Thrombocytopenia

Neurological complications in Dengue patients are extremely rare with 0.5-6% incidence including encephalopathy, Guillain Barre Syndrome, Brachial neuritis, Myelitis, Encephalomyelitis. Stroke as a neurological complication is extremely rare with very few cases reported previously. We present the case of a 69-year-old male with Dengue fever where the patient presented with persistent hiccups was found to have pontine infarct.

Características clínicas y epidemiológicas de las muertes por dengue durante un brote en el norte del Perú / Clinical-epidemiological characteristics of dengue deaths during an outbreak in northern Peru

Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con cristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

Objective: To describe the clinical-epidemiological characteristics of patients who died from dengue during 2017. Methods: We conducted a retrospective study of the information related to cases of dengue deaths in the department of Piura. Results: We reviewed 24 medical records. Sixty-seven percent were women and 3 (12.5%) were pregnant. Diabetes (12.5%) and hypertension (16.7%) were the most frequent comorbidities. Previous dengue fever was reported in only 12.5%. The time from health care and death was 4.10 ± 5.34 days. Red blood cell transfusions were performed in 45.8%, plasma in 25%, platelets in 16.8% and cryoprecipitate in 16.8% of cases. Crystalloid therapy (91.7%) and treatment with vasoactive drugs (70.8%) were also frequent. In conclusion, mortality from severe dengue fever was predominantly in adult women, and the time of care from the first health facility to a specialized unit was prolonged.

Surveillance on dengue vector Aedes albopictus in Ningbo City in 2021 / 中国血吸虫病防治杂志

Objective To analyze the density, distribution and insecticide resistance of Aedes albopictus in Ningbo City in 2021, so as to provide insights into formulation of dengue fever control strategies. Methods Four administrative villages were randomly selected from each county (district) in Ningbo City from April to November, 2021, to investigate the indoor population density of Aedes larvae, and the Breteau index (BI) was calculated. The population density of adult mosquitoes was investigated in residential areas, parks/bamboo forests, waste tire stacking sites/waste stations/construction sites in each county (district). On June 2021, larvae of the natural strain A. albopictus were collected from epidemic sites of dengue fever in Ningbo City in 2018, and raised in laboratory. Then, larvae and female mosquitoes without blood feeding were selected for insecticide resistance bioassays, while insecticide-sensitive strains of A. albopictus served as controls. The resistance of A. albopictus larvae to deltamethrin, beta-cypermethrin, propoxur, temephos and dichlorvos using the impregnation method, and the medium lethal concentration (LC50) and resistance ratio (RR) were calculated. The resistance of adult A. albopictus to beta-cypermethrin, permethrin, deltamethrin, propoxur and malathion was determined using the tube bioassay, and the mosquito mortality was calculated. Results A total of 10 072 small water containers from 9 935 households were investigated in Ningbo City in 2021, and there were 1 276 containers with Aedes larvae detected, with an average BI of 12.89. Totally 1 422 mosquito nets were allocated and 954 female A. albopictus were captured, with an average net trapping index of 1.34 mosquitoes/(net·hour). Both larval and adult A. albopictus mosquitoes were found from April to November, and the density of larval A. albopictus peaked in September (BI = 21.21), while the density of adult A. albopictus peaked in August, with a net trapping index of 2.38 mosquitoes/(net·hour). The LC50 values of delta-methrin, beta-cypermethrin, propoxur, temephos and dichlorvos were 0.017 4, 0.000 9, 0.364 1, 0.038 1 mg/L and 0.001 6 mg/L against larvae of natural strains of A. albopicchus, with RRs of 49.66, 25.53, 9.65, 2.24 and 6.06, and the mortality rates of adult mosquitoes were 66.00% (66/100), 69.39% (68/98), 25.00% (25/100), 98.97% (96/97) and 100.00% (98/98) 24 hours post-treatment with 0.08% beta-cypermethrin, 0.03% deltamethrin, 0.4% permethrin, 0.05% propoxur, and 0.5% malathion for 24 h, respectively. Conclusions A. albopictus is widely distributed in Ningbo City, with a high population density and presents high-level resistance to common pyrethroid insecticides. The population density and insecticide resistance of A. albopictus requires to be reinforced.

Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan

Abstract Dengue fever (DF) is increasingly recognized as one of the worlds major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

Resumo A dengue (DF) é cada vez mais reconhecida como uma das principais doenças transmitidas por mosquitos do mundo e causa significativa morbidade e mortalidade em países tropicais e subtropicais. A dengue é endêmica na maior parte do Paquistão e continua a ser um problema de saúde pública. Conhecimento, atitude e práticas podem desempenhar papel importante no manejo da doença. O presente estudo teve como objetivo determinar o nível de conhecimento, atitude e práticas em relação à dengue entre os profissionais de saúde, para estudar o nível de conhecimento e atitude com as práticas preventivas da dengue. Um estudo transversal foi realizado com médicos dos quatro distritos da região de Malakand de outubro a novembro de 2019. Um questionário pré-estruturado foi usado para coletar dados de médicos. Os dados foram analisados no Graph Pad versão 5. Valor significativo foi considerado quando menor que 0,05 (com intervalo de confiança de 95%). Os resultados revelaram que a maioria dos participantes já viu o vetor da dengue (62%), sendo a mídia a fonte de informação mais citada. Quase 81,2% dos participantes sabiam que a transmissão da dengue é por picada de mosquito. Constatou-se que as práticas baseadas em medidas preventivas se concentravam predominantemente na prevenção de picadas de mosquitos, e não na eliminação de criadouros. Embora o conhecimento sobre DF e medidas de controle de mosquitos fosse bastante elevado entre os médicos, esse conhecimento não foi colocado em prática. Mais estudos são necessários para conscientizar a população sobre a dengue e seu vetor, a fim de se obter prevenção e controle.

Research Progress on Disease Burden of Dengue in China / 中山大学学报(医学科学版)

The gradual relaxation of COVID-19 restrictions in China has increased the risk of imported dengue fever cases and may further prompt the outbreak. Systematic assessment of disease burden is crucial to improving prevention and control strategies， and resource allocation of dengue fever in China. After reviewing the definition， classification of disease burden， epidemiological evaluation methods such as potential years of life lost （PYLL） and disability adjusted of life years （DALY）， as well as economic evaluation methods such as step-by-step model method and human capital method， this article systematically summarizes the application of mixed models and catalytic models in quantifying the disease burden of latent dengue infected individuals， as well as the current research status and limitations of dengue disease burden in China， proposing suggestions for future assessment research on disease burden of dengue.

Epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 / 预防医学

Objective@#To investigate the epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021, so as to provide insights into the prevention and control of overseas imported arthropod-borne infectious diseases.@*Methods@#The data pertaining to imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 were collected from the Chinese Disease Prevention and Control Information System, and the temporal distribution, regional distribution, population distribution, sources, diagnosis and treatment of imported dengue fever and malaria cases were descriptively analyzed.@*Results@#Totally 4 332 overseas imported dengue fever cases and 2 011 overseas imported malaria cases were reported in Yunnan Province form 2015 to 2021, which accounted for 30.09% of all reported dengue fever cases and 98.53% of all reported malaria cases. The number of overseas imported dengue fever and malaria cases peaked from August to November (83.13% of all imported dengue fever cases) and from April to July (59.08% of all imported malaria cases), and the cases were predominantly reported in Dehong Prefecture (50.99% and 58.88%), with farmers as the predominant occupation (40.21% and 67.93%). The dengue fever and malaria cases were mainly imported from Southeast Asia (99.04% and 88.21%), and the proportions of definitive diagnosis of dengue fever and malaria were 88.33% and 97.80% at township hospitals, respectively.@*Conclusions@#The number of overseas imported dengue fever and malaria cases peaked from August to November and from April to July in Yunnan Province from 2015 to 2021, and the cases were predominantly reported in Dehong Prefecture and imported from Southeast Asia, with farmers as the predominant occupation.

