Showing papers on "Dengue fever published in 1991"
TL;DR: Results indicate (a) T lymphocytes are activated and produce IL-2 and IFN gamma in vivo during DHF and DF, (b) CD4+ T lymphocyte are activated inDHF andDF, and the level of activation is higher in DHF than in DF, and (c) activation of CD8+T lymphocytes is evident in DH, but not in DF.
Abstract: It has been reported that the severe complication of dengue virus infection, dengue hemorrhagic fever (DHF) is much more commonly observed during secondary dengue virus infections than primary infections. In order to elucidate the role of T lymphocytes in the pathogenesis of DHF, we attempted to determine whether T lymphocytes are activated in vivo during dengue virus infections, by examining the levels of soluble IL-2 receptor (sIL-2R), soluble CD4 (sCD4), soluble CD8 (sCD8), interleukin-2 (IL-2) and interferon-gamma (IFN gamma) in the sera of 59 patients with DHF and 41 patients with dengue fever (DF). The levels of sIL-2R, sCD4, sCD8, IL-2, and IFN gamma were significantly higher in the acute sera of patients with DHF than in the sera of healthy children (P less than 0.001 for all markers). The acute sera of patients with DF contained higher levels of sIL-2R, sCD4, IL-2, and IFN gamma than the sera of healthy children (P less than 0.001 for sIL-2R, IL-2, and IFN gamma; P less than 0.05 for sCD4), but did not have elevated levels of sCD8. The levels of sIL-2R (P less than 0.05), sCD4 (P less than 0.001), and sCD8 (P less than 0.001) were higher in DHF than in DF on days 3-4 after the onset of fever. The levels of IL-2 and IFN gamma in patients with DHF were highest 1 d before defervescence. There were no significant differences in the levels of sIL-2R, sCD4, sCD8, IL-2, and IFN gamma among grades 1, 2, and 3 of DHF. These results indicate (a) T lymphocytes are activated and produce IL-2 and IFN gamma in vivo during DHF and DF, (b) CD4+ T lymphocytes are activated in DHF and DF, and the level of activation is higher in DHF than in DF, and (c) activation of CD8+ T lymphocytes is evident in DHF, but not in DF.
326 citations
TL;DR: Evidence is presented that dengue virus recovered from permissive cells transfected with the in vitro RNA transcripts retained a mutation that was engineered into full-length cDNA that should facilitate the development of a safe and effective live vaccine for use in humans.
Abstract: Dengue virus is an enveloped positive-strand RNA virus with a genome approximately 11 kilobases in length. The four serotypes of dengue virus are currently the most important members of the flavivirus family in terms of geographical distribution and the incidence of infection in humans. In this communication we describe successful cloning of a stable full-length cDNA copy of dengue type 4 virus that can be used as the template for in vitro transcription of infectious RNA. Evidence is presented that dengue virus recovered from permissive cells transfected with the in vitro RNA transcripts retained a mutation that was engineered into full-length cDNA. The properties of the virus produced by cells transfected with infectious RNA transcripts of dengue cDNA resembled those of the virus from which the cDNA clone was derived. The dengue virus recombinant DNA system should prove helpful in gaining a better understanding of the molecular biology of dengue viruses and should facilitate the development of a safe and effective live vaccine for use in humans.
259 citations
TL;DR: Global warming may lead to changes in water ecology that could enhance similar spread of cholera in North America and other infectious diseases such as LaCrosse encephalitis and Lyme disease are caused by agents closely dependent on the integrity of their environment.
