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at is

Wh Dengue?
Four distinct serotypes

DEN- 1
DEN- 2
DEN- 4 DEN- 3
} Genus Flavivirus
Family Flaviviridae

First Recognised
in e s Vir

Aede
al T
ran

l l i p smi
tte

hi s ae r
osq ion

P gypt
es

i
uito
m m ect

!
fro l inf

Th
Vira

ai
la
nd
There is no
specific treatment !

Acetaminophen or
Paracetamol Drink plenty of
Avoid pain reliever water

Intravenous
(IV) fluid

Blood pressure
monitoring electrolyte
replacement
present in four to six days after getting the infection
of the disease and last for more than 10 days

High fever
Severe
headaches

Severe pain
behind the eyes Severe joint and
muscle pain
Nausea
Fatigue
Vomiting

Skin rash Low white cell


counts

Mild bleeding
such asnose bleed
1. Stay in air-conditioned or well-screened housing. The
mosquitoes that carry the dengue viruses are most active from dawn to
dusk, but they can also bite at night.

2. Wear protective clothing. When you go into mosquito-infested


areas, wear a long-sleeved shirt, long pants, socks and shoes.

3. Use mosquito repellent. Permethrin can be applied to your clothing,


shoes, camping gear and bed netting. For your skin, use a repellent
containing at least a 10 percent concentration of DEET.

4. Reduce mosquito habitat. The mosquitoes that carry the dengue


virus typically live in and around houses, breeding in standing water.
Thus, reduce the breeding habitat to lower mosquito populations.
Immune&response&to&dengue&virus&

Introduction&

When&patients&are&infected&with&dengue&virus,&they&can&show&a&range&of&symptoms.&Some&
patients&show&no&sign&of&the&disease,&while&other&show&very&severe&symptoms&which&can&
sometime&be&fatal.&However,&our&bodies&has&immune&responses&to&the&infections&of&the&
pathogens&that&invade&in&our&body.&

The&Immune&Response&

There&are&two&main&parts&of&immune&system.&The&first&part&is&called&innate&immune&system&
which&would&give&body&instant&and&general&response&to&the&pathogen&that&invade&through&our&
bodies.&However,&this&is&just&for&short&term&after&infection&instead&of&the&long@term&response&
against&pathogen.&The&second&part&is&called&adaptive&immune&response&that&will&produce&the&
cells&that&will&be&specific&and&productive&in&targeting&that&kind&of&pathogen&and&the&infected&cell.&
This&includes&antibody&that&secretes&B&cells&and&cytotoxic&T&cells.&Immunoglobulin,&the&
antibodies&that&is&secreted&by&B@cells,&will&recognise&and&bind&to&those&pathogens,&while&
cytotoxic&T&cells&will&kill&those&cells&that&are&either&pathogen&itself&or&the&ones&that&are&infected.&
Although&it&might&take&longer&time&in&order&to&respond&for&the&disease,&but&it&gives&our&body&
longer&protection&and&immune&against&that&pathogen.&

&

Dengue&Viral&Infection&

The&infection&for&dengue&virus&can&comes&from&the&bite&of&the&mosquito&Aedes&aegypti&that&
are&infected&with&this&virus.&By&biting&on&a&person,&it&injects&the&virus&directly&into&the&
bloodstream&and&nearby&the&skin&cells&known&as&keratinocytes.&Later,&virus&replicates&itself&
inside&the&specialized&immune&cell&known&as&Langerhans&cell,&which&is&a&type&of&dendritic&
cells.&&They&are&the&cell&that&detect&the&pathogens&that&are&invading&and&make&themselves&
resemble&the&molecule&from&the&pathogen,&known&as&antigen,&on&their&surface.&Then,&they&will&
travel&through&lymph&and&notify&our&immune&system&that&there&are&pathogens&inside&our&bodies&
and&alert&the&immune&responses&for&that.&Lymphatic&system&that&the&Langerhans&cells&use&as&a&
route&through&travel&are&vessels&network&throughout&the&body&and&contains&nodes&that&are&the&
stations&that&contains&immune&cells&that&will&fight&against&the&invading&pathogens.&