Caracterización y factores asociados con la atención de embarazadas con dengue en Cali, Colombia / Characterization and factors associated with the care of pregnant women with dengue in Cali, Colombia

Resumen OBJETIVO: Describir las características sociodemográficas y clínicas y determinar los factores asociados con la hospitalización y la oportunidad de consulta en embarazadas notificadas con dengue en Cali, Colombia. MATERIALES Y MÉTODOS: Estudio observacional, analítico y retrospectivo de base poblacional. Descripción de las características sociodemográficas y clínicas de las embarazadas con dengue que se notificaron al Sistema de Vigilancia en Salud Pública (SIVIGILA). Para identificar los factores asociados con la hospitalización se aplicó un modelo de regresión logística y para el procesamiento estadístico se utilizó SPSS versión 26. RESULTADOS: Se estudiaron 674 embarazadas con dengue, 63.9% (n = 431) sin signos de alarma, 36.1% (n = 243) con signos de alarma y ningún caso de dengue grave. En cuanto a la conducta, el 42.3% ( n = 285) se trató de manera ambulatoria, 39.5% (n = 266) en el hospital;12.5% (n = 84) permaneció en observación, 1.9% (n = 13) requirió el envío a otro centro de salud para su hospitalización y el 3.9% (n = 26) requirió atención en cuidados intensivos. CONCLUSIONES: En las embarazadas, la infección por dengue aumenta la morbilidad; los principales factores asociados con la hospitalización fueron: trombocitopenia, hipotensión, dolor abdominal, erupción cutánea y vómito. Por parte de las entidades de salud y la comunidad se requieren intervenciones efectivas enfocadas a la manipulación de residuos y educación e insistencia en los principales signos de alarma por los que deben solicitar la consulta médica.

Abstract OBJECTIVE: To describe the sociodemographic and clinical characteristics and to determine the factors associated with hospitalization and timeliness of consultation in pregnant women notified with dengue fever in Cali, Colombia. MATERIALS AND METHODS: Observational, analytical and retrospective population-based study. Description of the sociodemographic and clinical characteristics of pregnant women with dengue reported to the Public Health Surveillance System (SIVIGILA). A logistic regression model was applied to identify factors associated with hospitalization and SPSS version 26 was used for statistical processing. RESULTS: A total of 674 pregnant women with dengue were studied, 63.9% (n = 431) without alarm signs, 36.1% (n = 243) with alarm signs and no cases of severe dengue. In terms of behavior, 42.3% ( n = 285) were treated on an outpatient basis, 39.5% (n = 266) in hospital;12.5% (n = 84) remained under observation, 1.9% (n = 13) required referral to another health center for hospitalization and 3.9% (n = 26) required intensive care. CONCLUSIONS: In pregnant women, dengue infection increases morbidity; the main factors associated with hospitalization were: thrombocytopenia, hypotension, abdominal pain, rash, and vomiting. On the part of the health entities and the community, effective interventions focused on waste handling and education and insistence on the main warning signs for which they should seek medical consultation are required.

Diagnostic value of serum ferritin as an indicator of disease severity in children with dengue infection

