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      Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients

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          Abstract

          Backgrounds

          Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic.

          Methods

          This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients’ clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study.

          Results

          Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue.

          Conclusion

          The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.

          Author summary

          Dengue has become a significant public health concern worldwide in recent years especially for the South-East Asian, sub-Saharan African and Latin American countries. Bangladesh has experienced a number of outbreaks of dengue, the largest one occurred in 2019. Management of dengue cases during an epidemic is a major challenge for a limited resource country like Bangladesh. To predict the risk of developing severe dengue a combined evaluation of early symptoms and laboratory test profiles is necessary. Despite the fact, there is a lack of evidence of clinical and laboratory parameters of dengue patients in Bangladesh. Authors wanted to highlight the clinical features, and hematological and biochemical profiles of dengue patients diagnosed in Bogra district, a non-endemic zone situated in northern Bangladesh. The authors reported that fever, headache, and myalgia were the commonest presenting complaints of dengue patients whereas vomiting and abdominal pain was the most prevalent warning signs. Severe dengue was associated mostly with plasma leakage rather than hemorrhage and the rise of hematocrit during hospital stay was a predictor of severe dengue. These findings will guide physicians for prompt therapeutic management of dengue infection in the study area.

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          Most cited references 36

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          The global distribution and burden of dengue

          Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes 1 . For some patients dengue is a life-threatening illness 2 . There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread 3 . The contemporary worldwide distribution of the risk of dengue virus infection 4 and its public health burden are poorly known 2,5 . Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanisation. Using cartographic approaches, we estimate there to be 390 million (95 percent credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of clinical or sub-clinical severity). This infection total is more than three times the dengue burden estimate of the World Health Organization 2 . Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help guide improvements in disease control strategies using vaccine, drug and vector control methods and in their economic evaluation. [285]
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            Epidemiology of dengue: past, present and future prospects

            Dengue is currently regarded globally as the most important mosquito-borne viral disease. A history of symptoms compatible with dengue can be traced back to the Chin Dynasty of 265–420 AD. The virus and its vectors have now become widely distributed throughout tropical and subtropical regions of the world, particularly over the last half-century. Significant geographic expansion has been coupled with rapid increases in incident cases, epidemics, and hyperendemicity, leading to the more severe forms of dengue. Transmission of dengue is now present in every World Health Organization (WHO) region of the world and more than 125 countries are known to be dengue endemic. The true impact of dengue globally is difficult to ascertain due to factors such as inadequate disease surveillance, misdiagnosis, and low levels of reporting. Currently available data likely grossly underestimates the social, economic, and disease burden. Estimates of the global incidence of dengue infections per year have ranged between 50 million and 200 million; however, recent estimates using cartographic approaches suggest this number is closer to almost 400 million. The expansion of dengue is expected to increase due to factors such as the modern dynamics of climate change, globalization, travel, trade, socioeconomics, settlement and also viral evolution. No vaccine or specific antiviral therapy currently exists to address the growing threat of dengue. Prompt case detection and appropriate clinical management can reduce the mortality from severe dengue. Effective vector control is the mainstay of dengue prevention and control. Surveillance and improved reporting of dengue cases is also essential to gauge the true global situation as indicated in the objectives of the WHO Global Strategy for Dengue Prevention and Control, 2012–2020. More accurate data will inform the prioritization of research, health policy, and financial resources toward reducing this poorly controlled disease. The objective of this paper is to review historical and current epidemiology of dengue worldwide and, additionally, reflect on some potential reasons for expansion of dengue into the future.
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              Global Spread and Persistence of Dengue

              Dengue is a spectrum of disease caused by four serotypes of the most prevalent arthropod-borne virus affecting humans today, and its incidence has increased dramatically in the past 50 years. Due in part to population growth and uncontrolled urbanization in tropical and subtropical countries, breeding sites for the mosquitoes that transmit dengue virus have proliferated, and successful vector control has proven problematic. Dengue viruses have evolved rapidly as they have spread worldwide, and genotypes associated with increased virulence have expanded from South and Southeast Asia into the Pacific and the Americas. This review explores the human, mosquito, and viral factors that contribute to the global spread and persistence of dengue, as well as the interaction between the three spheres, in the context of ecological and climate changes. What is known, as well as gaps in knowledge, is emphasized in light of future prospects for control and prevention of this pandemic disease.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                13 October 2020
                October 2020
                : 14
                : 10
                Affiliations
                [1 ] Rajshahi Medical College, Rajshahi, Rajshahi, Bangladesh
                [2 ] Shaheed Ziaur Rahman Medical College, Bogra, Bogra, Bangladesh
                [3 ] Sir Salimullah Medical College, Dhaka, Dhaka, Bangladesh
                [4 ] Rangpur Medical College, Rangpur, Rangpur, Bangladesh
                [5 ] Medical Centre, University of Rajshahi, Rajshahi, Bangladesh
                [6 ] Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
                George Washington University School of Medicine and Health Sciences, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Article
                PNTD-D-20-00595
                10.1371/journal.pntd.0008567
                7553334
                33048921
                d3a72616-37aa-470b-9859-5dce55c0de9a
                © 2020 Rafi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 3, Pages: 14
                Product
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Neglected Tropical Diseases
                Dengue Fever
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Dengue Fever
                People and Places
                Geographical Locations
                Asia
                Bangladesh
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Flaviviruses
                Dengue Virus
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Hemorrhage
                Medicine and Health Sciences
                Vascular Medicine
                Hemorrhage
                Medicine and Health Sciences
                Hematology
                Hematocrit
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Blood Counts
                Hematocrit
                Medicine and Health Sciences
                Hematology
                Medicine and Health Sciences
                Diagnostic Medicine
                Clinical Laboratory Sciences
                Clinical Laboratories
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Abdominal Pain
                Custom metadata
                The primary data has been used in the present study, it can’t be shared publicly, data are available and can be requested from a non-co-author, Abu Sayed Md. Al Mamun, Associate Professor, Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi-6205, Bangladesh.

                Infectious disease & Microbiology

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