Rivera Jorge, Neira Marcela, Parra Edgar, Méndez Jairo, Sarmiento Ladys, Caldas María Leonor
Grupo de Morfología Celular, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, D.C, Colombia.
Grupo de Patología, Dirección Red en Salud Pública, Instituto Nacional de Salud, Bogotá, D.C, Colombia.
Biomedica. 2014 Oct-Dec;34(4):514-20. doi: 10.1590/S0120-41572014000400003.
The epidemiological situation of dengue has worsened over the last decade. The difficulties in preventing its transmission and the absence of a vaccine or specific treatment have made dengue a serious risk to public health, health centers and research systems at different levels. Currently, most studies on the pathogenesis of dengue infection focus on the T-cell immune response almost exclusively in secondary infections and are aimed at identifying the mechanisms involved in the development of vascular permeability and bleeding events that accompany the infection. This report describes the case of a baby girl less than 45 days of age with clinical signs of severe dengue, whose diagnosis was confirmed by reverse transcription polymerase chain reaction in post-mortem tissue samples and by the ancillary diagnostic use of immunohistochemistry, which detected viral antigens in all organs obtained at autopsy. This case highlights the importance of studying primary infections associated with severe dengue, particularly in children, who are more likely to develop the severe form of the disease without previous infection, and it further stresses the importance of a diagnosis that should not be based solely on the examination of liver tissue samples when studying the pathogenesis of the viral infection.
在过去十年中,登革热的流行病学形势恶化。预防其传播存在困难,且缺乏疫苗或特效治疗方法,这使得登革热对公共卫生、各级卫生中心及研究系统构成严重风险。目前,大多数关于登革热感染发病机制的研究几乎完全集中于二次感染时的T细胞免疫反应,旨在确定感染时伴随的血管通透性和出血事件发生发展的相关机制。本报告描述了一名年龄小于45天的女婴,她有严重登革热的临床症状,死后组织样本经逆转录聚合酶链反应确诊,尸检获取的所有器官经免疫组织化学辅助诊断检测到病毒抗原。该病例凸显了研究与严重登革热相关的原发性感染的重要性,尤其是在儿童中,他们在无既往感染的情况下更易发展为严重疾病形式,并且进一步强调了在研究病毒感染发病机制时,诊断不应仅基于肝组织样本检查的重要性。