Abstract: The effects of global climate change on infectious diseases are hypothetical until more is known about the degree of change in temperature and humidity that will occur. Diseases most likely to increase in their distribution and severity have three-factor (agent, vector, and human being) and four-factor (plus vertebrate reservoir host) ecology. Aedes aegypti and Aedes albopictus mosquitoes may move northward and have more rapid metamorphosis with global warming. These mosquitoes transmit dengue virus, and Aedes aegypti transmits yellow fever virus. The faster metamorphosis and a shorter extrinsic incubation of dengue and yellow fever viruses could lead to epidemics in North America. Vibrio cholerae is harbored persistently in the estuaries of the U.S. Gulf Coast. Over the past 200 years, cholera has become pandemic seven times with spread from Asia to Europe, Africa, and North America. Global warming may lead to changes in water ecology that could enhance similar spread of cholera in North America. Some other infectious diseases such as LaCrosse encephalitis and Lyme disease are caused by agents closely dependent on the integrity of their environment. These diseases may become less prominent with global warming because of anticipated modification of their habitats. Ecological studies will help us to understand more fully the possible consequences of global warming. New and more effective methods for control of vectors will be needed.
239 citations
TL;DR: The amplified sequence size revealed by ethidium bromide-stained agarose gel electrophoresis was unique for each serotype, using infected culture fluid of isolates from d Dengue fever or dengue hemorrhagic fever patients in Thailand, Indonesia, and the Philippines as well as from prototype viruses, thus facilitating simultaneous identification and typing.
Abstract: Four primer pairs were selected on the basis of the published sequence data of four dengue virus serotypes so that each unique target sequence size could be amplified for each serotype by polymerase chain reaction. The procedure consists of (i) RNA preparation, (ii) reverse transcription, and (iii) polymerase chain reaction, all of which could be completed within 2 h in a single tube for each specimen. The amplified sequence size revealed by ethidium bromide-stained agarose gel electrophoresis was unique for each serotype, using infected culture fluid of isolates from dengue fever or dengue hemorrhagic fever patients in Thailand, Indonesia, and the Philippines as well as from prototype viruses, thus facilitating simultaneous identification and typing.
169 citations
TL;DR: Two immunohistochemical techniques to determine the presence of yellow fever and dengue antigens in fixed tissue samples were developed and appeared to be highly reliable for yellow fever diagnosis; however, not enough cases were observed to adequately evaluate the procedures for d Dengue diagnosis.
Abstract: Two immunohistochemical techniques to determine the presence of yellow fever and dengue antigens in fixed tissue samples were developed for the purpose of making retrospective diagnoses of these viral diseases in humans. A horseradish peroxidase label was used for one technique and an alkaline phosphatase label for the other. In the former technique, acid hematin was removed from the tissues, iron-containing pigments were counterstained with Prussian blue, and the product of the diaminobenzidine reaction was enhanced with a dilute solution of osmium tetroxide that differentiated antigen from lipofuscin. In the latter technique, alkaline phosphatase was used as the enzyme labeling system with a red chromogen that contrasted nicely with the pigments in the tissues, as mentioned above. Thus, pigment removal or differentiation from antigen was not required. Replicate sections were cut and mouse polyclonal antibodies for yellow fever and all dengue types were applied to individual sections. On samples positive for dengue antigen, monoclonal antibodies were applied to additional replicate sections to demonstrate antigen of dengue types 1 and 4. In order to test the assay, samples of formalin-fixed liver tissue from Brazilian and Peruvian individuals who had died from a variety of causes as long as eight years earlier were received in a blinded fashion for immunohistochemical analysis. The techniques appeared to be highly reliable for yellow fever diagnosis; however, not enough cases were observed to adequately evaluate the procedures for dengue diagnosis. Both procedures appeared to have similar sensitivity.
155 citations
TL;DR: The retardation of replication of the type 2/type 4 chimeric virus suggests that this virus and possibly other intertypic dengue virus chimeras with similar properties should be examined for attenuation in primates and possible usefulness in a live d Dengue virus vaccine for humans.