Background: Dengue fever is an acute febrile illness, ranging from asymptomatic to severe state in connection with hosts immune response. Several biochemical markers such as decreased platelet count, prolonged prothrombin duration, and increased hematocrit level have been recommended to evaluate disease severity. Due to lack of their clinical relevance, evaluation of serum ferritin is distinguishing feature to predict the disease severity at the early stage of infection. Aims and Objectives: The aim of the study was to assess the levels of serum ferritin as an early predictor of infection severity in children with dengue fever. Materials and Methods: Seventy-four patients diagnosed with dengue fever by non-structural protein 1 antigen positive and ?12 years of age were recruited. Hematological investigation such as platelet count, C-reactive protein (CRP), complete blood picture, liver function tests, renal function tests, and serum ferritin was assessed. Cases were monitored for disease progression status and platelet count too. Categorical variables were assessed by Chi-square test and descriptive statistics were used to represent demographic data. Results: The mean differences of the levels of platelet count, CRP, total cholesterol, triglycerides, and low-density lipoprotein were statistically significant among severe and non-severe dengue cases. Serum ferritin levels in children with severe dengue fever showed 876.42 ng/ml, 1048.94 ng/ml and 1573.20 ng/ml on 3rd, 4th, and 5th day, respectively. Whereas, cases with non-severe dengue showed 431.12 ng/ml, 612.20 ng/ml, and 698.41 ng/ml on 3rd, 4th, and 5th day, respectively. Conclusion: Serum ferritin levels were significantly increased with severity dengue fever on 3rd, 4th, and 5th day of infection. Thus, serum ferritin is an efficient biomarker in estimating the dengue fever severity and progression at early stage of infection in children.

A retrospective analysis of serological & molecular testing data on dengue fever in Kolkata & adjacent districts during 2016-2019

Background & objectives: Regional Virus Research and Diagnostic Laboratory established at ICMR-National Institute of Cholera and Enteric Diseases (NICED) regularly receives samples for dengue screening and serotyping from patients of acute febrile illness (AFI) from Kolkata and adjacent districts. In this study, data over a three year period (August 2016-July 2019) was retrospectively analyzed to provide insight into the epidemiological trends of dengue fever in this region. Methods: Serological screening of dengue was performed by detection of NS1 antigen and/or immunoglobulin M (IgM) antibody. Dengue serotyping was done by conventional or real-time reverse transcriptase–PCR. The data were analyzed to describe the distribution of dengue with respect to age of patient, duration of fever on the day of blood collection and month of the year. Zip codes were used for spatial plotting. Results: Out of the 24,474 samples received from Kolkata and its adjacent districts (Hooghly, Howrah, North and South 24 Parganas), 38.3 per cent (95% confidence interval: 37.7-38.9%) samples were screened positive for dengue. The correlation between age and dengue positivity was found to be weak. A combination of dengue NS1 antigen and dengue IgM antibody detection may be a better option for detecting dengue positivity compared to a single test. Most AFI cases were tested from August to November during the study period, with maximum dengue positivity noted during September (45.9%). The predominant serotype of 2016, dengue virus serotype 1 (DENV-1), was almost entirely replaced by DENV-2 in 2017 and 2018. Interpretation & conclusions: Dengue continues to be an important cause of AFI in the region and round-the-year preventive measures are required for its control. Serotype switching is alarming and should be monitored routinely.

A Study of Serum Ferritin Level in Patients of Dengue Fever and Its Correlation with the Severity of Dengue Fever in Tertiary Care Hospital of South Gujarat

Introduction: In more than 100 endemic countries, there are 50 to 100 million new cases reported per year, according to the WHO. The dengue pandemic has caused significant death. There is usually only supportive care offered and no effective therapy. The purpose of the study was assess any effect on the level of serum ferritin in patients of dengue. Methodology: This was an observational, Prospective study conducted at Surat Municipal Institute of Medical Education and Research General Medicine department among dengue fever cases. Result: Serum ferritin level from on admission then on day 3 and then day 5 in non-severe and severe dengue cases showed p value <0.001 which was statically significant. Conclusion: The use of a serum ferritin level alone with a cut-off value of more than 900 ng/ml is indicated.

Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

Dengue and Scrub Typhus Co-infection in Children: Experience of a Teaching Hospital in an Endemic Area

Background: Dengue fever and scrub typhus are considered an endemic disease in the Indian subcontinent. The epidemiology and clinical presentations are complex and vary each year.? Objective: The objective of this study was to estimate the prevalence of coinfection with scrub typhus in children diagnosed with dengue fever. Methods: A retrospective hospital-based, cross-sectional study was done in the Department of Pediatrics of a teaching hospital in Puducherry. All children (0–14 years) who had enzyme?linked immunosorbent assay (ELISA) reported scrub typhus among those diagnosed with dengue fever (NS1Ag or immunoglobulin M ELISA positivity) during 2012–2016. Medical records with incomplete data were excluded from the study. Odds ratio was calculated to find out the association of coinfections. An independent t-test was used to find out the statistical significance. P < 0.05 was considered statistically significant. Results: Atypical features of dengue were present in 250/318 (78.6%) children. Coinfections were seen in 62/318 (19.4%) children. Scrub typhus was the most common (n = 51/62, 82.2%). The chance of scrub typhus in a dengue serology?positive child is significant when the symptoms are atypical or protracted (OR– 2.6, P = 0.033). Conclusion: High index of suspicion should be present in endemic dengue and scrub typhus coinfection.

Clinico-Pathological Profiles of patients with Dengue Fever in Dhaka, Bangladesh

Background: Dengue viral infections are among the most important mosquito-borne diseases of the Bangladeshi subcontinent and have become a major global public health concern. The spread of the disease has led to increased recognition of atypical manifestations apart from the classical clinical features of dengue infection.This study aimed to provide clinical and biochemical profiles of Bangladesh’s dengue-infected patients.Material & Methods:This cross-sectional study was conducted from January 2021 to December 2021 in different government and private tertiary care hospitals in Dhaka, Bangladesh. We collected information on demographic data, clinical characteristics, and laboratory profiles for 271 confirmed hospitalized acute dengue cases using a structured questionnaire.Results:A total of 271 patients were hospitalized and received treatment for DEVN infection from the respective hospital of our research. Table 1 describes the socio-demographic data of the enrolled patients in the study. As shown in Table-1, out of 271 patients, 164(60.52%) were male and 107(39.48%) were female Almost half of the patients (135(49.82%) were from the age group 20-40 years. Of the 271 patients, around 179(66.05%) patients had a nuclear family and 92(33.95%) patients had a joint family. lab parameters of the blood samples of patients with DENV infection; from the report of leukocyte count, 134(66.01%) patients had >4000/cumm and 69(33.09%) patients had ?4000/cumm. The pattern of seropositivity and clinical diagnostic method of patients with DENV infection of the study population.Conclusions:Over the last couple of years, dengue fever has become a major health issue in Bangladesh. To reduce the burden of this disease, timely diagnosis and prompt treatment are necessary. This analysis thus yields the clinical features, laboratory profiles, and seropositivity test results of dengue patients from Bangladesh. The research results may help clinicians understand the circumstantial diagnosis of dengue patients and facilitate early intervention.

DENGUE HEPATOPATHY AND ITS CORRELATION WITH SEVERITY OF DISEASE FROM WESTERN PART OF INDIA

Background and Objectives: The global incidence of dengue hasgrown dramatically in recent decades affecting children and young adults mainly intropical and subtropical countries.Dengue has a wide spectrum of clinicalpresentations, often with unpredictable clinical evalution and outcome. While mostpatients recover following a self-limiting non-severe clinical course, a smallproportion progress to severe disease, mostly characterised by plasma leakage with orwithout haemorrhage.Methods: It is a Prospective ,observational study including 150 serologicallyconfirmed Dengue fever in a tertiary care centre. The main objective was tostudy patterns of hepatopathy in dengue fever and to determine whether thepatterns of hepatic involvement correlate with clinical , laboratory profile andoutcome in Dengue fever according to WHO classification .Results: Younger age groups were found to be more prone tohepatopathy with 46.7 % of patients having hepatopathy(transaminases >3x UNL) belonging to ages 21-30 yrs. AST levelcorrelates maximum with severe Dengue ,followed by abnormal PTand APTT value .AST is more useful than ALT and AST:ALT Ratiois even more reliable indicator than using the values alone.Riskfactors which were statistically significant for mortality :PositiveTourniquet test, Abnormal CNS Examination, BleedingManifestations, and thrombocytopenia.Hepatic dysfunction Grade 3and 4 were not directly related to mortality.Interpretation and Conclusion: Even though hepatopathy does notcorrelate with the severity of disease directly, its significantassociation with warning signs ,thrombocytopenia and bleedingmanifestations make it very important factor to predict which subsetof patients will develop severe Dengue fever.Timely diagnosis ofhepatopathy in patients with dengue fever and its management mayimprove patient survival rate

