Changes and correlation of dengue fever epidemic and Aedes albopictus density in Haizhu district, Guangzhou before and after the COVID-19 pandemic

To analyze the population density, seasonal fluctuation of Aedes albopictus in Haizhu District, Guangzhou from 2017 to 2021, so as to provide a scientific basis for the monitoring and prevention and control of mosquito vector density of dengue fever. The data of dengue fever cases and Aedes surveillance data in Haizhu District, Guangzhou from 2017 to 2021 were collected, and the data of 2017-2019 and 2020-2021 were grouped to compare and analyze the characteristics of dengue epidemic and the density fluctuation of Aedes mosquitoes. A total of 517 dengue cases were reported in Haizhu District, Guangzhou from 2017 to 2021, of which only 7 cases were reported from 2020 to 2021, and the peak period of reported cases every year was August to November. Before the COVID-19 pandemic, there was a positive correlation between the number of local cases and the number of imported cases(rs=0.63, P<0.05) and BI(rs=0.73, P<0.05). The peak density of Aedes was from May to October, and the differences of mean BI(X~2=1 143.40,P<0.001), MOI(X~2=188.30,P<0.001), and SSI(X~2=4 499.43,P<0.001)before and after the COVID-19 pandemic were statistically significant. In general, before and after the COVID-19 pandemic, the density of Aedes in high-risk areas was higher than that in low-risk areas. After COVID-19 pandemic, the number of reported cases and the density of Aedes in Haizhu District decreased, but the density of Aedes in the high-risk area was still higher than that in low-risk areas, and a certain risk of outbreak still existed, so the government should continue to take more precise measures to strictly prevent dengue epidemic.

Expanded Dengue Syndrome Presenting as Intracranial Hemorrhage, Fever, and Rhabdomyolysis: A Case Report.

Rare clinical manifestations of dengue are included under the expanded dengue syndrome (EDS), with intracranial hemorrhage (ICH) being one of them. We discuss an uncommon presentation of dengue with basal ganglia hemorrhage, hyperthermia, and rhabdomyolysis in a 53-year-old hypertensive female who presented with sudden onset syncope, left-sided weakness, and altered sensorium for days, with high-grade fever and vomiting. The Glasgow coma scale (GCS) score was 5, and the patient was intubated. Noncontrast computerized tomography (NCCT) of the brain revealed right basal ganglia bleeding with intraventricular hemorrhage. Electrocardiography (ECG) revealed sinus tachycardia. The patient had spikes of high-grade fever, rhabdomyolysis, stage III acute kidney disease, and coagulopathy. Dengue IgM antibodies were positive. Treatment was started, and the patient was in the intensive care unit (ICU) for six months, following which she was discharged. Given this, one can speculate on the importance of viral diseases presenting with ICH as these are rare and are diagnosed quite late, which can also prove to be fatal.

Severe Dengue with Multisystem Inflammatory Syndrome in Children Due to Covid-19: A Coinfection Case Series from a Tertiary Care Centre Hyderabad India

BACKGROUND AND AIM: India is currently facing a double burden of severe dengue and SARS-CoV-2 infection. Co-infection with these viruses can result in severe morbidity. We present five cases of severe dengue with MIS-C due to SARS-CoV-2 infection in children. METHOD(S): All the children presented with shock with variable degrees of plasma leakage. They were treated initially as Dengue cases only but due to refractory symptoms like persistent fever, inotropic requirements an alternate diagnosis was suspected. RESULT(S): They were successfully managed according to WHO dengue shock syndrome and COVID-19 MISC guidelines with IV fluids, Methylprednisolone, Aspirin and IVIG. CONCLUSION(S): Severe dengue in endemic regions coexisting with COVID-19 makes it hard to diagnose which can be fatal without early, appropriate management.

