Dengue

Dengue ka Denge hanesan moras tropikal ida ne’ebé kauza husi infesaun virus dengue. Virus ida ne’e hanesan virus RNA ne’ebe pertense ba familia Flavivirus. Denge maka moras ne'ebé da'et lalais tebes no hada'et lui husi susuk; númeru kazu aumenta dala tolu-nulu entre 1960 no 2010.^[1]

Moras ne'e dala barak manifesta ho sintomas hanesan isin manas, ulun moras, isin no artikula moras, kulit nakloke no troka kor atu hanesan ho karakteristika moras sarampu. Iha kazu ki'ik balun moras ida ne'e bele evolui ba iha forma dengue hemorrágica ne'ebé bele fo risku mate tan nia halo ran sai, hatun nível plaketa raan nian, plasma kuak (fuga) hodi hali ba iha raan, ka presaun arterial ne'ebé tun to iha nivel ida ne'ebé perigu. OMS kalkula katak ema millaun 50 to’o 100 hetan moras dengue tinan-tinan, 500,000 hetan moras todan, no 22,000 mate tanba moras ne’e; maioria hosi vítima mortál sira maka labarik sira. Maski nune'e, sientista sira fó sai iha jornál Nature iha fulan-Abril 2013 katak, tuir sira nia peskiza, maizumenus ema millaun 390 maka infetadu duni ho virus dengue kada tinan.^[2]

Transmisaun

Vetor sira ne'ebé importante liu ba vírus sira isin-manas dengue nian maka susuk mean (Aedes aegypti) no susuk tigre aziátiku (Aedes albopictus).^[3] Iha rejiaun balu, espésie susuk sira seluk maka vetor potensiál sira ba moras dengue, hanesan susuk tigre polinéziu (Aedes (Stegomyia) polynesiensis) iha Pasífiku Súl^[4] ka Aedes scutellaris iha Nova Guiné.^[5] Espésie susuk sira seluk mós hatudu ona katak sira bele transmite patójenu sira.^[6]^[7]

Infeksaun bele akontese wainhira susuk tata dala ida. Hanesan ho arbovirus sira seluk ne'ebé hada'et hosi susuk, vírus dengue hetan injestaun hosi susuk inan ida ne'ebé han ema infetadu nia raan. Virus sira hafoin ne'e tama iha susuk nia estómagu, no se karga viral aas sufisiente, virion sira bele infeta sélula epiteliál estómagu nian no multiplika iha ne'ebá. Husi ne'ebá, sira tama iha hemozole (susuk nia raan) no tuirmai iha glándula salivar sira. Dala tuirmai susuk han, nia injeta nia saliva ba kanek, nune'e hatama vírus ba raan hosi primata ne'ebé tata. Virus ne parese la iha efeitu negativu ba susuk ne rasik, tan mesmu que susuk ne hetan infeksaun maibe nia la iha sintoma ida. Iha mós evidénsia ba transmisaun vertikál hosi vírus dengue, signifika transmisaun hosi susuk inan ida ba nia tolun sira no nune'e ba larva sira.^[6]^[7]^[8]^[9]

Divulga

Moras dengue ne’e endémika iha rejiaun tropikál no subtropikál, ho 75% kazu globál akontese iha rejiaun Ázia-Pasífiku. Área prevalénsia prinsipál sira inklui Amérika Latina, Áfrika Sentrál, Índia, Sudeste Aziátiku, parte sira Pasífiku nian (inklui Nova Kaledónia no Hawaii), no súl Estadus Unidus nian.

