Dengue fever pathophysiology: Difference between revisions

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{{Dengue fever}}
{{Dengue fever}}


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{{CMG}}; {{AE}} {{Alonso}}


==Overview==
==Overview==
[[Aedes aegypti]] is the principal [[mosquito]] vector of dengue viruses and is closely associated with humans and their dwellings.


==The Vector is Aedes aegypti==
[[Aedes aegypti]] is the principal [[mosquito]] vector of [[dengue fever viruses]] and is closely associated with humans and their dwellings.  The Dengue fever virus also inhibits the human immune response.
 
==The Vector is the Aedes aegypti Mosquito==
 
*[[Aedes aegypti]], the principal [[mosquito]] vector of dengue viruses, is an insect closely associated with humans and their dwellings.  People not only provide the [[mosquitoes]] with blood meals but also water-holding containers in and around the home needed to complete their development.
*[[Aedes aegypti]], the principal [[mosquito]] vector of dengue viruses, is an insect closely associated with humans and their dwellings.  People not only provide the [[mosquitoes]] with blood meals but also water-holding containers in and around the home needed to complete their development.
*The [[mosquito]] lays her eggs on the sides of containers with water and eggs hatch into larvae after a rain or flooding.
*The [[mosquito]] lays her eggs on the sides of containers with water and eggs hatch into larvae after a rain or flooding.
*A larva changes into a pupa in about a week and into a mosquito in two days.
*A larva changes into a pupa in about a week and into a mosquito in two days.


==The Pathogen is Dengue virus==
==The Pathogen is Dengue fever virus==


Dengue fever virus (DENV) is an [[RNA]] virus of the family [[Flaviviridae]]; genus Flavivirus.  Other members of the same genus include [[yellow fever]] virus, [[West Nile virus]], [[St. Louis encephalitis]] virus, [[japanese encephalitis]] virus, [[tick-borne encephalitis]], [[Kyasanur Forest disease]] virus, and Omsk hemorrhagic fever virus.  Most are transmitted by arthropods ([[mosquitoes]] or [[ticks]]), and are therefore also referred to as [[arboviruses]] (arthropod-borne viruses).
[[Dengue fever virus]] ([[DENV]]) is an [[RNA]] virus of the family [[Flaviviridae]]; genus [[Flavivirus]].  Other members of the same genus include [[yellow fever]] virus, [[West Nile virus]], [[St. Louis encephalitis]] virus, [[japanese encephalitis]] virus, [[tick-borne encephalitis]], [[Kyasanur Forest disease]] virus, and [[Omsk hemorrhagic fever virus]].  Most are transmitted by arthropods ([[mosquitoes]] or [[ticks]]), and are therefore also referred to as [[arboviruses]] (arthropod-borne viruses).


The dengue virus [[genome]] contains about 11,000 nucleotide bases, which code for the three different types of protein molecules (C, prM and E) that form the [[virus]] particle and seven other types of protein molecules (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5) that are only found in infected host cells and are required for replication of the virus.  There are five strains of the virus, of which the first four are referred to as [[DENV-1], [[DENV-2]], [[DENV-3]] and [[DENV-4]].  The distinctions between the [[serotypes]] is based on the their [[antigenicity]].
The dengue virus [[genome]] contains about 11,000 nucleotide bases, which code for the three different types of protein molecules (C, prM and E) that form the [[virus]] particle and seven other types of protein molecules (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5) that are only found in infected host cells and are required for replication of the virus.  There are five strains of the virus, of which the first four are referred to as [[DENV-1]], [[DENV-2]], [[DENV-3]] and [[DENV-4]].  The distinctions between the [[serotypes]] is based on the their [[antigenicity]].


==Transmission==
==Transmission==
Line 25: Line 26:
Dengue can also be transmitted via infected blood products and through organ donation and through [[Vertical transmission]].  Other person-to-person modes of transmission have also been reported, but are very unusual.  The genetic variation in dengue viruses is region specific, suggestive that establishment into new territories is relatively infrequent, despite dengue emerging in new regions in recent decades.
Dengue can also be transmitted via infected blood products and through organ donation and through [[Vertical transmission]].  Other person-to-person modes of transmission have also been reported, but are very unusual.  The genetic variation in dengue viruses is region specific, suggestive that establishment into new territories is relatively infrequent, despite dengue emerging in new regions in recent decades.


