MRSA Treatment in the Setting of Highly Active Antiretroviral Therapy HAART

Diagnosis and Treatment of Dengue Infection Dewi Dian Sukmawati Division of Tropical and Infectious Disease Department of Internal Medicine Udayana University School of Medicine-Sanglah Hospital Denpasar Dengue infection, a mosquito – borne flavivirus, is caused by dengue virus transmitted mainly by vector Aedes aegypti and Aedes albopictus, other species Aedes polynesiensis and Aedes scutellaris play the role of less common vector. There are five serotypes, DEN-1, 2, 3, 4 and 5. Each episode of infection induces a life-long protective immunity to the homologous serotype which confers partial and transient protection against subsequent infection by the other serotypes. Secondary infection by another serotype is a major risk factor for DHF, mainly due to antibody induced enhancement. Epidemiologic studies have identified young age, female sex, high body-mass index, virus strain or virulence and genetics of the human host e.g. major histocompatibility complex class I related sequence B and phospholipase C epsilon 1 genes as risk factors for severe dengue. All five serotypes may be circulating in the population at any one time but from the experience in the south-east Asia it appears that the predominant circulating dengue virus will show a sinusoidal pattern – with a peak to peak interval of 7 – 9 years. It is likely that this interval allows a buildup of immune – naïve population of children. 1,2,3,4 1. Course of Dengue Infection Infection by Dengue viruses may cause symptomatic infections or asymptomatic seroconversion. Symptomatic dengue infection manifests as a systemic and dynamic disease with wide clinical spectrum. The spectrum ranges from non severe to severe clinical manifestations. Following the incubation period, the illness begins abruptly and evolving in three phases: febrile, critical and recovery Figure 1. Due to its dynamic nature, the severity of the disease will usually only be apparent around defervescence period during the transition of the febrile to the afebrile phase and often overlapping with the onset of the critical phase. 5,6 Figure 1. The course of dengue fever IgM = immunoglobulin M; IgG = immunoglobulin G. Temperature is given in degrees Celsius °C Source: adapted from Yip, 1980 6

2. Dengue Case Classification The recent WHO guidelines

7 use three categories for case management namely A, B and C based on case classification that follows after the patient fulfilled the criteria for probable dengue Figure 2. Figure 2. Dengue case classification by severity AST = alanine aminotransferase; AST = Aspartate aminotransferase; CNS= Central nervous system; DSS= dengue shock syndrome; HCT= Hematocrit. Source: WHO 2009 7