Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. In 1998 this mosquito-borne disease is the most important tropical infectious disease after malaria, with an estimated 100 million cases of dengue fever, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually. The reasons for this resurgence and emergence of dengue hemorrhagic fever in the waning years of the 20th century are complex and not fully understood, but demographic, societal, and public health infrastructure changes in the past 30 years have contributed greatly. This paper reviews the changing epidemiology of dengue and dengue hemorrhagic fever by geographic region, the natural history and transmission cycles, clinical diagnosis of both dengue fever and dengue hemorrhagic fever, serologic and virologic laboratory diagnoses, pathogenesis, surveillance, prevention, and control. A major challenge for public health officials in all tropical areas of the world is to devleop and implement sustainable prevention and control programs that will reverse the trend of emergent dengue hemorrhagic fever.

/pdf/dengue-and-dengue-hemorrhagic-fever-1p5i046g8l.pdf

Dengue and Dengue Hemorrhagic Fever

Dengue and dengue hemorrhagic fever.

Viremia titers in serial plasma samples from 168 children with acute dengue virus infection who were enrolled in a prospective study at 2 hospitals in Thailand were examined to determine the role of virus load in the pathogenesis of dengue hemorrhagic fever (DHF). The infecting virus serotype was identified for 165 patients (DEN-1, 46 patients; DEN-2, 47 patients; DEN-3, 47 patients, DEN-4, 25 patients). Patients with DEN-2 infections experienced more severe disease than those infected with other serotypes. Eighty-one percent of patients experienced a secondary dengue virus infection that was associated with more severe disease. Viremia titers were determined for 41 DEN-1 and 46 DEN-2 patients. Higher peak titers were associated with increased disease severity for the 31 patients with a peak titer identified (mean titer of 107.6 for those with dengue fever vs. 108.5 for patients with DHF, P=.01). Increased dengue disease severity correlated with high viremia titer, secondary dengue virus infection, and DEN-2 virus type.

https://www.jstor.org/stable/info/30111267

Dengue Viremia Titer, Antibody Response Pattern, and Virus Serotype Correlate with Disease Severity

An epidemic form of arthritis has been occurring in eastern Connecticut at least since 1972, with the peak incidence of new cases in the summer and early fall. Its identification has been possible because of tight geographic clustering in some areas, and because of a characteristic preceding skin lesion in some patients. The authors studied 51 residents of three contiguous Connecticut communities -- 39 children and 12 adults -- who developed an illness characterized by recurrent attacks of asymmetric swelling and pain in a few large joints, especially the knee. Attacks were usually short (median: 1 week) with much longer intervening periods of complete remission (median: 2.5 months), but some attacks lasted for months. To date the typical patient has had three recurrences, but 16 patients have had none. A median of 4 weeks (range: 1-24) before the onset of arthritis, 13 patients (25%) noted an erythematous papule that developed into an expanding, red, annular lesion, as much as 50 cm in diameter. Only 2 of 159 family members of patients had such a lesion and did not develop arthritis (P less than 0.000001). The overalll prevalence of the arthritis was 4.3 cases per 1,000 residents, but the prevalence among children living on four roads was 1 in 10. Six families had more than 1 affected member. Nine of 20 symptomatic patients had low serum C3 levels, compared to none of 31 asymptomatic patients (P less than 0.005); no patient had iridocyclitis or a positive test for antinuclear antibodies. Neither cultures of synovium and synovial fluid nor serologic tests were positive for agents known to cause arthritis. "Lynne arthritis" is thought to be a previously unrecognized clinical entity, the epidemiology of which suggests transmission by an arthropod vector.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780200102

An epidemic of oligoarticular arthritis in children and adults in three connecticut communities

Dengue and dengue hemorrhagic fever

Preparation of Antigens 561; Preparation of Sera 567; Preparation of Erythrocytes 568; Chemical Reagents 569; Technique of HA and HI Tests 570; HA Titrations 571; HI Tests 572; References 573
During the past few years, the methods for conducting hemagglutination (HA) and hemagglutination-inhibition (HI) tests with arthropod-borne (arbor) viruses have undergone a number of modifications, directed toward simplification and improvement as well as extension of the tests to include a larger number of arbor viruses. Accordingly, it seems desirable at this time to bring together, in one publication rather than in a series of papers, a description of the procedures currently in use in The Rockefeller Foundation Virus Laboratories. Some of the procedures were initially developed elsewhere; of those developed in this laboratory, most aspects have not been previously reported.
It was stated by Hallauer (1946) that he had obtained a hemagglutinating antigen from viscerotropic but not from neurotropic strains of yellow fever.

J Casals

Papers

Techniques for hemagglutination and hemagglutination-inhibition with arthropod-borne viruses.