==Predisposition==
==Inhibition of the Human Immune System by the Dengue Fever Virus==
 
Severe disease is more common in babies and young children, and in contrast to many other infections it is more common in children that are relatively well nourished.  Other risk factors for severe disease include female sex, high [[body mass index]], and [[viral load]].  While each serotype can cause the full spectrum of disease, virus strain is a risk factor.  Infection with one serotype is thought to produce lifelong immunity to that type, but only short term protection against the other three.  The risk of severe disease from secondary infection increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2.  Dengue can be life-threatening in people with chronic diseases such as [[diabetes]] and [[asthma]].


[[Polymorphisms]] in particular [[genes]] have been linked with an increased risk of severe dengue complications. Examples include the genes coding for the proteins known as [[TNF-α]], [[mannan-binding lectin]], [[CTLA-4]], [[TGF-β]], [[DC-SIGN]], [[PLCE1]], and particular forms of human leukocyte antigen from gene variations of [[HLA-B]]. A common genetic abnormality in Africans, known as [[glucose-6-phosphate dehydrogenase deficiency]], appears to increase the risk[[Polymorphisms]] in the genes for the [[vitamin D]] receptorand FcγR seem to offer protection against severe disease in secondary dengue infection.
Dengue virus inhibits the [[innate immune response]] in serval ways as discussed below.<ref name="pmid19694536">{{cite journal| author=Diamond MS| title=Mechanisms of evasion of the type I interferon antiviral response by flaviviruses. | journal=J Interferon Cytokine Res | year= 2009 | volume= 29 | issue= 9 | pages= 521-30 | pmid=19694536 | doi=10.1089/jir.2009.0069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19694536  }} </ref><ref name="pmid15827155">{{cite journal| author=Jones M, Davidson A, Hibbert L, Gruenwald P, Schlaak J, Ball S et al.| title=Dengue virus inhibits alpha interferon signaling by reducing STAT2 expression. | journal=J Virol | year= 2005 | volume= 79 | issue= 9 | pages= 5414-20 | pmid=15827155 | doi=10.1128/JVI.79.9.5414-5420.2005 | pmc=PMC1082737 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15827155 }} </ref>


====Inteeraction with the humman immune system====
===Inhibition of interferon signaling by blocking signal transducer <small><ref name="pmid15944325">{{cite journal| author=Ho LJ, Hung LF, Weng CY, Wu WL, Chou P, Lin YL et al.| title=Dengue virus type 2 antagonizes IFN-alpha but not IFN-gamma antiviral effect via down-regulating Tyk2-STAT signaling in the human dendritic cell. | journal=J Immunol | year= 2005 | volume= 174 | issue= 12 | pages= 8163-72 | pmid=15944325 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15944325  }} </ref><ref name="pmid19279106">{{cite journal| author=Ashour J, Laurent-Rolle M, Shi PY, García-Sastre A| title=NS5 of dengue virus mediates STAT2 binding and degradation. | journal=J Virol | year= 2009 | volume= 83 | issue= 11 | pages= 5408-18 | pmid=19279106 | doi=10.1128/JVI.02188-08 | pmc=PMC2681973 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19279106  }} </ref></small>===
It has been proved that the dengue virus inhibits the [[innate immune response]] through inhibit proteins:<ref name="pmid19694536">{{cite journal| author=Diamond MS| title=Mechanisms of evasion of the type I interferon antiviral response by flaviviruses. | journal=J Interferon Cytokine Res | year= 2009 | volume= 29 | issue= 9 | pages= 521-30 | pmid=19694536 | doi=10.1089/jir.2009.0069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19694536  }} </ref><ref name="pmid15827155">{{cite journal| author=Jones M, Davidson A, Hibbert L, Gruenwald P, Schlaak J, Ball S et al.| title=Dengue virus inhibits alpha interferon signaling by reducing STAT2 expression. | journal=J Virol | year= 2005 | volume= 79 | issue= 9 | pages= 5414-20 | pmid=15827155 | doi=10.1128/JVI.79.9.5414-5420.2005 | pmc=PMC1082737 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15827155  }} </ref>
 