Dengue and Its Secondary Hemorrhagic Fever among Children: A Life-Threatening Health Problem in Brazil

BACKGROUND AND AIM: Dengue is a viral febrile infectious disease characterized by mild symptoms that can progress to dengue hemorrhagic fever (DHF). Due to socioeconomic and environmental reasons, it is a significant public health problem in Brazil with high morbidity rates among children. The objective is to analyze the epidemiological behavior of dengue and DHF hospitalizations in Brazil and point out the importance of health surveillance. METHOD(S): Data were collected from the Sistema de Informacoes Hospitalares of the Brazilian Ministry of Health. The study population was children from zero to 14 years old diagnosed with classic dengue and/or DHF from January 2008 to November 2021 in Brazil. The variables analyzed were hospitalizations and deaths over the years, hospitalization time and expenses. RESULT(S): A total of 192,424 hospitalizations for dengue and DHF were reported, of which 95.3% were considered medical emergencies. Its epidemiological behavior has fluctuated over the years, with an increase of 162.0% between 2017 and 2019, followed by a decreasing trend starting in 2020. Despite the low mortality rate (0.24%), this scenario was responsible for $12,347,942.38 in expenses and a total of 652,552 hospitalization days. CONCLUSION(S): Dengue is responsible for a major socioeconomic impact on Brazilian's public health system since its severe cases require intensive care to avoid shock, organ failure and death. Due to COVID-19 pandemic and population's fear of contamination in medical facilities, underreporting of arboviruses cases was observed. Since early diagnosis and monitoring are predictors of good prognosis, it is crucial to encourage notification, epidemiological surveillance and sanitary hygiene measures.

NSAIDs in COVID-19, friend or foe?

At the beginning of COVID-19 pandemic the use of NSAIDS was avoided. This was because the previous studies suggesting that NSAIDs may be linked to an increased risk of lower respiratory tract infection consequences. Later on studies involved the patients who used NSAIDs for some chronic conditions and showed no additional harm among these patients. Then many studied assessed the benefit of using NSAIDs in COVID-19 patients for management of pain and fever and showed no additional risk among these patients

Prevalence of dengue hemorrhagic fever in Bali from 2015 to 2020 and during the COVID-19 pandemic

Background: Dengue hemorrhagic fever cases increased significantly during the COVID-19 pandemic phase. Purpose: This study defines, describes, and evaluates the dengue hemorrhagic fever incidence in Bali Province from 2015 to 2020 and in the context of the COVID-19 pandemic.

The fatal fetal sting of Dengue: experience from a tropical country

Objectives: Dengue is a vector borne infectious disease, endemic in the tropical regions, that may be associated with significant maternal and fetal morbidity and mortality. However, literature is sparse on the rate and factors associated with stillbirths in women suffering from dengue. In this study, we aimed to explore the frequency of stillbirths in dengue infection in pregnancy during the COVID pandemic. We also studied the effect of severity of the disease on fetal morbidity and mortality. Design: Retrospective review of registers and case records Method: We reviewed the data of pregnant women admitted for dengue in the Obstetrics & Gynecology department in a tertiary care hospital of Northern India between September and December, 2021. Data collected included the age, parity, gestation at admission, severity of the maternal disease, other comorbities, maternal outcome, obstetrical outcome during the dengue disease and fetal outcome. Results: Twenty three pregnant women were admitted to the department between September and December 2021. The average age of the women was 26+/-5 years. Half of these women were primigravidas (12 out of 25). Most women were in the third trimester, while one woman each presented in second trimester and the postpartum period. Eleven mothers presented with severe dengue, 11 had dengue with warning signs and only one woman had dengue without warning signs. There were 7 maternal deaths. Three mothers died undelivered. There were 10 stillbirths of 20 deliveries and 22 babies. Majority of the woman delivered preterm. There were 2 twin deliveries. Of the babies who delivered at term, most were liveborn(6 of 7). The stillbirth rate was higher in the severe dengue group, dengue with warning signs and dengue without warning signs were 60%, 36% and nil respectively. Conclusions: The stillbirth rate is high in women with dengue in pregnancy, especially in the third trimester. The chances of stillbirth escalate with the severity of dengue. Maternal mortality is high in women admitted with dengue in pregnancy. Public health strategies to prevent dengue should be strengthened to avoid high stillbirth rates and maternal mortality. The data is limited by the retrospective design and skewed as women with only severe form of dengue would have been admitted.

Study of Utility of Basic Arterial Blood Gas Parameters and Lactate as Prognostic Markers in Patients With Severe Dengue.

