OBJECTIVE

To present the case of a 17-year-old girl who was readmitted post-tonsillectomy due to dengue fever, hematemesis and late tonsillar bleeding three weeks after the surgery.

Design:Case Report

Setting:Tertiary Government Training Hospital

Patient: One

A previously healthy 17-year-old Filipino girl underwent uncomplicated elective tonsillectomy for chronic hypertrophic tonsillitis. Twenty days post-operatively, she developed fever, thrombocytopenia and massive hematemesis. Despite intensive care management for severe dengue fever with concurrent late post-tonsillectomy bleeding, the patient died from hemorrhagic shock on post-operative day 21.

This appears to be the first reported case of concurrent late post-tonsillectomy hemorrhage and dengue fever in a previously healthy adolescent girl. In dengue-endemic areas, post-tonsillectomy patients should be counseled about dengue prevention and advised to seek medical attention for persistent fever. Early recognition and management of this potentially fatal combination is crucial for improving patient outcomes.

Dengue hemorrhagic fever is a severe form of dengue presenting commonly with bleeding diathesis, but rarely with peripheral nervous system manifestations. Proximal median neuropathy comprises 1% of upper limb compression syndromes, and this case is the first to report injury to the proximal median nerve due to compression from hematoma formation. This case report presents the rehabilitation process of a 25-year-old Filipino female median nerve entrapment from venipuncture-associated hematoma presenting as burning sensation on the medial elbow, forearm and hand, weak flexion movement of her left thumb, index, and middle fingers. The patient was managed conservatively with pain medications, range of motion, gross and fine motor, and sensory re-education exercises. At 12 months, there was partial but functional recovery of median motor distribution and full recovery of median sensory distribution, as evidenced by improved sensory nerve action potential conduction velocity and amplitude, and compound motor action potential conduction velocity, with persistent decreased amplitude at 50%, and decrease in cross-sectional area of the left median nerve.

This paper highlights the functional outcomes of a conservatively managed median nerve entrapment from venipuncture hematoma from dengue hemorrhagic fever. This case report also emphasizes that in the presence of severe bleeding risk of surgery in the background of severe thrombocytopenia, timely rehabilitation medicine referral with monitoring through clinical evaluation, musculoskeletal ultrasound, and electrodiagnostic study presents a viable alternative in the management of compression neuropathy.

Dengue fever is an important health problem for international travelers to all endemic areas. The steadily increasing numbers of tourists visiting endemic areas raise the risk of exposure, and imported dengue cases are increasingly observed in nonendemic area. Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting, non-severe clinical course, a small proportion progress to severe disease such as dengue hemorrhagic fever or dengue shock syndrome. Therefore, it is important to suspect dengue fever in every febrile patient returning from the tropics. Whenever it is suspected, a quick diagnosis and adequate managements are essential to avoid complications. We report two cases of imported dengue fever in Korean children presenting with fever, headache, nausea, and rash.
Child ; Dengue ; Dengue Hemorrhagic Fever ; Exanthema ; Fever ; Headache ; Humans ; Korea ; Nausea ; Philippines

Dengue is an acute febrile mosquito-transmitted viral disease which is endemic throughout tropical and subtropical regions around the world. Dengue leads to a spectrum of clinical presentations that comprise dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome. DHF usually begins with fever, rash and other symptoms resembling dengue fever. However, DHF is a potentially fatal syndrome that can evolve into dengue shock syndrome. DHF is characterized by fever, hemorrhagic tendency, thrombocytopenia and plasma leakage. Although the number of imported cases of DHF are steadily increasing in Korea, DHF has been rarely described in the Korean dermatologic literature. Herein, we report a case of DHF developed after traveling to Vietnam.
Dengue ; Dengue Hemorrhagic Fever ; Exanthema ; Fever ; Korea ; Plasma ; Thrombocytopenia ; Vietnam ; Virus Diseases

