Dengue VirusDengue Virus

By: Inna Gnipp andBy: Inna Gnipp and

Hamza IqbalHamza Iqbal

Dengue DeclassifiedDengue Declassified

Family: FlaviviridaeFamily: Flaviviridae Genus: FlavivirusGenus: Flavivirus Species: Dengue virusSpecies: Dengue virus

What is the Dengue What is the Dengue Virus?Virus?

Arbovirus Arbovirus Arthropod, Mosquito, bornArthropod, Mosquito, born

(Aedes aegypti)(Aedes aegypti) It is a pathogen that causes It is a pathogen that causes

Dengue fever (DF)Dengue fever (DF) Dengue hemorrhagic fever (DHF)Dengue hemorrhagic fever (DHF)

Can lead to Dengue shock syndrome (DSS)Can lead to Dengue shock syndrome (DSS)

Has four different serotypes (DEN-1,2,3,4)Has four different serotypes (DEN-1,2,3,4) First reported epidemics in 1780 in Asia, Africa, First reported epidemics in 1780 in Asia, Africa,

and North Americaand North America

Target tissuesTarget tissues Dengue induces cytokine production in cellsDengue induces cytokine production in cells Cytotoxic factor effects endothelial cells Cytotoxic factor effects endothelial cells

involved in most of the followinginvolved in most of the following:: HeartHeart LiverLiver KidneysKidneys LungsLungs IntestinesIntestines SpleenSpleen Lymph nodesLymph nodes BrainBrain Skin (inflammatory rashes)Skin (inflammatory rashes)

Symptoms: DHFSymptoms: DHF

FeverFever HeadacheHeadache Muscle and joint painMuscle and joint pain DehydrationDehydration Nausea and/or Haematemesis (vomiting of blood)Nausea and/or Haematemesis (vomiting of blood) Epistaxis (Bleeding from the nose, mouth, or gums)Epistaxis (Bleeding from the nose, mouth, or gums) Haematuria (Blood in Urine)Haematuria (Blood in Urine) Pain behind the eyesPain behind the eyes Plasma leakagePlasma leakage Respiratory distressRespiratory distress Petechia (Skin rash) and/or Purpura (Lesions)Petechia (Skin rash) and/or Purpura (Lesions)

Diagnostic testsDiagnostic tests

Virus isolation by infection of mice using Virus isolation by infection of mice using infected mosquitoesinfected mosquitoes

Detection of IgM antibodies in the blood by Detection of IgM antibodies in the blood by PCR or Viral isolation (Serology)PCR or Viral isolation (Serology)

ELISAELISA (Enzyme-Linked Immunoabsorbent (Enzyme-Linked Immunoabsorbent assay)assay)

ThrombopeniaThrombopenia Raised hematocritRaised hematocrit

Pathogenesis and infection Pathogenesis and infection process of Dengueprocess of Dengue

Humans are initially infected through a mosquito vectorHumans are initially infected through a mosquito vector Initial interaction with cell occurs with the viruses ability Initial interaction with cell occurs with the viruses ability

to infect cellto infect cell Primary target, PhagocytesPrimary target, Phagocytes

Virus uses cell receptor molecule to enter cellVirus uses cell receptor molecule to enter cell Cell receptor molecules include:Cell receptor molecules include:

GlycosaminoglycanGlycosaminoglycan Heparan Sulfate (Expressed in almost all cell types)Heparan Sulfate (Expressed in almost all cell types)

Virus replicates in target organsVirus replicates in target organs Infects white blood cells and lymphatic tissuesInfects white blood cells and lymphatic tissues Virus is released and circulates in bloodVirus is released and circulates in blood Alternate mosquito then bites host and receives virusAlternate mosquito then bites host and receives virus

Prevention: Prevention: There is no specific treatmentThere is no specific treatmentRelieving symptoms and Relieving symptoms and

complicationscomplications:: Plasma volume replacementPlasma volume replacement Sedatives for restless patientsSedatives for restless patients Blood transfusion with Blood transfusion with

patients with significant blood patients with significant blood lossloss

Aspirin should be avoidedAspirin should be avoided

All efforts of control are aimed All efforts of control are aimed against mosquitoesagainst mosquitoes Elimination of breeding areasElimination of breeding areas Actions to prevent mosquito Actions to prevent mosquito

bites (repellant, nets, and bites (repellant, nets, and vapors)vapors)

Vaccinations are pendingVaccinations are pending Problem is that the Problem is that the

vaccination needs to prevent vaccination needs to prevent all four serotypesall four serotypes

TreatmentTreatment::

DHF

EpidemiologyEpidemiology

Affects humansAffects humans Is prominent in tropical environmentsIs prominent in tropical environments

Ideal for Mosquito habitatsIdeal for Mosquito habitats

What is promoting the disease?What is promoting the disease? Global warming is causing climate changes which is Global warming is causing climate changes which is

causing the disease to move to more environmentscausing the disease to move to more environments (higher altitudes and amplitudes)(higher altitudes and amplitudes) More habitats for mosquitoes to thrive inMore habitats for mosquitoes to thrive in

Spread has been increased by urbanization and Spread has been increased by urbanization and population growthpopulation growth

Inability of mosquito control in countries is also a major Inability of mosquito control in countries is also a major factorfactor

Morbidity and MortalityMorbidity and Mortality

More than 2.5 Billion people live in areas More than 2.5 Billion people live in areas that have a risk of infectionthat have a risk of infection

Over 100 million cases of Dengue Over 100 million cases of Dengue infection are reported each year globallyinfection are reported each year globally 500,000 cases pertain to DHF500,000 cases pertain to DHF

DHF has a 5% fatality rate for those DHF has a 5% fatality rate for those infectedinfected

People at high risk are children and the People at high risk are children and the elderlyelderly

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