Background The importance of prognostication in critical care cannot be over-emphasized, especially in the context of diseases like dengue, as their presentation may vary from mild fever to critical life-threatening illness. With the help of prognostic markers, it is possible to identify patients at higher risk and thus improve their outcome with timely intervention. Basic arterial blood gas (ABG) parameters, i.e., potential of hydrogen (pH), partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and bicarbonate are useful parameters, especially in critical care medicine as they are known to vary with the severity of illness. Hyperlactatemia is often referred to as a "powerful predictor of mortality". Basic ABG parameters and lactate have been used as an essential prognostic modality in critically ill patients for decades; however, the evidence remains limited for their role as prognostic markers in patients with severe dengue. Method We carried out an observational retrospective cohort study comprising 163 patients with severe dengue, admitted between July 2021 and November 2021 at Medical Intensive Care Unit (MICU) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, Uttar Pradesh, India. Basic ABG parameters and lactate levels at the time of admission to MICU were compared between survivor and non-survivor groups of patients with severe dengue in order to evaluate their prognostic utility as predictors of mortality. Results pH (p<0.0001), PO2 (p=0.01) and bicarbonate (<0.0001) levels were significantly lower, while PCO2 (p=0.002) and lactate (p<0.0001) levels were significantly higher in non-survivor group as compared to survivor group. Lactate was found to be the best prognostic marker with Area Under the Curve (AUC) of 88.7% on Receiver Operating Characteristics (ROC) analysis. Conclusion Basic arterial blood gas parameters and lactate can be used as feasible prognostic markers in patients with severe dengue.

Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil.

We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.

Association of Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 (MIS-C) with Coinfections: A Retrospective Cross Sectional Analytical Study from Northern India

Introduction: Multisystem Inflammatory Response Syndrome in Children (MIS-C) temporally associated with Coronavirus Disease 2019 (COVID-19) is characterized by fever, raised inflammatory markers, multisystem involvement with evidence of COVID-19 infection (positive RT-PCR or serology). It occurs concurrently or after 4-6 weeks of acute COVID infection.It has wide range of clinical presentation ranging from mild asymptomatic infection to severe life-threatening illness. Clinical presentation of MIS-C has considerable overlapping features with other tropical infections. During peak wave of COVID-19, when large proportion of population has been affected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), contracting other infections during and within four weeks of active COVID-19 is inevitable. Despite of this concern, only few researchers have studied co-infection and they explained a complex interaction between COVID-19 and other infections like tuberculosis and dengue. They demonstrated how one infection augments the severity of other. To the best of our knowledge no pediatric population-based study explained the interaction of acute COVID-19 & MIS-C with other infections so far. Aim: To determine the association of MIS-C with co-infections in SARS-CoV-2 positive children of 1 month to less than 18 years of age. Materials and Methods: A retrospective review of the medical records of pediatric patients with SARS-CoV-2 infection, treated from September 2020 to February 2021, was performed.All the patients who fulfilled World Health Organization (WHO) criteria of MIS-C were included. Detailed demographic, clinical, laboratory parameters and associated co-infections were recorded.The severe and non severe MIS-C groups were compared. Sample ‘t’ test, Wilcoxon test and Chi-squared test were used for statistical analysis. results: A total of 44 children fulfilled the diagnostic criteria of MIS-C and were included in the study. Out of 44, 20 children (45.4%) had severe disease and 24 had non severe disease. The mean age of children with severe MIS-C was 7.38±5.39 years, as compared to 4.37±4.61 years in the non severe group (p-value= 0.044). Males were predominantly affected in both the groups (Male: Female =1.22:1 in severe MIS-C and 2.4:1 in non severe MIS-C). The gastrointestinal system was most commonly affected in both groups. Associated co-infection was noted more in severe MIS-C group (11 vs 1 patient in severe vs non severe group, p-value=<0.001). Tuberculosis was found to be associated in three patients, followed by complicated enteric fever, and severe dengue in two patients each. The odds ratio for developing severe MIS-C in the presence of co-infections was 10.5(CI=2.33-47.27) while in its absence it was 0.10(0.02-0.43). conclusion: The findings of this study support that concurrent infections in COVID-19 can exacerbate the severity of COVID-19 illness and may lead to severe MIS-C.