Sintoma

Dengue transmite husi susuk tata no iha períodu inkubasaun loron 3 to’o 14. 80% hosi infesaun sira maka asintomátiku, enkuantu restu 20% normalmente akompaña ho sintoma kmaan to'o moderadu. Kazu grave sira ladún akontese no jeralmente akontese de'it hafoin infesaun daruak.^[10] Sintoma sira inklui isin-manas (to'o 40 °C) ho isin-manas no ulun-moras maka'as, moras iha muskulu, no moras iha artikulasaun sira. Hamutuk ho erupsaun, sintoma sira-ne'e mós koñesidu hanesan denguetrias. Fuuk monu ne'ebé namkari bele akontese hanesan manifestasaun tarde ida to'o fulan rua hafoin moras ne'e hahú.^[11]

Iha pasiente barak liu, moras ne'e sai menus hafoin loron 3 to'o 7. Maibé, iha kazu pursentu 2 to'o 4, moras ne'e hetan kursu ne'ebé maka'as, hodi rezulta iha isin-manas hemorrájiku dengue (Dengue hemorrhagic fever, DHF) ka síndrome xoke dengue (DSS). Taxa mortalidade ba kazu grave sira-ne'e maka pursentu 1 to'o 5, maibé bele to'o pursentu 15 durante epidemia individuál sira.

Isin-manas hemorrájiku dengue maka síndrome xoke agudu ida ho hemorajia sira, durante ne'ebé permeabilidade parede vazu sira nian aumenta, hodi hamosu sangramentu ne'ebé la kontroladu. Forma hemorrájiku hahú hanesan isin-manas dengue baibain, maibé pasiente nia kondisaun sai aat maka'as liutiha loron 2 to'o 6. Kolapsu sirkulatóriu akontese, hodi rezulta iha oin-been, ran sai internu, dezidrasaun, konvulsaun serebrál, koma, ran sai iha ibun-been, muta raan, melena (fezes metan, ho alkatraun), bubu iha aten, no sinál jerál sira xoke nian (takikardia, hipotensaun, malirin, kulit ne'ebé namdoras, pálidu). Adisionalmente, petekia ne'ebé namkari bele mosu durante faze ida-ne'e. Hirak-ne'e maka hemorajia mikrosirkulár sira iha kulit, ne'ebé mosu hanesan pontu mean sira.^[12]

Diagnosa

Diagnóstiku klíniku susar tanba númeru boot hosi patójenu posivel sira ba moras infesiozu sira ho sintoma inisiál sira ne'ebé hanesan. Kazu esporádiku no kmaan sira bele de'it identifika ho konfiável liuhosi teste virolójiku. Karik deskonfia iha infesaun, virus dengue bele detekta uza reasaun kadeia polimeraze transkrisaun reversa (RT-PCR), métodu ida ne'ebé amplifika material jenétiku virus nian no nune'e identifika diretamente.^[12] Deteksaun patojéniu direta bele mós hetan liuhosi izolamentu vírus liuhosi kultura sélula, prosesu ida ne'ebé bele lori semana ida to'o haat. Métodu rua ne'e hala'o uza plasma raan nian; PCR bele mós hala'o uza sérum raan nian. Serolojikamente, ensaiu imunosorbente ligadu ho enzima (ELISA) normalmente labele detekta antikorpu IgM espesífiku ba dengue iha faze aguda, maibé rezultadu pozitivu hafoin sintoma sira tun bele konfirma diagnóstiku. Títulu IgG espesífiku bele diferensia entre infesaun primária no sekundária (la mosu antikorpu IgG durante loron ualu dahuluk infesaun primária nian). Aumentu dala haat iha títulu antikorpu espesífiku kompara ho teste anteriór konsidera hanesan konkluzivu. Maibé, tanba teste serolójiku sira dala barak halo reasaun kruzada ho flavivirus sira seluk, métodu indiretu sira-ne'e nunka sai prova konkluziva ba infesaun.^[12]

Teste antíjenu sira bazeia ba deteksaun direta hosi proteína NS1 (ne'ebé maka konservadu tebes iha serotipu haat nia laran) mós disponivel komersialmente. Sira karakteriza ho sira nia fasilidade atu uza (la presiza laboratóriu), maibé signifikativamente menus sensivel no espesífiku duké métodu teste sira ne'ebé kompleksu liu.^[12]

