Ophthalmic complications during the dengue epidemic in Reunion Island in 2020: a case series and review of the literature

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Abstract

Introduction

Dengue is an arboviral disease transmitted by the dengue virus, whose vectors are Aedes aegypti and Aedes albopictus. The acute phase with its cohort of well-known symptoms is usually spontaneously favorable. Since 2020 in Reunion Island, a new symptom has appeared: the ocular damage of dengue fever, which has already been described in South Asia and South-East Asia. We therefore decided to describe the clinical, biological, ophthalmological, therapeutic, and outcomes of patients with ocular manifestations during dengue fever in Reunion Island in 2020.

Patients and methods

This was a retrospective observational study. Patients were included from January 2020 to August 2020 and then reassessed by teleconsultation 1 year later. The patients were identified from the French public health surveillance network by all ophthalmologists on the island. Medical data were collected directly from medical records.

Results

Twenty-eight patients were included. The mean age was 41.9 years. Ocular involvement occurred approximately 9.2 days after the onset of dengue symptoms. The main symptoms were scotoma (71.4%) and sudden decrease of visual acuity (39.2%). Eighteen patients (64.2%) had macular involvement. Fourteen patients were treated with oral or intravenous corticosteroids. Twenty-two (78.5%) patients were evaluated by telephone one year later. Scotoma and decreased visual acuity persisted in 15 patients. Thirteen patients (59%) were bothered by night driving, 32% of patients had reading difficulties and 27% of patients became sensitive to prolonged exposure to screens.

Conclusion

Ocular complications of dengue require early and collegial management to limit the risk of long-term sequelae. Further studies on the characteristics and complications of dengue fever are needed to better understand this disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-023-08432-4.

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Most cited references 37

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Dengue virus NS1 protein activates cells via Toll-like receptor 4 and disrupts endothelial cell monolayer integrity.

Naphak Modhiran, Daniel Watterson, David Muller … (2015)

Complications arising from dengue virus infection include potentially fatal vascular leak, and severe disease has been linked with excessive immune cell activation. An understanding of the triggers of this activation is critical for the development of appropriately targeted disease control strategies. We show here that the secreted form of the dengue virus nonstructural protein 1 (NS1) is a pathogen-associated molecular pattern (PAMP). Highly purified NS1 devoid of bacterial endotoxin activity directly activated mouse macrophages and human peripheral blood mononuclear cells (PBMCs) via Toll-like receptor 4 (TLR4), leading to the induction and release of proinflammatory cytokines and chemokines. In an in vitro model of vascular leak, treatment with NS1 alone resulted in the disruption of endothelial cell monolayer integrity. Both NS1-mediated activation of PBMCs and NS1-induced vascular leak in vitro were inhibited by a TLR4 antagonist and by anti-TLR4 antibody treatment. The importance of TLR4 activation in vivo was confirmed by the reduction in capillary leak by a TLR4 antagonist in a mouse model of dengue virus infection. These results pinpoint NS1 as a viral toxin counterpart of the bacterial endotoxin lipopolysaccharide (LPS). Similar to the role of LPS in septic shock, NS1 might contribute to vascular leak in dengue patients, which highlights TLR4 antagonists as a possible therapeutic option.

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Exosomes and Their Role in the Life Cycle and Pathogenesis of RNA Viruses

Harendra Singh Chahar, Xiaoyong Bao, Antonella Casola (2015)

Exosomes are membrane-enclosed vesicles actively released into the extracellular space, whose content reflect the physiological/pathological state of the cells they originate from. These vesicles participate in cell-to-cell communication and transfer of biologically active proteins, lipids, and RNAs. Their role in viral infections is just beginning to be appreciated. RNA viruses are an important class of pathogens and affect millions of people worldwide. Recent studies on Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), human T-cell lymphotropic virus (HTLV), and Dengue Virus (DENV) have demonstrated that exosomes released from infected cells harbor and deliver many regulatory factors including viral RNA and proteins, viral and cellular miRNA, and other host functional genetic elements to neighboring cells, helping to establish productive infections and modulating cellular responses. Exosomes can either spread or limit an infection depending on the type of pathogen and target cells, and can be exploited as candidates for development of antiviral or vaccine treatments. This review summarizes recent progress made in understanding the role of exosomes in RNA virus infections with an emphasis on their potential contribution to pathogenesis.