&

How&the&Dengue&Virus&Tricks&the&Immune&System&
&
When&the&Langerhans&cells&on&the&skin&are&infected&with&the&dengue&virus,&they&will&
resemble&themselves&with&the&pathogens&and&travel&from&the&infected&area&to&the&lymph&nodes.&
This&will&alert&the&innate&immune&responses,&activating&two&types&of&white&blood&cells&which&are&
monocytes&and&macrophages.&These&will&fight&against&the&infections&by&ingesting&and&digesting.&
Nevertheless,&instead&of&raging&against&the&virus,&they&become&the&target&for&the&infection&by&the&
virus.&Dengue&tricked&the&immune&system&target&more&cells&over&the&infected&areas&and&infected&
all&those&cells.&Later,&the&infected&white&blood&cells&travel&through&the&lymphatic&vessel&and&the&
virus&spread&all&over&the&body.&During&the&journey&through&the&lymphatic&system,&it&infected&
more&cell&including&lymph&nodes,&bone&marrow,&monocyte&in&blood&vessel&and&macrophages&in&
spleen&and&liver.&The&spread&of&the&virus&lead&patient&to&the&condition&of&viremia,&which&there&are&
high&level&of&dengue&virus&in&the&bloodstream.&
&&

How&the&Immune&System&Defeats&the&Dengue&Virus&

Dengue&virus&has&tricked&the&immune&system&to&infect&the&body&cells&and&then&spread&the&
infection&throughout&the&body.&However,&the&immune&system&also&has&the&additional&defenses&to&
fight&with&virus.&The&cells&that&are&infected&will&release&small&proteins&which&called&interferons&
which&have&the&ability&to&interfere&with&viral&replication&and&activate&both&the&innate&and&
adaptive&immune&system&defenses.&The&immune&system&get&help&to&recognize&dengue@infected&
cells&and&prevent&the&uninfected&cells&from&infection.&While&the&immune&system&are&working,&
infected&people&will&likely&to&get&a&fever.&

As&the&immune&system&starts&to&kill&the&Denque&infection,&B&cells&are&producing&the&
antibodies&which&called&IgM&and&IgG&that&are&released&in&the&blood&and&lymph&fluid.&While&T&cells&
are&recognizing&and&kill&the&cells&that&got&the&infection.&It&helps&antibodies&and&white&blood&cells&
remove&the&virus.&
&

Secondary&Dengue&Infections&

&
After&the&body&recovers&from&the&Denque&infection,&a&infected&person&will&be&protected&from&
the&infection&with&the&remaining&Denque&serotypes&for&about&three&months.&However,&its&not&a&
long@term&protection&and&when&time&passes&for&two&months,&the&person&can&still&be&infected&with&
any&type&of&the&remaining&three&Denque&serotypes.&
&
In&the&1960s,&Dr.&Scott&Halstead&and&his&colleagues&were&learning&about&the&denque&virus&in&
Thailand.&They&found&that&people&who&get&the&infection&of&Denque&for&the&second&time&will&likely&
to&show&the&symptom&more&severe&than&the&people&who&get&the&virus&for&the&first&time.&And&they&
tried&to&figure&that&out.&

The&body&will&remember&infection&for&a&long&time&after&we&get&the&infection&with&a&pathogen.&
The&infection&is&remembered&by&the&memory&B&cells&and&memory&T&cells&which&already&present&
in&the&body.&Since&they&remember&the&first&infection,&the&reaction&can&occurs&rapidly&to&respond&
to&the&second&infection.&Memory&cells&can&remain&in&the&body&for&many&years&but&they&wonder&
why&the&second&time&of&Denque&is&worse&than&the&first&time.&

