An evidence of intestinal mucosal injury in dengue infection.

The aim of this study was to determine whether there is an association between dengue infection and intestinal mucosal injury. Serum levels of intestinal fatty acid binding protein (I-FABP) were used as a specific marker for mucosal injury. The diagnosis of all patients was serologically confirmed by anti-dengue IgG or IgM. Serum I-FABP levels of 120 patients were determined and compared to those of 25 controls using ELISA. In order to investigate serum I-FABP among dengue patients, they were categorized into 5 groups according to disease severity: dengue fever (DF), dengue hemorrhagic fever (DHF) grade I through DHF grade IV. The dengue patients had higher levels of serum I-FABP compared to 25 controls (408.0 +/- 499.3 vs 124.72 +/- 147.81 pg/ml, p=0.006). The patients with DHF grade IV had the highest levels of serum I-FABP, ALT, and AST compared to the other groups. However, there were no differences in serum I-FABP, ALT, and AST levels among patients with DF, DHF grade I, grade II, and grade III. Evidence of intestinal mucosal injury in patients with dengue infection was demonstrated. Patients with DHF grade IV had high serum I-FABP levels and had associated liver injury.

Oxido nitrico en la patologia del dengue / Nitric oxide in dengue pathology

El óxido nítrico (ON) es una molécula pleyotropica, que interviene tanto en procesos citoprotectivos como citotóxicos, su síntesis debe estar altamente regulada por la célula, ya que la alteración en su producción esta asociada a una gran variedad de patologías, entre las que se encuentran el shock séptico, anafiláctico y hemorrágico. La infección con el virus dengue produce una enfermedad que clínicamente presenta un espectro que va desde un polo benigno conocido como fiebre dengue, hasta un polo severo denominado fiebre hemorrágica que puede progresar y producir el síndrome de shock por dengue, que en la mayoría de los casos determina la muerte del paciente. En el presente trabajo se discuten evidencias que involucran al óxido nítrico en la patología del polo severo de la enfermedad producida por este virus.

Dengue fever with thrombocytopenia: studies towards defining vulnerability of bleeding

PURPOSE: To define the period of greater vulnerability of bleeding in patients with Dengue fever in reference to the onset of their constitutional symptoms and the laboratory abnormalities. PATIENTS AND METHODS: In a retrospective study we reviewed the records of all patients admitted to San Pablo Medical Center in 1991 with a diagnosis of Dengue Fever or Hemorrhagic Dengue. All patients with a platelet count of less than 125,000 were included for analysis. The exclusion criteria included the presence of systemic disorders which may influence the platelet count, and patients without documentation regarding the presence of constitutional symptoms suggestive of viral illness. RESULTS: A total of 101 patients were analyzed of which only 74 were included in the study. All patients had fever and chills; skin rash, asthenia and general malaise was seen in over 50 of patients. Over 70 of patients had recovery of their platelet count, and most had their maximal thrombocytopenia within the 5th day and 8th day from the onset of constitutional symptoms. Leukopenia was seen in over 70 of patients with its lowest level within the 5th and 8th day from the onset of the constitutional symptoms. Significantly prolonged partial thromboplastin time was seen in 11 of the patients. Proteinuria was seen in 22 of the patients, 38 of which had it within the first 4 days of the onset of constitutional symptoms and also noted on the 5th and 6th day. Alteration in liver enzymes were noted in 47 of patients, with a maximal severity distributed in all time frames. Hypoalbuminemia was present in 28 of the patients, of these 67 presented within the first 4 days from the onset of constitutional symptoms. The pulse rate was usually normal in spite of the patient's dehydration and fever. CONCLUSIONS: We identified three phases that define the sequence of events seen in the majority of patients with Dengue Fever and Thrombocytopenia. These are: 1. proteinuria and hypoalbuminemia; 2. maximal cytopenia; 3. bradycardia and liver enzyme elevation. We believe this information is useful in the management of patients with Dengue Fever and thrombocytopenia