ABSTRACT
INTRODUCTION: HPS is a potentially life-threatening histiocytic disorder that has been described in various viral infections including dengue. Its involvement in severe and fatal dengue is probably more common but is presently under recognized. CASE DESCRIPTION: A 38-year-old female was admitted after 5 days of fever. She was deeply jaundiced, leukopenic and thrombocytopenic. Marked elevation of transaminases, hyperbilirubinemia and hypoalbuminemia were observed. She had deranged INR values and prolonged aPTT accompanied with hypofibrinogenemia. She also had splenomegaly. She was positive for dengue IgM. Five days later she became polyuric and CT brain image showed gross generalized cerebral edema. Her conditions deteriorated by day 9, became confused with GCS of 9/15. Her BMAT showed minimal histiocytes. Her serum ferritin level peaked at 13,670.00 µg/mL and her sCD163 and sCD25 values were markedly elevated at 4750.00 ng/mL and 4191.00 pg/mL, respectively. She succumbed to the disease on day 10 and examination of her tissues showed the presence of dengue virus genome in the bone marrow. DISCUSSION AND EVALUATION: It is described here, a case of fatal dengue with clinical features of HPS. Though BMAT results did not show the presence of macrophage hemophagocytosis, other laboratory features were consistent with HPS especially marked elevation of ferritin, sCD163 and sCD25. Detection of dengue virus in the patient's bone marrow, fifteen days after the onset of fever was also consistent with the suggestion that the HPS is associated with dengue virus infection. CONCLUSIONS: The findings highlight HPS as a possible complication leading to severe dengue and revealed persistent dengue virus infection of the bone marrow. Detection of HPS markers; ferritin, sCD163 and sCD25, therefore, should be considered for early recognition of HPS-associated dengue.
ABSTRACT
We have analysed the average annual cost of dengue in Malaysia during the period 2002–2007 and in Thailand between 2000 and 2005. The key cost components, estimated by combining existing data from both published and unpublished studies, consist of: (i) costs of non-fatal illness; (ii) vector (Aedes mosquitoes) control costs; and (iii) research and development (R&D) costs incurred by government institutions. We found the immediate cost of dengue to Malaysia to be in the range of US$ 88 million to US$ 215 million (mean US$ 133 million) per annum. For Thailand, the corresponding range is US$ 56 million to US$ 264 million (mean US$ 135 million) per annum. For the period analysed, Thailand has 3.6 times more total cases of dengue, but Malaysia has a 4.6 times higher cost per case. In Malaysia, the most important parameters creating uncertainty in the immediate cost are reporting rate, hospitalization rate, and cost per ambulatory case. The corresponding parameters in Thailand are cost per ambulatory case, cost per hospitalized case, and reporting rate. Better estimates of cost per ambulatory case and reporting rate are therefore needed for both countries. Future studies should also refine the estimates of hospitalization rate in Malaysia and the cost per hospitalized case in Thailand.Malaysia’s immediate cost of dengue is substantial and is equivalent to 3%–7% of the government’s spending on health care. According to our estimates the illness costs due to dengue are 11 times (range 5 to 28 times) the amount of government spending on Aedes vector control in Malaysia, and 13 times (range 1 to 106 times) the government’s spending on Aedes vector control in Thailand. This relationship shows that increased investment on prevention could potentially generate large offsets in illness costs. In addition to the immediate costs reported here, dengue may also adversely impact tourism and create emotional and long-term burdens on families affected by illness and deaths.
Subject(s)
Dengue , Malaysia , Thailand , Health Care Costs , Ambulatory Care FacilitiesABSTRACT
BACKGROUND: The human leukocyte antigen alleles have been implicated as probable genetic markers in predicting the susceptibility and/or protection to severe manifestations of dengue virus (DENV) infection. In this present study, we aimed to investigate for the first time, the genotype variants of HLA Class 1(-A and -B) of DENV infected patients against healthy individuals in Malaysia. METHODOLOGY/PRINCIPAL FINDINGS: This study was carried out with 92 dengue disease patients and 95 healthy controls from three different ethnic groups (Malay, Chinese and Indian) in Malaysia. All patients with clinical and laboratory confirmation of DENV infection were typed for the HLA-A and B loci, using polymerase chain reaction-sequence specific primer techniques. In our total population, a significant increase for HLA-B*53 (P = 0.042, Pc = 1.008) allele and a significant decrease for A*03 (P = 0.015, Pc = 0.18, OR = 5.23, 95% CI = 1.19-23.02) and B*18 (P = 0.017, Pc = 0.408) alleles were noted in DHF patients as compared to healthy donors. We also observed that in the Malay DHF patients, allele B*13 (P = 0.049, Pc = 1.176, OR = 0.18, 95% CI = 0.03-0.90) was present at a significantly higher frequency in this population while allele HLA-B*18 (P = 0.024, Pc = 0.576) was seen to be negatively associated with DHF. CONCLUSIONS/SIGNIFICANCE: These are the first findings on genetic polymorphisms in our population and we conclude that: (1) In our total population, HLA-B*53 probably involve in disease susceptibility, while the HLA-A*03 and HLA-B*18 may confer protection from progression to severe disease; (2) In the Malay population, HLA-B*13 and B*18 are probably associated in disease susceptibility and protection, respectively. These results could furnish as a valuable predictive tool to identify ethnically different individuals at risk and/or protection from severe forms of DENV infection and would provide valuable informations for the design of future dengue vaccine.