Efficacy and Safety of Low Dose, Short Course Eltrombopag in Management of DF and DHF

Background: Dengue is the most widespread aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life-threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production.Material & Methods:This study was a cross-sectional observational study which was conducted at Tairunnesa Memorial Medical College and Hospital (TMMCH), Gazipur and Shin Shin Japan Hospital, Uttara, Dhaka. The study was conducted in between July 2021- December 2021. The sample size for this study was 100.Results:The mean age in group 1 was 25� in group 2 29�and in control group 29� The mean Baseline PLT * 109 /L for group 1 was 57�, for group 2, 51� and for control group 54�. Mean of systolic baseline BP (mmHg) for group 1 was 103.55� 5.04 for group 2 was 105.38�.34 and for control group was 101.97�28 and followed by the mean of diastolic baseline BP (mmHg) was 72.83�56, 72.84�.93 and 71.97�75. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%) and in control group was 3(9.1%). In day 7, the recovery rate of group 1 was 93.9% and in group 2 the recovery rate was 94.1%.Conclusions:Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia.

Role Of Individualised Homoeopathic Medicines In Integrated Management Of Post Dengue Fever Weakness

Background:Communicable diseases are major health hazards in developing countries like India. Due to alteration in host, environment or agent factors, there are various manifestations as well as severity were seen in Dengue cases. So, it is imperative to know about management of this communicable disease in brief as well as preventive measures to maintain good health in Community. Integrated approach with alternative medicine opens a new path for management of Communicable diseases in effective way.Material And Methods:At the Manglam Clinic Rajkot, 30 year old patient with Post Dengue Fever weakness was treated with individualized homoeopathy between 30/09/2021 to 03/10/2021. The treatment involved prescription of individually selected homoe opathic single remedy. During Follow up visits, outcome was assessed with Blood Report and general wellbing feeling of patient. Result:over an observation, an increasingly beneficial result from individualized Homoeopathy was noted in post Dengue Fever Weakness as well as on laboratory reports.Conclusion:Homoeopathy is branch of medical science and known for its gentle healing. This gentle art of healing finds a good scope in integrated Management of Post Dengue Fever Weakness

Estudio aleatorizado, doble ciego, placebo controlado de doxiciclina en pacientes con dengue. Modulación de citoquinas y respuesta clínica

Resumen Introducción: Los niveles de citoquinas podrían ser determinantes en la severidad de la Fiebre Dengue. La supresión de su actividad con inmunomoduladores modificaría su evolución. Objetivo: Determinar el efecto de la adición de doxiciclina sobre el perfil de citocinas de pacientes con dengue y valorar la respuesta clínica y el impacto en la severidad de pacientes con Fiebre de Dengue. Materiales y métodos: Estudio aleatorio, doble ciego, placebo controlado con doxiciclina. Ambos grupos recibieron la medicación por 7 días y se controló la evolución clínica, laboratorio y niveles de citoquinas en los días 0, 3 y 7. Resultados: Fueron incluídos en el estudio 61 pacientes, 36 (59%) en el grupo placebo y 25 (41%) en el grupo doxiciclina. Se observó que los pacientes tratados con doxiciclina mostraron menor plaquetopenia en el día 0 y 3 [(170029±47483/mm3 vs 198875±52211/mm3)(p<0,05) y 129545±62840/mm3 vs 165048±51142/mm3)(p<0,05)] al compararlo con el grupo placebo. Los niveles de IL-6, TNF y raIL-1 no mostraron diferencias significativas. Se observó una tendencia a menores niveles de IL-1ß en el grupo tratado con doxiciclina (52,1±97 vs 3,3±7,7)(0,08). Conclusiones: No se constató diferencias en la presentación clínica, hospitalización ni en la mortalidad entre pacientes tratados con doxiciclina comparados con placebo. Hubo una tendencia a menores niveles de IL-1ß en los pacientes tratados con doxiciclina. Debe aumentarse el tamaño de la muestra para confirmar o rechazar los resultados.