=====Inhibition of interferon signaling by blocking signal transducer <small><ref name="pmid15944325">{{cite journal| author=Ho LJ, Hung LF, Weng CY, Wu WL, Chou P, Lin YL et al.| title=Dengue virus type 2 antagonizes IFN-alpha but not IFN-gamma antiviral effect via down-regulating Tyk2-STAT signaling in the human dendritic cell. | journal=J Immunol | year= 2005 | volume= 174 | issue= 12 | pages= 8163-72 | pmid=15944325 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15944325  }} </ref><ref name="pmid19279106">{{cite journal| author=Ashour J, Laurent-Rolle M, Shi PY, García-Sastre A| title=NS5 of dengue virus mediates STAT2 binding and degradation. | journal=J Virol | year= 2009 | volume= 83 | issue= 11 | pages= 5408-18 | pmid=19279106 | doi=10.1128/JVI.02188-08 | pmc=PMC2681973 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19279106  }} </ref></small>=====


*NS4B: Is a protein associated with the [[endoplasmic reticulum]].  It may block the phosphorylation of STAT 1 after induction by [[interferons]] type I alpha and beta.  The activity of Tyk2 kinase decreases with the dengue virus; then the STAT 1 phosphorylation also decreases.  Therefore, the [[innate immune system]] response may be blocked. Thus there is no production of ISG. NS2A and NS4A cofactor may also take part in the STAT 1 inhibition.<ref name="pmid14612562">{{cite journal| author=Muñoz-Jordan JL, Sánchez-Burgos GG, Laurent-Rolle M, García-Sastre A| title=Inhibition of interferon signaling by dengue virus. | journal=Proc Natl Acad Sci U S A | year= 2003 | volume= 100 | issue= 24 | pages= 14333-8 | pmid=14612562 | doi=10.1073/pnas.2335168100 | pmc=PMC283592 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14612562  }} </ref>
*NS4B: Is a protein associated with the [[endoplasmic reticulum]].  It may block the phosphorylation of STAT 1 after induction by [[interferons]] type I alpha and beta.  The activity of Tyk2 kinase decreases with the dengue virus; then the STAT 1 phosphorylation also decreases.  Therefore, the [[innate immune system]] response may be blocked. Thus there is no production of ISG. NS2A and NS4A cofactor may also take part in the STAT 1 inhibition.<ref name="pmid14612562">{{cite journal| author=Muñoz-Jordan JL, Sánchez-Burgos GG, Laurent-Rolle M, García-Sastre A| title=Inhibition of interferon signaling by dengue virus. | journal=Proc Natl Acad Sci U S A | year= 2003 | volume= 100 | issue= 24 | pages= 14333-8 | pmid=14612562 | doi=10.1073/pnas.2335168100 | pmc=PMC283592 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14612562  }} </ref>
*NS5 : Is a protein associated with the inactivation of STAT2 (via the signal transduction of the response to interferon) when it is expressed alone.  When NS5 is cleaved with NS4B by a protease (NS2B3) it can degrade STAT2. In fact, after the cleavage of NS5 by the protease, there is an E3 ligase association with STAT2, and the E3 ligase targets STAT2 for the degradation.
*NS5 : Is a protein associated with the inactivation of STAT2 (via the signal transduction of the response to interferon) when it is expressed alone.  When NS5 is cleaved with NS4B by a protease (NS2B3) it can degrade STAT2. In fact, after the cleavage of NS5 by the protease, there is an E3 ligase association with STAT2, and the E3 ligase targets STAT2 for the degradation.