Dengue infection, one of the most devastating mosquito-borne viral diseases in humans, is now a significant problem in many countries. The disease, caused by the four dengue virus serotypes, ranges from asymptomatic infection to undifferentiated fever, dengue fever (DF), and severe dengue hemorrhagic fever (DHF) with or without shock. DHF is characterized by fever, bleeding diathesis and a tendency to develop a potentially fatal shock syndrome. Dengue infection with organ impairment mainly involves central nervous system and liver. Consistent hematological Findings include vasculopathy, coagulopathy, and thrombocytopenia. Laboratory diagnosis includes virus isolation, serology, and detection of dengue ribonucleic acid. Successful treatment, which is mainly supportive, depends on early recognition of the disease and careful monitoring for shock. A severity-based revised dengue classification for medical interventions has been developed and validated in many countries. Prevent depends primarily on control of the mosquito vector. The feasibility of a dengue vaccine is high.
Human ; Male ; Female ; DENGUE ; DENGUE HEMORRHAGIC FEVER

BACKGROUND: Dengue virus, which belongs to the Flavivirus genus of the Flaviviridae family, causes fatal dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) with infection risk of 2.5 billion people worldwide. However, approved vaccines are still not available. Here, we explored the immune responses induced by alternating prime-boost vaccination using DNA vaccine, adenovirus, and vaccinia virus expressing E protein of dengue virus type 2 (DenV2). METHODS: Following immunization with DNA vaccine (pDE), adenovirus (rAd-E), and/or vaccinia virus (VV-E) expressing E protein, E protein-specific IgG and its isotypes were determined by conventional ELISA. Intracellular CD154 and cytokine staining was used for enumerating CD4+ T cells specific for E protein. E protein-specific CD8+ T cell responses were evaluated by in vivo CTL killing activity and intracellular IFN-gamma staining. RESULTS: Among three constructs, VV-E induced the most potent IgG responses, Th1-type cytokine production by stimulated CD4+ T cells, and the CD8+ T cell response. Furthermore, when the three constructs were used for alternating prime-boost vaccination, the results revealed a different pattern of CD4+ and CD8+ T cell responses. i) Priming with VV-E induced higher E-specific IgG level but it was decreased rapidly. ii) Strong CD8+ T cell responses specific for E protein were induced when VV-E was used for the priming step, and such CD8+ T cell responses were significantly boosted with pDE. iii) Priming with rAd-E induced stronger CD4+ T cell responses which subsequently boosted with pDE to a greater extent than VV-E and rAd-E. CONCLUSION: These results indicate that priming with live viral vector vaccines could induce different patterns of E protein- specific CD4+ and CD8+ T cell responses which were significantly enhanced by booster vaccination with the DNA vaccine. Therefore, our observation will provide valuable information for the establishment of optimal prime-boost vaccination against DenV.
Adenoviridae ; Dengue ; Dengue Hemorrhagic Fever ; Dengue Virus ; DNA ; Enzyme-Linked Immunosorbent Assay ; Flaviviridae ; Flavivirus ; Homicide ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin G ; Plasmids ; T-Lymphocytes ; Vaccination ; Vaccines ; Vaccinia virus