Abstract: Dengue virus contains an 11-kilobase positive-strand RNA genome that codes for, in one open reading frame, three structural proteins (capsid, premembrane, and envelope), followed by seven nonstructural proteins. The structural protein genes of a full-length cDNA clone of type 4 dengue virus were replaced with the corresponding genes of dengue 1 or dengue 2 to create intertypic chimeric cDNA. The RNA transcripts made from these templates were infectious when transfected into permissive cells in culture. Progeny of chimeric cDNA produced apparently authentic dengue 1 or dengue 2 structural proteins, together with dengue 4 nonstructural proteins, and as a consequence exhibited type 1 or type 2 serological specificity. Both of the chimeras ultimately grew to the same titer as their type 1 or type 2 parent, but the type 2/type 4 chimera grew very slowly. This chimera also produced small plaques; in contrast, the type 1/type 4 chimera produced normal size plaques. The type 2/type 4 chimera retained the mouse neurovirulence of the dengue 2 virus, which was the source of its structural protein genes. Each of the mice inoculated intracerebrally with the chimera died, but survival time was prolonged. The retardation of replication of the type 2/type 4 chimeric virus suggests that this virus and possibly other intertypic dengue virus chimeras with similar properties should be examined for attenuation in primates and possible usefulness in a live dengue virus vaccine for humans.
143 citations
TL;DR: Results indicate that heterogeneous dengue virus-specific CD4+ cytotoxic T cells are stimulated in response to infection with a d Dengue virus and that a nonstructural protein, NS3, contains multiple dominant T-cell epitopes.
Abstract: Thirteen dengue virus-specific, cytotoxic CD4+ CD8- T-cell clones were established from a donor who was infected with dengue virus type 3. These clones were examined for virus specificity and human leukocyte antigen (HLA) restriction in cytotoxic assays. Six patterns of virus specificities were determined. Two serotype-specific clones recognized only dengue virus type 3. Two dengue virus subcomplex-specific clones recognized dengue virus types 2, 3, and 4, and one subcomplex-specific clone recognized dengue virus types 1, 2, and 3. Four dengue virus serotype-cross-reactive clones recognized dengue virus types 1, 2, 3, and 4. One flavivirus-cross-reactive clone recognized dengue virus types 1, 2, 3, and 4 and West Nile virus (WNV), but did not recognize yellow fever virus (YFV), whereas three flavivirus-cross-reactive clones recognized dengue virus types 1, 2, 3, and 4, WNV, and YFV. HLA restriction in the lysis by these T-cell clones was also heterogeneous. HLA-DP, HLA-DQ, and HLA-DR were used as restriction elements by various T-cell clones. We also examined the recognition of viral nonstructural protein NS3, purified from cells infected with dengue virus type 3 or WNV, by these T-cell clones. One serotype-specific clone, two dengue virus subcomplex-specific clones, and three dengue virus serotype-cross-reactive clones recognized NS3 of dengue virus type 3. One flavivirus-cross-reactive clone recognized NS3 of dengue virus type 3 and WNV. These results indicate that heterogeneous dengue virus-specific CD4+ cytotoxic T cells are stimulated in response to infection with a dengue virus and that a nonstructural protein, NS3, contains multiple dominant T-cell epitopes.
141 citations
01 Jan 1991
TL;DR: A program developed to cope with the ongoing resurgence of Aedes aegypti in the Americas that emphasizes disease prevention rather than general mosquito control measures is described.
Abstract: The ongoing resurgence of Aedes aegypti in the Americas--abetted by poor mosquito control, urbanization, and increased air travel--has led to dengue hyperendemicity, more frequent dengue epidemics, and the emergence of dengue hemorrhagic fever (DHF). This article describes a program developed to cope with this situation that emphasizes disease prevention rather than general mosquito control measures.
120 citations
TL;DR: In this paper, the authors used polyacrylamide gel electrophoresis, Western blotting, and enzyme immunoassay to detect the presence of dengue virus.