=====Inhibition of the type I interferon response=====
===Inhibition of the type I interferon response===


NS2B3 protease complex is a proteolytic core consisting of the last 40 [[amino acids]] of NS2B and the first 180 [[amino acids]] of NS3.  Cleavage of the NS2B3 precursor activates the [[protease]] complex.  This [[protease]] complex allows the inhibition of the production of type I [[interferon]] by reducing the activity of [[Interferon|IFN-β]] promoter: studies have shown that NS2B3 protease complex is involved in inhibiting the phosphorylation of IRF3.<ref name="pmid20660196">{{cite journal| author=Rodriguez-Madoz JR, Belicha-Villanueva A, Bernal-Rubio D, Ashour J, Ayllon J, Fernandez-Sesma A| title=Inhibition of the type I interferon response in human dendritic cells by dengue virus infection requires a catalytically active NS2B3 complex. | journal=J Virol | year= 2010 | volume= 84 | issue= 19 | pages= 9760-74 | pmid=20660196 | doi=10.1128/JVI.01051-10 | pmc=PMC2937777 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20660196  }} </ref>  A recent study shows that the NS2B3 protease complex inhibits (by cleaving) protein MITA which allows the IRF3 activation.
NS2B3 protease complex is a proteolytic core consisting of the last 40 [[amino acids]] of NS2B and the first 180 [[amino acids]] of NS3.  Cleavage of the NS2B3 precursor activates the [[protease]] complex.  This [[protease]] complex allows the inhibition of the production of type I [[interferon]] by reducing the activity of [[Interferon|IFN-β]] promoter: studies have shown that NS2B3 protease complex is involved in inhibiting the phosphorylation of IRF3.<ref name="pmid20660196">{{cite journal| author=Rodriguez-Madoz JR, Belicha-Villanueva A, Bernal-Rubio D, Ashour J, Ayllon J, Fernandez-Sesma A| title=Inhibition of the type I interferon response in human dendritic cells by dengue virus infection requires a catalytically active NS2B3 complex. | journal=J Virol | year= 2010 | volume= 84 | issue= 19 | pages= 9760-74 | pmid=20660196 | doi=10.1128/JVI.01051-10 | pmc=PMC2937777 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20660196  }} </ref>  A recent study shows that the NS2B3 protease complex inhibits (by cleaving) protein MITA which allows the IRF3 activation.


==References==
==References==
{{Reflist|2}}
 
{{reflist|2}}


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Latest revision as of 21:16, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]

Overview

Aedes aegypti is the principal mosquito vector of dengue fever viruses and is closely associated with humans and their dwellings. The Dengue fever virus also inhibits the human immune response.

The Vector is the Aedes aegypti Mosquito

  • Aedes aegypti, the principal mosquito vector of dengue viruses, is an insect closely associated with humans and their dwellings. People not only provide the mosquitoes with blood meals but also water-holding containers in and around the home needed to complete their development.
  • The mosquito lays her eggs on the sides of containers with water and eggs hatch into larvae after a rain or flooding.
  • A larva changes into a pupa in about a week and into a mosquito in two days.

The Pathogen is Dengue fever virus

Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus Flavivirus. Other members of the same genus include yellow fever virus, West Nile virus, St. Louis encephalitis virus, japanese encephalitis virus, tick-borne encephalitis, Kyasanur Forest disease virus, and Omsk hemorrhagic fever virus. Most are transmitted by arthropods (mosquitoes or ticks), and are therefore also referred to as arboviruses (arthropod-borne viruses).

The dengue virus genome contains about 11,000 nucleotide bases, which code for the three different types of protein molecules (C, prM and E) that form the virus particle and seven other types of protein molecules (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5) that are only found in infected host cells and are required for replication of the virus. There are five strains of the virus, of which the first four are referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes is based on the their antigenicity.

Transmission

Dengue virus is primarily transmitted by Aedes mosquitoes, particularly A. aegypti. These mosquitoes typically bite during the day, particularly in the early morning and in the evening, but they are able to bite and thus spread infection at any time of day through all the year. Other Aedes species that transmit the disease include A. albopictus, A. polynesiensis and A. scutellaris. Humans are the primary host of the virus, but it also circulates in nonhuman primates. An infection can be acquired via a single bite. A female mosquito that takes a blood meal from a person infected with dengue fever, during the initial 2 to 10 day febrile period, becomes itself infected with the virus in the cells lining its gut. About 8 to 10 days later, the virus spreads to other tissues including the mosquito's salivary glands and is subsequently released into its saliva. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Aedes aegypti prefers to lay its eggs in artificial water containers, to live in close proximity to humans, and to feed on people rather than other vertebrates.