BACKGROUND: Dengue virus, which belongs to the Flavivirus genus of the Flaviviridae family, causes fatal dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) with infection risk of 2.5 billion people worldwide. However, approved vaccines are still not available. Here, we explored the immune responses induced by alternating prime-boost vaccination using DNA vaccine, adenovirus, and vaccinia virus expressing E protein of dengue virus type 2 (DenV2). METHODS: Following immunization with DNA vaccine (pDE), adenovirus (rAd-E), and/or vaccinia virus (VV-E) expressing E protein, E protein-specific IgG and its isotypes were determined by conventional ELISA. Intracellular CD154 and cytokine staining was used for enumerating CD4+ T cells specific for E protein. E protein-specific CD8+ T cell responses were evaluated by in vivo CTL killing activity and intracellular IFN-gamma staining. RESULTS: Among three constructs, VV-E induced the most potent IgG responses, Th1-type cytokine production by stimulated CD4+ T cells, and the CD8+ T cell response. Furthermore, when the three constructs were used for alternating prime-boost vaccination, the results revealed a different pattern of CD4+ and CD8+ T cell responses. i) Priming with VV-E induced higher E-specific IgG level but it was decreased rapidly. ii) Strong CD8+ T cell responses specific for E protein were induced when VV-E was used for the priming step, and such CD8+ T cell responses were significantly boosted with pDE. iii) Priming with rAd-E induced stronger CD4+ T cell responses which subsequently boosted with pDE to a greater extent than VV-E and rAd-E. CONCLUSION: These results indicate that priming with live viral vector vaccines could induce different patterns of E protein- specific CD4+ and CD8+ T cell responses which were significantly enhanced by booster vaccination with the DNA vaccine. Therefore, our observation will provide valuable information for the establishment of optimal prime-boost vaccination against DenV.
Adenoviridae ; Dengue ; Dengue Hemorrhagic Fever ; Dengue Virus ; DNA ; Enzyme-Linked Immunosorbent Assay ; Flaviviridae ; Flavivirus ; Homicide ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin G ; Plasmids ; T-Lymphocytes ; Vaccination ; Vaccines ; Vaccinia virus

Dengue is an acute febrile viral disease which is found in tropical and sub-tropical regions around the world. Dengue fever has steadily increased in both incidence and distribution over the past 50 years. Even though Korea is not an endemic country for dengue fever, with the increasing numbers of overseas travelers in Korea, the numbers of imported dengue cases are steadily increasing. Here, we report a case of imported dengue hemorrhagic fever in a Korean child presenting with fever and epistaxis. Dengue fever should be considered if a patient who has a recent travel history to endemic areas showed classical symptoms.
Child ; Dengue ; Dengue Hemorrhagic Fever ; Epistaxis ; Exanthema ; Fever ; Humans ; Incidence ; Korea ; Purpura ; Virus Diseases

Objectives: This study was conducted to determine the clinico-demographic profile of pediatric patients who were admitted for dengue infection at the Research Institute for Tropical Medicine (RITM) from 2000 to 2004. Methods: This is a retrospective, descriptive study. Charts of patients who were less than 19 years of age and were admitted at the RITM due to confirmed dengue (using paired dengue HI titer results) were reviewed. Conclusion: The clinico-demographic profile of patients involved in the study was very similar to that of other studies done, both locally and abroad. By using Spearman's correlation of ranks, the study showed that there was no significant relationship between the severity of dengue infection based on the World Health Organization (WHO) Grade and whether it was a primary or secondary infection with r=.018, p-value=.025.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; DENGUE ; DENGUE HEMORRHAGIC FEVER

Dengue virus causes dengue fever and its more severe form, dengue hemorrhagic fever. The classical symptoms of dengue fever are high fever lasting for 5~7 days and bright reddish petechiae developed at the end of fever. The virus is transmitted by mosquitoes belonging to the genus Aedes, which are distributed in the tropical and subtropical areas of Africa, America, Southeast Asia, and Pacific islands. The currant pandemic of dengue viral infection began after the 1940s, possibly in consequence to the World War II, and the dengue virus infection has become the most important arthropod-borne viral infection. With an increase in the number of Koreans traveling to dengue fever-endemic areas since 1988, there has been an increase in the incidence of dengue viral infection and is reported to affect 50 to 90 patients annually. Further, it is the most common notifiable imported disease in Korea. Most of the patients with dengue infection presented with dengue fever or dengue hemorrhagic fever, and 1 fatal case of dengue shock syndrome was reported.
Aedes ; Africa ; Americas ; Asia, Southeastern ; Culicidae ; Dengue ; Dengue Hemorrhagic Fever ; Dengue Virus ; Fever ; Humans ; Incidence ; Korea ; Pacific Islands ; Pandemics ; Purpura ; Viruses ; World War II