Abstract: Antibodies against dengue viral proteins were demonstrated in sera from dengue-infected patients by polyacrylamide gel electrophoresis, Western blotting, and enzyme immunoassay. Primary dengue cases showed low titers of IgG class antibodies to envelope (E) proteins and two non-structural proteins, NS3 and NS5, in sera collected during the convalescent phase. Secondary dengue- infected patients always demonstrated IgG antibodies to E proteins in sera collected during the acute phase, and high titers of IgG antibodies to many other proteins, including NS1, NS3, NS5, and C proteins in sera collected during the convalescent phase. Appearance of antibodies to E, NS3, and NS5 could be detected within five days after the onset of fever. These three dengue viral proteins and their corresponding antibodies may be involved in the immunopathologic mechanism underlying this disease. For diagnostic purposes, identifying the non-structural proteins such as NS3 and NS5 may be the best means for early confirmation of the disease.
113 citations
TL;DR: Two inbred Aedes aegypti mosquito lines were derived that manifested a resistant or susceptible phenotype following ingestion of yellow fever virus; lack of virus movement from the midgut defined the resistant phenotype.
Abstract: Two inbred (isofemale) Aedes aegypti mosquito lines were derived that manifested a resistant or susceptible phenotype following ingestion of yellow fever virus; lack of virus movement from the midgut defined the resistant phenotype. Other flaviviruses, including dengue 1–4, Uganda S, and Zika, viruses behaved in a similar fashion in the two mosquito lines. Crosses between the two lines produced progeny that were of intermediate susceptibility, indicating codominance; F2 backcrosses to the parents yielded results consistent with a major controlling genetic locus and provide evidence of a second locus capable of modulating the phenotype of the major gene. The rapid selection necessary to fix the susceptible and refractory phenotypes support the hypothesis of a single major controlling locus. Viral movement across the midgut is likely to be governed by a single major gene and modifying minor genes or a group of closely linked genes. These inbred mosquito lines will be useful in discovering the molecular basis for flavivirus resistance in Ae. aegypti.
101 citations
Journal Article•
TL;DR: Results indicate that cell surface molecules other than Fc Gamma R can mediate ADE and suggest that the Fc gamma R does not provide a unique signal necessary for enhanced infection.
Abstract: It is known that antibodies to dengue viruses at subneutralizing concentrations enhance dengue virus infection of Fc gamma R+ cells This phenomenon called antibody-dependent enhancement (ADE) occurs when virus-antibody complexes bind to the Fc gamma R via the Fc portion of the Ig It has been hypothesized that ADE may be responsible for the pathogenesis of the severe manifestations of dengue virus infection including dengue hemorrhagic fever/dengue shock syndrome To further analyze the mechanisms of ADE, we prepared bispecific antibodies by chemically cross-linking antidengue virus antibodies to antibodies specific for Fc gamma RI or Fc gamma RII and the non-Fc R molecules beta2 microglobulin, CD15 or CD33 and examined whether these bispecific antibodies could enhance infection Bispecific antibodies targeting dengue virus to Fc gamma RI or Fc gamma RII enhanced dengue virus infection, consistent with previous reports using conventional antibodies Furthermore, bispecific antibodies targeting dengue virus to beta2 microglobulin, CD15 or CD33 also enhanced dengue virus infection Bispecific antibody mediated ADE was inhibited by pretreating the cells with the appropriate blocking mAb These results indicate that cell surface molecules other than Fc gamma R can mediate ADE and suggest that the Fc gamma R does not provide a unique signal necessary for enhanced infection We hypothesize that directing dengue virus to the cell surface by a bispecific antibody facilitates the interaction between dengue virus and its receptor, thereby increasing its infectivity
TL;DR: Recombinant vaccinia viruses that express the premembrane (pre-M), membrane (M), or the cleaved, residual portion of pre-M (non-M) proteins of dengue 4 virus are constructed to evaluate their ability to induce protective immunity in mice.
TL;DR: This is the first report of the isolation of MAbs which define these determinants and which will allow their further analysis, and several of these MAbs were able to cross-react with other flaviviruses, most notably viruses from the Japanese encephalitis antigenic complex.