Karik deskonfia isin-manas dengue, moras viral sira seluk (gripe, sarampu, rubéola, isin-manas chikungunya, isin-manas mean no ensefalite japoneza) no baktéria (tifu, leptospiroze, sepsis, meningococcus no rickettsia) no mós malária tenke esklui.^[12]

Tratamentu

Hanesan ho moras hotu-hotu ne'ebé kauza hosi flavivirus, laiha terapia kauza ba isin-manas dengue. Iha kazu grave sira, ospitál maka nesesáriu, no tanba kondisaun ne'ebé maka sai aat lalais iha kazu balu, monitorizasaun kuidadu intensivu maka akonsellavel. Tratamentu sintomátiku inklui medida sira atu enxe fali líkidu sira no administra ai-moruk sira hanesan parasetamol atu hamenus moras. Ásidu asetilsalisíliku (ezemplu, aspirina) tenke evita tanba nia efeitu antikoagulante, tanba ida-ne'e bele iha konsekuénsia devastadora ba pasiente iha kazu sangramentu internu, ne'ebé bele akontese iha isin-manas dengue. Aleinde ne'e, administrasaun líkidu intravenozu lalais bele sai krusiál.^[12]

Prevensaun

Kontentór bee nian ne'ebé la taka no kuantidade ki'ik bee ne'ebé paradu, hanesan sira ne'ebé hetan iha balde, lata, botir, pneu karreta nian, ka plástiku, maka fatin ne'ebé sufisiente ba larva susuk tigre nian. Aleinde ne'e, susuk tigre nia fulun sira rezistente ba rai-maran no bele moris iha períodu rai-maran. Buat sira-ne'e hotu halo susar atu kontrola susuk sira.

Medida prevensaun pesoál hasoru moras dengue inklui evita susuk tata iha área sira ne'ebé moras dengue sai endémiku. Medida institusionál sira ba prevensaun moras dengue inklui kontrola susuk sira ne'ebé lori moras.

Ligasaun Web

World Health Organization: Dengue – Guidelines for Diagnosis, Treatment, Prevention and Control – New edition, 2009, ISBN 978-92-4154787-1.

Referénsia individuál sira

↑ WHO: Dengue – Guidelines for diagnosis, treatment, prevention and control.
↑ Samir Bhatt, Peter W. Gething, Oliver J. Brady u. a.: The global distribution and burden of dengue. In: Nature. No. 496, 25. April 2013, p. 504–507, doi:10.1038/nature12060 (Volltext).
↑ D. Fontenille, A.B. Failloux, R. Romi: Should we expect Chikungunya and Dengue in Southern Europe? In: W. Takken, B. G. J. Knols (Hrsg.): Emerging pests and vector-borne diseases in Europe. Band 1. Wageningen Academic Publishers, Wageningen 2007, ISBN 978-90-8686-053-1.
↑ L. Rosen, L.E. Rozeboom, B.H. Sweet & A.B. Sabin: The transmission of dengue by 'Aedes polynesiensis’ Marks. In: American Journal of Tropical Medicine and Hygiene. 1954, No. 3, p. 878–882.
↑ I.M. Mackerras: Transmission of dengue fever by Ae. (Stegomyia) scutellaris Walk. in New Guinea. In: Transactions of the Royal Society of Tropical Medicine and Hygiene. 1946, No. 40, p. 294–312.
1 2 J. E. Freier, L. Rosen: Vertical transmission of dengue virus by ‚Aedes mediovittatus‘. In: American Journal of Tropical Medicine and Hygiene. 1988, Band 39, Nr. 2, S. 218–222.
1 2 J. E. Freier, L. Rosen: Vertical transmission of dengue virus by mosquitoes of the 'Aedes scutellaris’ group. In: American Journal of Tropical Medicine and Hygiene. 1987, Band 37, No. 3, p. 640–647.
↑ J. Günther, J. P. Martínez-Muñoz, D. G. Pérez-Ishiwara, J. Salas-Benito: Evidence of vertical transmission of dengue virus in two endemic localities in the state of Oaxaca, Mexico, p. 347–352, 2007, Vol. 50, No. 5, doi: 10.1159/000107272.
↑ V. Thenmozhi, J. G. Hiriyan, S. C. Tewari u. a.: Natural vertical transmission of dengue virus in Aedes albopictus (Diptera: Culicidae) in Kerala, a southern Indian state, In: Japanese Journal of Infectious Diseases, p. 245–249, 2007, Vol. 60, No. 5.
↑ B. Angel, V. Joshi: Distribution and seasonality of vertically transmitted dengue viruses in Aedes mosquitoes in arid and semi-arid areas of Rajasthan, India In: Journal of Vector Borne Diseases, p. 56–59, 2008, Vol. 45, No. 1.
↑ tropenmedizin-wien.at: Haarausfall durch Denguefieber?.
1 2 3 4 5 6 M. A. Tolle: Mosquito-borne diseases. In: Current Problems in Pediatric and Adolescent Health Care, 2009, p. 97–140, Vol. 39, No. 4.

