DENGUE

Selected abstracts:

1.                  Chua SK, Selvanesan S, Sivalingam B, Chem YK, Norizah I, Zuridah H, Kumarasamy V, Chua KB. Isolation of monoclonal antibodies-escape variant of dengue virus serotype 1. Singapore Med J. 2006 Nov;47(11):940-6.

Hospital Tengku Ampuan Rahimah, Jalan Banting, Klang 41200, Malaysia. chuakawbing@yahoo.com.sg

INTRODUCTION: During an outbreak from December 2004 to March 2005, 138 isolates of dengue virus were prospectively obtained from acute-phase serum samples of 1,067 patients with the provisional clinical diagnosis of acute dengue illness admitted to the adult wards of Hospital Tengku Ampuan Rahimah, Klang, Malaysia. Of the 138 dengue virus isolates, 87, 11, 24 and 3 were typed as dengue serotypes 1, 2, 3 and 4, respectively, by a commercial dengue virus typing kit using monoclonal antibodies (Mab). 13 dengue virus isolates could not be assigned to any specific serotype by serotyping Mab and molecular typing using dengue-type specific molecular typing primer pairs. We report the associated clinical features and limited molecular genetics of this Mab-escape dengue virus variant. METHODS: Limited molecular characterisation of the Mab-escape dengue virus variants with respect to a few concurrently isolated dengue serotype 1 virus was performed by reverse transcriptase polymerase chain reaction (RT-PCR), followed by nucleic acid sequencing of the 500-bp dengue virus partial genomic capsid-PreM fragment. RESULTS: The aligned nucleic acid sequence of RT-PCR products showed that these Mab-escape variants were of identical nucleic acid sequence, and shared the highest sequence homology (99 percent) with dengue virus serotype 1 (GeneBank accession No. AB178040) isolated from a Japanese patient in 2004. Though these Mab-escape dengue virus variants were noted to replicate to a 2-log higher titre than the current circulating dengue virus serotype 1, there was no significant difference between these variants and the currently circulating dengue virus serotype 1 with respect to disease severity (dengue fever versus dengue haemorrhagic fever) and clinical features. CONCLUSION: There was no significant difference in the proportion of patients developing dengue haemorrhagic fever following acute infection by Mab-escape dengue virus 1 variant in comparison with infection by the conventional dengue virus 1. Similarly, there was no significant difference in the pattern of clinical presentations following acute infection by the two different strains of virus.

2.                  Ranganathan SS, Sathiadas MG, Sumanasena S, Fernandopulle M, Lamabadusuriya SP, Fernandopulle BM.  Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children. Indian J Pediatr. 2006 Oct;73(10):871-5.

Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.

OBJECTIVE: To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children. METHODS: It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls. RESULTS: Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 mg /dl and 0.051 mg /dl (p< 0.001). The mean duration of paracetamol intake prior to admission in cases was 3. 45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1, 2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died. CONCLUSION: Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

15337.  Kamath SR, Ranjit S.  Clinical features, complications and atypical manifestations of children with severe forms of dengue hemorrhagic fever in South India. Indian J Pediatr. 2006 Oct;73(10):889-95. 

15338.  Seema, Jain SK. Molecular mechanism of pathogenesis of dengue virus: entry and fusion with target cell. Indian J clin Biochem 2005, 20(2), 92-103.

Therapy:

15337.  Penafiel A, Devanand A, Tan HK, Eng P. Use of molecular adsorbent recirculating system in acute liver failure attributable to dengue hemorrhagic fever. J Intensive Care Med. 2006 Nov-Dec;21(6):369-71.