Abstract: A panel of mouse monoclonal antibodies (MAbs) raised against the non-structural glycoprotein NS1 of dengue 2 virus (PR159) was studied for cross-reactivity with the NS1 protein of other dengue virus serotypes and other members of the Flaviviridae using immuno-blotting. Most of the 35 anti-NS1 MAbs were found to be specific for dengue 2 virus NS1 (some of which were specific for the native, dimeric form of this protein), but others were found to cross-react within the dengue virus group. This latter group of MAbs, although dominated by MAbs defining a dengue 2 and 4 virus subgroup, also contained some MAbs that were shown to cross-react with both linear (sequential) and conformational epitopes common to the NS1 glycoproteins of all four dengue virus serotypes. Several of these MAbs were also able to cross-react with other flaviviruses, most notably viruses from the Japanese encephalitis antigenic complex. Although cross-reactive epitopes were previously demonstrated on this glycoprotein using polyclonal sera from dengue virus-infected animals and human, this is the first report of the isolation of MAbs which define these determinants and which will allow their further analysis.
TL;DR: Computer analysis revealed a 20-residue region of similarity in amino acid sequence between the dengue type 4 envelope glycoprotein (E) and a family of clotting factors, including plasminogen, the prime mediator of fibrinolysis, that is largely conserved within the currently known flavivirus E sequences.
Abstract: The four serotypes of dengue virus (a mosquito-borne flavivirus) cause an acute febrile illness (dengue fever) or a more prolonged illness with plasma leakage resulting in hypovolemia (dengue hemorrhagic fever). Hemorrhage may accompany either. Epidemiologic data suggest a role for dengue antibodies in pathogenesis. Computer analysis revealed a 20-residue region of similarity in amino acid sequence between the dengue type 4 envelope glycoprotein (E) and a family of clotting factors, including plasminogen, the prime mediator of fibrinolysis. By use of synthetic peptides in ELISA, E antibodies that potentially bind plasminogen were detected in 75% of 40 Thai patients acutely infected with dengue virus type 1, 2, 3, or 4. Plasminogen cross-reactivity of dengue antibodies was shown to be specific for the related sites in E and plasminogen. The dengue E sequence with similarity to plasminogen is largely conserved within the currently known flavivirus E sequences. However, 15 Thai patients hospitalized for illness caused by Japanese encephalitis virus (a flavivirus not associated with hemorrhage) did not develop plasminogen-cross-reactive antibodies, and this finding correlated with failure of Japanese encephalitis virus antibodies to bind to the plasminogen-cross-reactive site in E.
TL;DR: The double infection was confirmed directly in blood samples by the polymerase chain reaction (PCR) on genomic RNA and hybridization of the amplified cDNA fragments with type‐specific DNA probes.
Abstract: A dual viremia resulting from naturally acquired dengue 1 and dengue 3 infections in six patients experiencing a dengue-like syndrome during the epidemic in New Caledonia in 1989 is reported. Serotype identification was first based on virus isolation in mosquito cells and immunofluorescence using type-specific monoclonal antibodies. The double infection was confirmed directly in blood samples by the polymerase chain reaction (PCR) on genomic RNA and hybridization of the amplified cDNA fragments with type-specific DNA probes.
TL;DR: Preliminary observations suggest the possibility that viral factors, whether surface antigens, attachment sites for entry into leukocytes, or intrinsic replication properties in human mononuclear phagocytes, might contribute to enhanced DEN infection and to the severity of the disease.
Abstract: We tested three dengue type 2 (DEN-2) isolates from children with clinically apparent but mild secondary dengue infections, and 10 isolates from children with moderately severe dengue hemorrhagic fever, and noted significant growth differences in peripheral blood leukocytes, but not in C6/36 cells. We also observed cytopathic effects in C6/36 cells that correlated with disease severity. These preliminary observations suggest the possibility that viral factors, whether surface antigens, attachment sites for entry into leukocytes, or intrinsic replication properties in human mononuclear phagocytes, might contribute to enhanced DEN infection and to the severity of the disease.