Summary of global surveillance data of infectious diseases in December 2021

In December 2021, a total of 64 infectious diseases were reported globally, affecting 228 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were corona virus disease 2019 (COVID-19, 228), measles (29), dengue fever (28), cholera (12) and chikungunya fever (9). The top five infectious diseases with highest case fatality rates were Ebola virus disease (81.8%), Middle East respiratory syndrome (34.4%), yellow fever (22.0%), Lassa fever (20.0%) and plague (10.8%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, measles, dengue fever and cholera. The prevalent infectious diseases in Asia were COVID-19 and dengue fever, the prevalent infectious diseases in Africa were COVID-19, cholera, yellow fever, plague, Lassa fever, poliomyelitis, malaria and measles, the prevalent infectious diseases in America were COVID-19, dengue fever, chikungunya fever and Zika virus disease, the prevalent infectious disease in Europe was COVID-19.

Special Issue: New coronavirus (2019 n-CoV or SARS-CoV-2) and the outbreak of the respiratory illness (COVID-19): part xv. (Special Issue: New coronavirus (2019 n-CoV or SARS-CoV-2) and the outbreak of the respiratory illness (COVID-19): part xv.)

This special issue contains 58 articles that discuss COVID-19 in relation to other diseases. Topics include dengue fever, tuberculosis, Guillain-Barre syndrome, antiretroviral shortage amidst the pandemic, measles, reinfection by 2 genetically distinct SARS-CoV-2 viruses, Lassa fever, molecular biology of SARS-CoV-2 proteins, dermatological manifestation of COVID-19, immunosuppressive therapy in COVID-19-positive patients, rapid antigen tests for detection of COVID-19, among others.

Role of Corticosteroids in Dengue Fever in Pakistan

Aim: To compare and evaluate clinical efficacy of corticosteroids in thrombocytopenia in patients suffering from moderate to severe Dengue. Methods: This randomized single blinded study was conducted at Furqan Clinic Gulbahar Peshawar from August 2021 to October 2021. 100 individuals of ages between 20 to 60 years irrespective of gender, with positive NS1 antigen test and no co-morbidities were included in study by convenient sampling technique. Patients with dengue and Covid-19 were excluded from the study. Randomization was done in four treatment groups. Consent was taken from all patients prior treatment with Cefixime, artemether/lumefantrine, IV Dexamethasone in adjunct to oral papaya leaf extracts. Duration of study was 3 months. Statistical analysis done using SPSS software version 24. Results: Group C and D showed the significant increase in platelet count as compared to group A and B. Pronounced effect was observed in group D. Conclusion: Intravenous Dexamethasone produced more beneficial effects in adjunct to oral carica papaya leaf extracts on thrombocytopenia with reduced risk of bleeding.

Dengue With COVID-19: Associated With Co-infection and Multiple Organ Dysfunction in a Child.

Coronavirus disease 2019 (COVID-19), due to SARS-CoV-2 infection, has been a global concern since January 2020. Southeast Asia, including Bangladesh, is facing outbreaks of endemic diseases such as dengue. Here, we report the case of an eight-year-old female from Dhaka with high-grade, continued fever, shock, features of pneumonia, and plasma leakage with multiple organ dysfunction. Both nonstructural protein 1 antigen (NS1 Ag) for dengue and reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 were positive in the patient. The echocardiographic evaluation showed coronary arterial dilatations. The patient was managed according to the WHO guidelines for dengue with immunoglobulin, methylprednisolone, and aspirin for the involvement of coronary arteries. The patient required a mechanical ventilator due to pulmonary hemorrhage and unstable vitals. She showed gradual improvement with timely managements. Although a single case report does not portray the full picture, through this case report, we aim to describe the severity of co-infection of the mentioned viruses in a child in Bangladesh during the pandemic of SARS-CoV-2. Without appropriate diagnosis and management, it can be fatal.

Severe Dengue With Multisystem Inflammatory Syndrome in Children Due to COVID-19: A Co-infection Case Series.