Abstract Background: Cytokine levels could be determinant in the severity of Dengue Fever. The suppression of their activity with immunomodulators would modify its evolution. Objective: To determine the effect of doxycycline on the cytokine profile of patients with dengue fever and to assess the clinical response and the impact on the severity of patients with dengue fever. Materials and methods: Randomized, double-blind, placebo-controlled study with doxycycline. Both groups received the medication for 7 days and clinical evolution, laboratory and cytokine levels were monitored on days 0, 3 and 7. Results: 61 patients were included in the study, 36 (59%) in the placebo group and 25 (41%) in the doxycycline group. It was observed that patients treated with doxycycline showed lower thrombocytopenia at day 0 and 3 [(170029±47483/mm3 vs 198875±52211/mm3)(p<0.05) and 129545±62840/mm3 vs 165048±51142/mm3)(p<0.05)] when compared to the placebo group. IL-6, TNF and raIL-1 levels showed no significant differences. A trend to lower IL-1ß levels was observed in the doxycycline treated group (52.1±97 vs 3.3±7.7)(0.08). Conclusions: There was no difference in clinical presentation, hospitalization or mortality among patients treated with doxycycline compared to placebo. There was a trend to lower IL-1ß levels in patients treated with doxycycline. The sample size should be increased to confirm or reject the results.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon

Purpose: To report a retrospective series of three cases of infectious panophthalmitis post?dengue fever with ex vivo confirmation of dengue virus ribonucleic acid (RNA) in the tissues of the eye. Methods: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1?specific reverse transcription loop?mediated isothermal amplification (RT?LAMP) assay). Results: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow?up had healthy eviscerated sockets. Conclusion: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Isolated Unilateral Third Cranial Nerve Palsy : A Rare Presentation of Dengue Fever

We herein report a case of unilateral 3rd cranial nerve palsy in a 15 years old boy. It can be due to numerous aetiologies like infectious, inflammatory, malignant, metabolic or vascular. In our case the nerve palsy was preceded by history of high grade fever of 5 days. Involvement of 3rd cranial nerve started 9 days after fever onset, insidiously, presenting as Ptosis and Diplopia. No history of altered sensorium, limb weakness, diurnal variation. Routine investigation was normal. Integrated Counselling and Testing Centre (ICTC) was negative. Cerebrospinal Fluid (CSF) study revealed viral picture but was negative for neurotropic viral panel. MRI brain was essentially normal except for presence of small Lipoma over prepontine cistern. Antinuclear Antibody (ANA) and Antineutrophil Cytoplasmic Antibodies (ANCA) were negative. Serology for Dengue was sent considering the history of high grade fever associated with blanchable rash. Dengue IgM report came out to be reactive. CSF Dengue IgM also came out to be reactive. Patient was put on short course of oral steroid therapy and cranial nerve palsy improved gradually. Neurological complications of dengue is uncommon. Few cases of Cranial Nerve Involvement associated with Dengue have been reported in the literature, most of them are associated with encephalitis. But in our case Cranial Nerve involvement was not associated with Encephalitis, it was probably due to immune reactions secondary to Dengue, making this case atypical.