Dengue can also be transmitted via infected blood products and through organ donation and through Vertical transmission. Other person-to-person modes of transmission have also been reported, but are very unusual. The genetic variation in dengue viruses is region specific, suggestive that establishment into new territories is relatively infrequent, despite dengue emerging in new regions in recent decades.

Inhibition of the Human Immune System by the Dengue Fever Virus

Dengue virus inhibits the innate immune response in serval ways as discussed below.[1][2]

Inhibition of interferon signaling by blocking signal transducer [3][4]

  • NS4B: Is a protein associated with the endoplasmic reticulum. It may block the phosphorylation of STAT 1 after induction by interferons type I alpha and beta. The activity of Tyk2 kinase decreases with the dengue virus; then the STAT 1 phosphorylation also decreases. Therefore, the innate immune system response may be blocked. Thus there is no production of ISG. NS2A and NS4A cofactor may also take part in the STAT 1 inhibition.[5]
  • NS5 : Is a protein associated with the inactivation of STAT2 (via the signal transduction of the response to interferon) when it is expressed alone. When NS5 is cleaved with NS4B by a protease (NS2B3) it can degrade STAT2. In fact, after the cleavage of NS5 by the protease, there is an E3 ligase association with STAT2, and the E3 ligase targets STAT2 for the degradation.

Inhibition of the type I interferon response

NS2B3 protease complex is a proteolytic core consisting of the last 40 amino acids of NS2B and the first 180 amino acids of NS3. Cleavage of the NS2B3 precursor activates the protease complex. This protease complex allows the inhibition of the production of type I interferon by reducing the activity of IFN-β promoter: studies have shown that NS2B3 protease complex is involved in inhibiting the phosphorylation of IRF3.[6] A recent study shows that the NS2B3 protease complex inhibits (by cleaving) protein MITA which allows the IRF3 activation.

References

  1. Diamond MS (2009). "Mechanisms of evasion of the type I interferon antiviral response by flaviviruses". J Interferon Cytokine Res. 29 (9): 521–30. doi:10.1089/jir.2009.0069. PMID 19694536.
  2. Jones M, Davidson A, Hibbert L, Gruenwald P, Schlaak J, Ball S; et al. (2005). "Dengue virus inhibits alpha interferon signaling by reducing STAT2 expression". J Virol. 79 (9): 5414–20. doi:10.1128/JVI.79.9.5414-5420.2005. PMC 1082737. PMID 15827155.
  3. Ho LJ, Hung LF, Weng CY, Wu WL, Chou P, Lin YL; et al. (2005). "Dengue virus type 2 antagonizes IFN-alpha but not IFN-gamma antiviral effect via down-regulating Tyk2-STAT signaling in the human dendritic cell". J Immunol. 174 (12): 8163–72. PMID 15944325.
  4. Ashour J, Laurent-Rolle M, Shi PY, García-Sastre A (2009). "NS5 of dengue virus mediates STAT2 binding and degradation". J Virol. 83 (11): 5408–18. doi:10.1128/JVI.02188-08. PMC 2681973. PMID 19279106.
  5. Muñoz-Jordan JL, Sánchez-Burgos GG, Laurent-Rolle M, García-Sastre A (2003). "Inhibition of interferon signaling by dengue virus". Proc Natl Acad Sci U S A. 100 (24): 14333–8. doi:10.1073/pnas.2335168100. PMC 283592. PMID 14612562.
  6. Rodriguez-Madoz JR, Belicha-Villanueva A, Bernal-Rubio D, Ashour J, Ayllon J, Fernandez-Sesma A (2010). "Inhibition of the type I interferon response in human dendritic cells by dengue virus infection requires a catalytically active NS2B3 complex". J Virol. 84 (19): 9760–74. doi:10.1128/JVI.01051-10. PMC 2937777. PMID 20660196.