Severe dengue with the multisystem inflammatory syndrome in children (MIS-C) can be difficult to diagnose as both diseases have similar symptoms and laboratory findings. Bangladesh is currently facing a double burden of severe dengue and SARS-CoV-2 infection. Co-infection with these viruses can result in severe morbidity. Worldwide this co-infection is rare. However, we present five cases of severe dengue with possible MIS-C due to SARS-CoV-2 infection in children. All the children presented with shock with variable degrees of plasma leakage. Mucocutaneous and gastrointestinal involvement were common. All tested positive for dengue nonstructural protein 1 antigen on the second to the third day of fever and tested positive for anti-SARS-CoV-2 IgG by enzyme-linked immunosorbent assay. Echocardiographic evaluation in all patients showed coronary arterial abnormalities. Cardiac enzymes were abnormal, and there were raised inflammatory markers and abnormal coagulation profiles. One patient had neurological involvement and needed mechanical ventilatory support. All cases were successfully managed according to dengue shock syndrome guidelines and required intravenous immunoglobulin with prednisolone, aspirin, and in some cases, enoxaparin for the management of coronary arterial involvements, which is not a documented feature for severe dengue infection, but typically found in MIS-C due to SARS-CoV-2 infection or Kawasaki disease. This case series aims to describe the possibility of co-infection of severe dengue with MIS-C due to SARS-CoV-2 infection in a dengue-endemic region during the coronavirus disease 2019 (COVID-19) pandemic, and alternatively, dengue virus as an unusual etiology for Kawasaki disease was also entertained. Severe dengue in endemic regions can coexist with COVID-19 during an outbreak, making it hard to diagnose. It can be fatal without early, appropriate management.

A Case Study of Dual Infection of Dengue and COVID-19: Presenting as Multiorgan Dysfunction in an Infant.

Dengue is a major health concern in South Asian countries transmitted by bite of day breeder mosquitoes Aedes aegypti and Aedes albopictus. Severity of plasma leak, shock, bleeding tendency and other organ dysfunction can be more pronounced in infants. The management becomes further complicated in the presence of a co-existing COVID-19 infection. Although COVID-19 infection is usually asymptomatic or has mild manifestations in children, however in presence of serious co-infection like dengue it can modify the course of the illness and lead to drastic consequences. Here, we present one such case of a 9-month-old female child who tested positive for dengue as well as COVID-19 during the ongoing corona pandemic and went on to develop shock, encephalopathy with deranged liver enzymes but managed to overcome all odds and recover from the disease by day 14 of illness.

Dengue Fever and Severe Dengue in Barbados, 2008-2016.

Analysis of the temporal, seasonal and demographic distribution of dengue virus (DENV) infections in Barbados was conducted using national surveillance data from a total of 3994 confirmed dengue cases. Diagnosis was confirmed either by DENV-specific real time reverse transcriptase polymerase chain reaction (rRT-PCR), or non-structural protein 1 (NS1) antigen or enzyme linked immunosorbent assay (ELISA) tests; a case fatality rate of 0.4% (10/3994) was observed. The prevalence rate of dengue fever (DF) varied from 27.5 to 453.9 cases per 100,000 population among febrile patients who sought medical attention annually. DF cases occurred throughout the year with low level of transmission observed during the dry season (December to June), then increased transmission during rainy season (July to November) peaking in October. Three major dengue epidemics occurred in Barbados during 2010, 2013 and possibly 2016 with an emerging three-year interval. DF prevalence rate among febrile patients who sought medical attention overall was highest among the 10-19 years old age group. The highest DF hospitalisation prevalence rate was observed in 2013. Multiple serotypes circulated during the study period and Dengue virus serotype 2 (DENV-2) was the most prevalent serotype during 2010, whilst DENV-1 was the most prevalent serotype in 2013. Two DENV-1 strains from the 2013 DENV epidemic were genetically more closely related to South East Asian strains, than Caribbean or South American strains, and represent the first ever sequencing of DENV strains in Barbados. However, the small sample size (n = 2) limits any meaningful conclusions. DF prevalence rates were not significantly different between females and males. Public health planning should consider DENV inter-epidemic periodicity, the current COVID-19 pandemic and similar clinical symptomology between DF and COVID-19. The implementation of routine sequencing of DENV strains to obtain critical data can aid in battling DENV epidemics in Barbados.