Professional Documents
Culture Documents
Etiological Agent
Family: Flaviviridae Genus: flavivirus ssRNA positive genome Enveloped virus Four serotypes (D1, D2, D3, D4)
2.5 billions people in urban, peri-urban and rural areas of tropics and subtropics at risk There are an estimated of 50 million infections yearly, 500,000 hospitalized patients and more than 25,000 fatalities Global prevalence has increased dramatically in recent years DF/DHF occurred in more than 100 countries In South Asia more than 95% of cases are children
Transmission
Clinical Presentation
CDC
CDC
1981 Cuban DHF/DSS Virus The virulence of a virus isEpidemic its More than 300,000 cases strain capacity, when compared with other
150 death
DHF/DSS Pathogenesis
Antibody-dependent enhancement (ADE): Certain strains of dengue
virus, complexed with non-neutralizing antibodies (from previous infection), can enter a greater proportion of cells of the mononuclear lineage, thus increasing virus production.
Primary Infection
Secondary Infection
DEN-2AB
95% of DHF/DSS occur in children < 15 years of age > 5 % occur in infants
Vs.
INF-g/IL-10
A. Rothman, Journal of Clinical Investigation http://www.jci.org Volume 113 Number 7 April 2004
Why DHF/DSS
leaky capillaries/ Incremento de la permeabilidad capilar
Unlikely to be a single mechanism Slow leak suggests not direct cytopathic effects on endothelium Antigen driven Complement Histamine cytokine mediated
Thrombocytopenia
Platelet immune-destruction
NS1
An Integral Hypothesis
Age Gender Race Nutritional status Chronic Diseases Host Response Genetic Factors Number of susceptibles Vector High Density Wide Viral Circulation Hyperendemicity
Individual Factors
Viral Factors
Acknowledgments
Caribbean Primate Research Center Dr. Edmundo Kraiselburd Virology Laboratory, CPRC Petraleight Pantoja, MT Teresa Arana, MT Animals Research Center Dr. Idia Vanessa Rodriguez Dr. Melween Martinez Staff at ARC Virology Laboratory, Dept Microbiology, UPR. Dr. Idali Martinez Dengue Laboratory, CDC, San Juan PR. Dr. Jorge Muoz-Jordan