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Estimating Chikungunya prevalence in La Réunion Island outbreak by serosurveys: Two methods for two critical times of the epidemic

Patrick Gérardin, Vanina Guernier, Joelle Perrau … (2008)

Background Chikungunya virus (CHIKV) caused a major two-wave seventeen-month-long outbreak in La Réunion Island in 2005–2006. The aim of this study was to refine clinical estimates provided by a regional surveillance-system using a two-stage serological assessment as gold standard. Methods Two serosurveys were implemented: first, a rapid survey using stored sera of pregnant women, in order to assess the attack rate at the epidemic upsurge (s1, February 2006; n = 888); second, a population-based survey among a random sample of the community, to assess the herd immunity in the post-epidemic era (s2, October 2006; n = 2442). Sera were screened for anti-CHIKV specific antibodies (IgM and IgG in s1, IgG only in s2) using enzyme-linked immunosorbent assays. Seroprevalence rates were compared to clinical estimates of attack rates. Results In s1, 18.2% of the pregnant women were tested positive for CHIKV specific antibodies (13.8% for both IgM and IgG, 4.3% for IgM, 0.1% for IgG only) which provided a congruent estimate with the 16.5% attack rate calculated from the surveillance-system. In s2, the seroprevalence in community was estimated to 38.2% (95% CI, 35.9 to 40.6%). Extrapolations of seroprevalence rates led to estimate, at 143,000 and at 300,000 (95% CI, 283,000 to 320,000), the number of people infected in s1 and in s2, respectively. In comparison, the surveillance-system estimated at 130,000 and 266,000 the number of people infected for the same periods. Conclusion A rapid serosurvey in pregnant women can be helpful to assess the attack rate when large seroprevalence studies cannot be done. On the other hand, a population-based serosurvey is useful to refine the estimate when clinical diagnosis underestimates it. Our findings give valuable insights to assess the herd immunity along the course of epidemics.

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Author and article information

Contributors

Antoine Bertolotti: antoine_bertolotti@yahoo.fr

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 2 August 2023

Publication date PMC-release: 2 August 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 506

Affiliations

[1 ]GRID grid.440886.6, ISNI 0000 0004 0594 5118, Département de maladies infectieuses-médecine interne-dermatologie, , CHU de La Réunion, ; Saint Pierre, La Réunion France

[2 ]GRID grid.493975.5, ISNI 0000 0004 5948 8741, Santé Publique France, Océan Indien, ; Saint Denis, La Réunion France

[3 ]Département d’ophtalmologie, CHOR, Saint Paul, La Réunion France

[4 ]GRID grid.440886.6, ISNI 0000 0004 0594 5118, Département d’ophtalmologie, , CHU de La Réunion, ; Saint Pierre, La Réunion France

[5 ]GRID grid.440886.6, ISNI 0000 0004 0594 5118, Département d’ophtalmologie, , CHU de La Réunion, ; Saint Denis, La Réunion France

[6 ]GRID grid.440886.6, ISNI 0000 0004 0594 5118, Département de médecine interne, , CHU de La Réunion, ; Saint Denis, La Réunion France

[7 ]GRID grid.11642.30, ISNI 0000 0001 2111 2608, Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Université de La Réunion, INSERM UMR 1187, ; CNRS 9192, IRD 249, Plateforme CYROI, Sainte Clotilde, La Réunion France

[8 ]GRID grid.440886.6, ISNI 0000 0004 0594 5118, CHU de La Réunion, ; CIC-INSERM1410, Saint Pierre, La Réunion France

Article

Publisher ID: 8432

DOI: 10.1186/s12879-023-08432-4

PMC ID: 10394947

PubMed ID: 37528344

SO-VID: bd424427-c468-4ac9-9fb0-4e63b4b806e3

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 December 2022

Date accepted : 28 June 2023

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: dengue,reunion island,maculopathy,scotoma,arbovirosis,ophthalmology

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: dengue, reunion island, maculopathy, scotoma, arbovirosis, ophthalmology

Ophthalmic complications during the dengue epidemic in Reunion Island in 2020: a case series and review of the literature

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Abstract

Introduction

Patients and methods

Results

Conclusion

Supplementary Information

Related collections

Zika Virus

Most cited references 37

Dengue virus NS1 protein activates cells via Toll-like receptor 4 and disrupts endothelial cell monolayer integrity.

Exosomes and Their Role in the Life Cycle and Pathogenesis of RNA Viruses

Estimating Chikungunya prevalence in La Réunion Island outbreak by serosurveys: Two methods for two critical times of the epidemic

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