Tiêu chảy

- Dengue is the most rapidly spreading mosquito-

borne viral disease in the world

- Some 1.8 billion (more than 70%) of the population at

risk for dengue worldwide live in member states of
the WHO South-East Asia Region and Western
Pacific Region
- Symptomatic dengue virus infections were grouped
into three categories: undifferentiated fever, dengue
fever (DF) and dengue haemorrhagic fever (DHF)

- DHF was further classified into four severity grades,

with grades III and IV being defined as dengue shock
syndrome
- Dengue virus (DEN) is a small single-stranded RNA
virus comprising four distinct serotypes (DEN-1 to -
4).
- Flavivirus, family Flaviviridae
- The genome is cleaved by host and viral proteases
in three structural proteins (capsid, C, prM, the
precursor of membrane, M, protein and envelope, E)
and seven nonstructural proteins (NS).
- Ae. aegypti has been found as far north as 45 0N, but
such invasions have occurred during warmer
months and the mosquitoes have not survived the
winters. Also, because of lower temperatures, Ae.
aegypti is relatively uncommon above 1000 metres
- incubation period of 4--10 days
 Febrile phase
- Some patients may have sore throat, injected
pharynx and conjunctival injection. Anorexia,
nausea and vomiting are common. It can be difficult
to distinguish dengue clinically from non-dengue
febrile diseases in the early febrile phase.
- Mild haemorrhagic manifestations
- The liver is often enlarged and tender after a few
days of fever
- progressive decrease in total white cell
 Critical phase
- Usually on days 3–7 of illness
- an increase in capillary permeability in parallel with
increasing haematocrit levels may occur
- The period of clinically significant plasma leakage
usually lasts 24–48 hours
- Progressive leukopenia (3) followed by a rapid
decrease in platelet count usually precedes plasma
leakage
- Shock occurs when a critical volume of plasma is
lost through leakage

- It is often preceded by warning signs

 Recovery phase
- 48–72 hours
- General well-being improves, appetite returns,
gastrointestinal symptoms abate, haemodynamic status
stabilizes and diuresis ensues. Some patients may have a
rash of “isles of white in the sea of red” (9). Some may
experience generalized pruritus. Bradycardia and
electrocardiographic changes are common during this
stage
- White blood cell count usually starts to rise soon after
defervescence
- platelet count is typically later than that of white blood cell
count
 Primary infection
- flavivirus or immunized with a flavivirus vaccine (e.g.
for yellow fever, Japanese encephalitis, tick-borne
encephalitis)
 Primary infection
- the virus can be detected in serum, plasma, circulating
blood cells and other tissues for 4–5 days
- IgM antibodies detectable in 50% of patients by days 3-5
after onset of illness, increasing to 80% by day 5 and 99%
by day 10.
- IgM levels peak about two weeks after the onset of
symptoms and then decline generally to undetectable
levels over 2–3 months
- Anti-dengue serum IgG is generally detectable at low titres
at the end of the first week of illness, increasing slowly
thereafter, with serum IgG still detectable after several
months, and probably even for life
 secondary dengue infection
- Previously been infected by a dengue virus, or
sometimes after non-dengue flavivirus vaccination
or infection
- dominant immunoglobulin isotype is IgG which is
detectable at high levels, even in the acute phase,
and persists for periods lasting from 10 months to
life.
- Early convalescent stage IgM levels are significantly
lower in secondary infections than in primary ones
and may be undetectable in some cases, depending
on the test used
- RT-PCR methods varies from 80% to 100% and
depends on the region of the genome targeted by
the primers, the approach