Complexities of Dengue Fever: Pathogenesis, Clinical Features and Management Strategies.

Abstract

Dengue fever, transmitted through the bite of infected Aedes mosquitos, poses a significant global threat, particularly in the tropical and subtropical region. In this review, we aim to summarize the existent literature on dengue virus infection and to enlighten the reader on recent advances and knowledge. Dengue virus infection can cause a spectrum of clinical manifestations, ranging from asymptomatic or mild illness to more severe and potentially life-threatening complications. Pathogenesis of dengue is based on viral and host factors. Viral factors include NS1 antigen and genomic factors. Host factors include antibody dependent enhancement, anti-NS1 antibodies, cytokines, cross reactive T-Cell response, HLA allele variation and non-HLA mediated polymorphisms. The clinical picture of dengue is described on the basis of WHO 1997 and 2009 criteria. It is classified into dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Life-threatening complications can develop in severe cases, and this includes renal complications such as acute kidney injury (AKI) and hepatic complications such as hepatic dysfunction and in rare cases, fulminant hepatic failure. Neurological complications, cardiac complications and respiratory distress syndrome have also been reported. Treatment methods include targeting the dengue vector and Carica papaya, a natural remedy with antiviral properties. Additionally, the role of corticosteroids, intravenous immunoglobulins, and mast cell inhibitors has been explored in dengue treatment, aiming to reduce severity. Novel approaches involve drugs targeting dengue proteins and host factors necessary for the virus's life cycle, offering potential avenues for more targeted therapeutic interventions. In recent years, significant progress has been made in the development of vaccines against dengue, with Sanofi Pasteur's Dengvaxia being the first licensed vaccine approved for use. Utilizing various approaches such as recombinant proteins, viral vectors and viral like particles, various alternatives have been provided which aim to be safer substitutes to Dengvaxia while maintaining the effectiveness. A review on dengue is essential for clinicians and healthcare professionals to stay updated on diagnostics, treatment protocols and prevention strategies.