[urlwhqlibdoc.who.int-1] WHO: Dengue – Guidelines for diagnosis, treatment, prevention and control.

[2] Samir Bhatt, Peter W. Gething, Oliver J. Brady u. a.: The global distribution and burden of dengue. In: Nature. No. 496, 25. April 2013, p. 504–507, doi:10.1038/nature12060 (Volltext).

[Fontenille-3] D. Fontenille, A.B. Failloux, R. Romi: Should we expect Chikungunya and Dengue in Southern Europe? In: W. Takken, B. G. J. Knols (Hrsg.): Emerging pests and vector-borne diseases in Europe. Band 1. Wageningen Academic Publishers, Wageningen 2007, ISBN 978-90-8686-053-1.

[Rosen-4] L. Rosen, L.E. Rozeboom, B.H. Sweet & A.B. Sabin: The transmission of dengue by 'Aedes polynesiensis’ Marks. In: American Journal of Tropical Medicine and Hygiene. 1954, No. 3, p. 878–882.

[Mackerras-5] I.M. Mackerras: Transmission of dengue fever by Ae. (Stegomyia) scutellaris Walk. in New Guinea. In: Transactions of the Royal Society of Tropical Medicine and Hygiene. 1946, No. 40, p. 294–312.

[Freier1988-6] 1 2 J. E. Freier, L. Rosen: Vertical transmission of dengue virus by ‚Aedes mediovittatus‘. In: American Journal of Tropical Medicine and Hygiene. 1988, Band 39, Nr. 2, S. 218–222.

[Freier1987-7] 1 2 J. E. Freier, L. Rosen: Vertical transmission of dengue virus by mosquitoes of the 'Aedes scutellaris’ group. In: American Journal of Tropical Medicine and Hygiene. 1987, Band 37, No. 3, p. 640–647.

[pmid17700030-8] J. Günther, J. P. Martínez-Muñoz, D. G. Pérez-Ishiwara, J. Salas-Benito: Evidence of vertical transmission of dengue virus in two endemic localities in the state of Oaxaca, Mexico, p. 347–352, 2007, Vol. 50, No. 5, doi: 10.1159/000107272.

[pmid17881861-9] V. Thenmozhi, J. G. Hiriyan, S. C. Tewari u. a.: Natural vertical transmission of dengue virus in Aedes albopictus (Diptera: Culicidae) in Kerala, a southern Indian state, In: Japanese Journal of Infectious Diseases, p. 245–249, 2007, Vol. 60, No. 5.

[pmid18399318-10] B. Angel, V. Joshi: Distribution and seasonality of vertically transmitted dengue viruses in Aedes mosquitoes in arid and semi-arid areas of Rajasthan, India In: Journal of Vector Borne Diseases, p. 56–59, 2008, Vol. 45, No. 1.

[test-11] tropenmedizin-wien.at: Haarausfall durch Denguefieber?.

[pmid19327647-12] 1 2 3 4 5 6 M. A. Tolle: Mosquito-borne diseases. In: Current Problems in Pediatric and Adolescent Health Care, 2009, p. 97–140, Vol. 39, No. 4.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]