Halstead&explain&that&the&antibodies&that&responds&to&the&first&infection&will&help&spread&the&
dengue&viral&infection&and&increase&viremia,&the&amount&of&virus&in&the&bloodstream.&This&
phenomenon&can&occur&to&the&children&who&receive&the&antibodies&from&their&mom&when&mom&
pregnant.&The&existing&antibodies&including&the&one&that&newly&produced&can&help&the&virus&
infect&the&host&cells.&&

&

Figure&3:&Model&of&antibody@dependent&enhancement&of&dengue&infection&

Conclusion&

Researchers&also&observed&that&during&a&second&infection&with&dengue,&the&immune&system&
produce&the&cytotoxic&T&cells&which&provide&only&partial&immunity&against&the&new&dengue&
serotype.&The&cytotoxic&T&cells&do&not&clear&the&virus&from&the&body&effectively,&and&they&release&
excess&quantities&of&molecules&called&cytokines&which&helps&the&immune&response.&However,&if&
the&amount&of&cytokines&is&too&high,&it&can&cause&serious&inflammation&and&tissue&damage&such&
as&leakage&from&the&capillaries,&possibly&contributing&to&the&development&of&severe&dengue&
diseases.&

In&conclusion,&the&first&response&to&the&dengue&virus&in&our&body&is&the&immune&system.&After&
our&body&recognize&the&dengue&virus,&both&innate&and&adaptive&immunity&that&function&as&an&
immunity&response&will&combine&and&fight&off&the&virus.&Firstly,&the&white&blood&cells&that&
produce&the&antibodies&will&come&and&recognize&the&viral&particles&and&later,&the&cytotoxic&T&cell&
will&kill&all&of&the&cells&that&was&infected&by&dengue&virus.&Patient&that&had&been&infected&with&the&
various&type&of&dengue&virus&for&a&long&period&can&experience&with&the&antibody@dependent&
enhancement.&This&condition&can&happen&during&the&time&when&our&immune&response&cause&
the&dengue&symptoms&become&even&worse&which&finally&increase&the&risk&of&harmful&dengue.&&
Blibilography&
!
Dengue&Fever&.&(n.d.).&Retrieved&May&19,&2017,&from&WebMD:&http://www.webmd.com/a@to@z@&
& guides/dengue@fever@reference#1&
Host&Response&to&the&Dengue&Virus.&(n.d.).&Retrieved&May&19,&2017,&from:&&
& https://www.nature.com/scitable/topicpage/host@response@to@the@dengue@virus@&
& 22402106&
Maron,&D.&F.&(2015,&December&30).&First&Dengue&Fever&Vaccine&Gets&Green&Light&in&3&Countries.&&
& Retrieved&May&20,&2016,&from&https://www.scientificamerican.com/article/first@dengue@&
& fever@vaccine@gets@green@light@in@3@countries/&
Mayo&Clinic.&(2016,&April&20).&Diseases&and&Condtion&Dengue&Fever.&Retrieved&May&19,&2017,&&
& from&http://www.mayoclinic.org/diseases@conditions/dengue@fever/basics/causes/con@&
& 20032868&
Mayo&Clinic.&(2016,&April&20).&Prevention.&Retrieved&May&19,&2017,&from&&
& http://www.mayoclinic.org/diseases@conditions/dengue@fever/basics/prevention/con@&
& 20032868&
Mayo&Clinic.&(2016,&April&20).&Treatments&and&dugs.&Retrieved&May&19,&2017,&from&&
& http://www.mayoclinic.org/diseases@conditions/dengue@fever/basics/treatment/con@
& 20032868&
Symptoms&and&What&To&Do&If&You&Think&You&Have&Dengue.&(n.d.).&Retrieved&May&19,&2017,&from&&
& https://www.cdc.gov/dengue/symptoms/&
World&Health&Organization.&(2017,&April).&Dengue&and&severe&dengue.&Retrieved&May&19,&2017,&
& from&http://www.who.int/mediacentre/factsheets/fs117/en/&
&
&

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