TL;DR: Comparative research in anthropology and allied fields focusing on organization of urban areas and its relationship to disease is needed to identify new methodologies to encourage participation and social activism in health and increased knowledge about influencing health behavior.
Abstract: In 1989 researchers conducted interviews in El Progreso Honduras and in 1990 in Merida Mexico to examine the relationship between urbanization dengue and the health transition. Dengue cases occurred regularly in El Progreso. Yet malaria disease control strategies centered almost solely on malaria in El Progreso. Further municipal services did not reach all the residents. On the other hand Merida had provided such services for a long time. After the 1984 dengue epidemic public health officials in Merida launched spraying campaigns and extensive health education activities. Despite the differences in urbanization wealth services history of exposure to dengue and health education about dengue between the 2 cities knowledge levels and response to dengue were similar. In fact residents from both cities really did not understand dengue. They tended to compare dengue with influenza and respiratory illnesses. Further the residents believed these illnesses to be somewhat mild and that strong defenses and avoiding environmental stresses such as abrupt changes in temperature could prevent them. Moreover most people did not understand the relationship between mosquitoes and dengue. Those that did relate dengue with malaria did not clearly understand how transmission actually happened however. The fact that most residents were not aware of the aquatic stages of development further compounded the understanding of mosquito breeding sights. Furthermore they did not consider dengue as a health risk of garbage accumulation. Besides they regarded the mosquito problem to be a personal problem and not a community problem. In fact they blamed neighbors for providing breeding sites for mosquitoes. In conclusion comparative research in anthropology and allied fields focusing on organization of urban areas and its relationship to disease is needed to identify new methodologies to encourage participation and social activism in health and increased knowledge about influencing health behavior.
Journal Article•
TL;DR: Twenty-six virologically and serologically confirmed Dengue patients with signs of upper gastrointestinal tract bleeding were studied during the 1987 outbreak in southern Taiwan, indicating type I Dengue was the cause and supportive therapy and blood transfusions alone were adequate treatment.
TL;DR: A case is made for augmented TNF production having a role for the pathophysiological changes observed in DHF/DSS and mediator modulation as a possible therapeutic approach to treatment.
Abstract: A consecutive series of 24 patients with clinical features of primary dengue infection and 22 controls (14 patients with viral fever of unknown origin and 8 healthy subjects) were assayed for serum levels of tumour necrosis factor (TNF). The acute sera of the 24 patients with clinical dengue infection were positive for dengue virus-specific IgM antibody. Clinically, 8 had dengue fever (DF), 14 dengue haemorrhagic fever (DHF) and 2 dengue shock syndrome (DSS). All 16 patients with DHF/DSS had significantly elevated serum TNF levels but the 8 DF patients had TNF levels equivalent to that in the 22 controls. A case is made for augmented TNF production having a role for the pathophysiological changes observed in DHF/DSS and mediator modulation as a possible therapeutic approach to treatment.
Journal Article•
TL;DR: Though the sample size is small, the difference appears to be statistically significant and increased TNF levels have not been reported in the literature in association with DHF, although it has been shown to contribute to these features which appear in some other diseases.
Abstract: Acute and convalescent phase blood samples from five dengue fever (DF) patients and four dengue haemorrhagic fever (DHF) patients were tested for the presence of tumour necrosis factor (TNF). While all blood samples showed elevated levels, the acute phase blood sample levels were much higher. The mean TNF level in the acute samples of the five DF cases was 862 while in the DHF cases the level was 1722 pg/ml. Though the sample size is small, the difference appears to be statistically significant. Unlike in DF the distinctive features in DHF are the occurrence of shock, thrombocytopaenic purpura and sometimes disseminated intravascular coagulation (DIC). Increased TNF levels have not been reported in the literature in association with DHF, although it has been shown to contribute to these features which appear in some other diseases.
Journal Article•
TL;DR: The data suggested low arbovirus activity since 1982, when an epidemic of dengue occurred in this region, and revealed the first evidence of dugbe viral infection among humans in Kenya.
Abstract: A serosurvey was conducted during September 1987 for evidence of human arboviral infections in the Coast Province of Kenya. Sera were collected from 1624 outpatients at three hospitals and tested for antibody to eight arboviruses by the indirect immunofluorescent antibody technique. Antibody prevalence rates were: Rift Valley fever, 2.8%; Sindbis, 2.6%; dugbe, 2.1%; dengue-2, 1.0%; West Nile, 0.9%; chikungunya, 0.7% and Nairobi sheep disease, 0.3%. Evidence of Crimean-Congo haemorrhagic fever viral antibody was not detected. The data suggested low arbovirus activity since 1982, when an epidemic of dengue occurred in this region, and revealed the first evidence of dugbe viral infection among humans in Kenya.
Journal Article•
TL;DR: Higher prevalence of dengue fever was noted among larger families and in families that had two or more patients, the commonest duration between the first and the last patient was often less than 5 days and concomitant entomological studies proved Aedes aegypti breeding.
Abstract: Outbreak of dengue fever in Chikalthana, Pimpalgaon and Waloor villages in Parbhani district of Maharashtra (India) were investigated. Clinically, the illness was typical of dengue fever except for the absence of maculopapular rash. A total of 42 acute, 14 late acute, 73 convalescent and 19 sera from contacts were collected. Of the 15 virus isolates, 12 were identified as dengue virus type 2 and 1 as dengue virus type 1. Serological tests confirmed the etiological role of dengue virus in the outbreak. House-to-house survey was carried out in Chikalthana and Pimpalgaon villages. Overall, 15.09 per cent of the surveyed population was affected during the outbreak and attack rate was higher at Pimpalgaon. A tendency of water storage was observed in the households and concomitant entomological studies proved Aedes aegypti breeding. Higher prevalence of dengue fever was noted among larger families and in families that had two or more patients, the commonest duration between the first and the last patient was often less than 5 days.
Journal Article•
TL;DR: During the dengue epidemic from late 1987 to 1989, 6 specimens of cerebrospinal fluid (CSF) and sera for IgM detection were collected from 4 cases virologically confirmed d Dengue patients who had neural symptoms, and showed that IgM could be detected from 14 out of 20 serum specimens.
Abstract: During the dengue epidemic from late 1987 to 1989, 6 specimens of cerebrospinal fluid (CSF) and sera for IgM detection were collected from 4 cases virologically confirmed dengue patients who had neural symptoms. Another 20 serum specimens, which had been diagnosed as dengue infection either virologically or serologically, were sent to the laboratory from Kaohsiung Medical College Hospital. All these specimens were also taken to detect the existence of IgM. The results showed that IgM could be detected from 14 out of 20 serum specimens. One of the positive specimens showed IgM can last up to 252 days after onset of illness. In addition, IgM was detected from both CSF and sera of all four dengue patients with neural symptoms. The IgM titer in CSF (less than or equal to 1:20) was always lower than that in serum (greater than or equal to 1:80). Two cases with sequentially collected specimens showed the fading of IgM titer in CSF. As a matter of fact, it became undetectable about a month after onset of illness, which is apparently different from the situation in serum.
Journal Article•
TL;DR: Until now the following viruses have been proven to circulate in Yugoslavia: tick-borne encephalitis (TBE), Crimean-Congo hemorrhagic fever (CCHF), Bhanja, sandfly fever (SF), Tahyna (TAH), Calovo (CVO), West Nile (WN), dengue (DEN), Jug Bogdanovac (JB), and Hantaviruses.
Abstract: Studies of arboviruses started in Yugoslavia in 1953 following the isolation of TBE virus which caused a severe epidemic that year. Until now the following viruses have been proven to circulate in the country: tick-borne encephalitis (TBE), Crimean-Congo hemorrhagic fever (CCHF), Bhanja (BHA), sandfly fever (SF), Tahyna (TAH), Calovo (CVO), West Nile (WN), dengue (DEN), Jug Bogdanovac (JB), and Hantaviruses. TBE virus is endemic in the north-west part of the country, causing also epidemics in cyclical intervals. Its typical clinical picture is aseptic meningitis, but severe cases with paralysis have also been described. The bite of ticks is confirmed in about 80% of cases. CCF caused a small epidemic with ten clinical cases in Macedonia in 1976. Bhanja virus was isolated on the Dalmatian island of Brac in 1977, the antibody rate there, determined by the HI method, being about 31%. The first human disease in the world was caused by the Yugoslav Bhanja virus strain. Sandfly fever is still active in the country. The Naples type is prevailing and has proved hazardous for newcomers. Hantaviruses have been studied since 1980. They caused severe epidemics (1967, 1980, 1989) and sporadic cases all over the country. Three different strains are in circulation. Further studies are needed for the rest of the above mentioned viruses to learn more about their significance in human pathology.
Journal Article•
TL;DR: Outbreaks of dengue (DEN) fever are reported from 22 villages in five districts in the state of Maharashtra and continued surveillance of the spread of Ae.
Abstract: Outbreaks of dengue (DEN) fever are reported from 22 villages in five districts in the state of Maharashtra. DEN viral antigen was detected by indirect immunofluorescence test in 34 of 375 female Aedes aegypti mosquitoes collected from 8 villages. DEN types 2 and 3 were identified among the 16 strains that were isolated. None of the 64 male mosquitoes showed the presence of viral antigen; 281 males and 323 females reared from field collected larvae were also found negative. Indoor spraying of DDT in the affected villages produced a drastic reduction in Ae. aegypti catches. No viral antigen was detected in mosquitoes caught subsequent to the spray. With the introduction of water supply through taps, which is often inadequate, people are compelled to store water for domestic purposes, which favours an increase in Ae. aegypti breeding. In view of changing rural ecology associated with the development process, continued surveillance of the spread of Ae. aegypti as well as the diseases borne by this vector are recommended.
TL;DR: The first epidemic of dengue in China associated with significant severe and fatal hemorrhagic disease which met the World Health Organization case definition occurred on Hainan Island in 1985-1986 and involved 13 counties and cities of the island in 1986.
Abstract: The first epidemic of dengue in China associated with significant severe and fatal hemorrhagic disease which met the World Health Organization case definition occurred on Hainan Island in 1985-1986 The epidemic began in Zhan County in September 1985, spread throughout the coastal areas, and ultimately involved 13 counties and cities of the island in 1986 The mosquito vector was Aedes aegypti The morbidity associated with dengue infection on Hainan Island was 1,913 per 100,000 residents, with a case fatality rate of 025% Severe disease was more prevalent in the 10-29-year-old age group Principal clinical features in laboratory-confirmed cases were fever, osteoarthralgia, hemorrhage and/or shock, and thrombocytopenia Complications such as acute intravascular hemolysis, diffuse intravascular coagulation, hemoconcentration, pleural effusion, altered mentality, and pneumonia were also observed One hundred twenty-five isolates of dengue 2 virus were recovered from acute-phase serum samples from 278 patients, and 5 strains of this same virus serotype were isolated from 5 pools of adult Ae aegypti
TL;DR: Should provide the "morning after pill" under my agreement to provide contraceptive services to her and I was advised, however, that I should give patients specific instructions on where to obtain a second opinion and therefore the drugs they demand.
Abstract: should provide the \"morning after pill\" under my agreement to provide contraceptive services to her. It was only at the informal complaints procedure that the subject was clarified, and no further action was taken. I was advised, however, that I should give patients specific instructions on where to obtain a second opinion and therefore the drugs they demand, the analogy being that I should instruct someone with an injury how to find the accident and emergency department. PETER J M DAVIS