Recent advances in understanding dengue.
Recent advances in understanding dengue.
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DOI：
10.12688/f1000research.19197.1
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发表时间：
2019-01-01
期刊：
影响因子：
--
通讯作者：
Halstead, Scott
中科院分区：
文献类型：
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作者：
Halstead, Scott
这是一个选择性的审查，最近发表的登革热的临床特点，流行病学，发病机制，并放置在过去的半个世纪的观察背景下的疫苗开发。四种登革病毒（DENV）由城市循环蚊子传播，引起疾病，其性质和严重程度受相互作用的因素如病毒、年龄、宿主的免疫状态和人类遗传变异性的影响。控制DENV感染动力学的现象，抗体依赖性增强，最好地解释了血管通透性综合征与第二异型DENV感染和被动获得抗体存在下的感染的相关性。基于越来越多的体内和体外证据，组织损伤性登革病毒非结构蛋白1（NS1）负责严重登革的大多数病理生理学特征。这篇综述考虑了噬血细胞组织细胞增多综合征对严重登革热病例的贡献，人类运动在登革热流行病学中的作用，以及建模和规划控制方案，并描述了孟加拉国登革热感染的全国范围内的调查，并努力了解控制登革热感染的临床结果。综述了三种四价减毒活疫苗的研究进展和存在的问题。一些研究谜团仍然存在：为什么在第二次异型登革病毒感染期间发生严重疾病的风险如此低，为什么血管通透性的发生与退热相关，以及保护性免疫的关键成分是什么？
This is a selective review of recent publications on dengue clinical features, epidemiology, pathogenesis, and vaccine development placed in a context of observations made over the past half century. Four dengue viruses (DENVs) are transmitted by urban cycle mosquitoes causing diseases whose nature and severity are influenced by interacting factors such as virus, age, immune status of the host, and human genetic variability. A phenomenon that controls the kinetics of DENV infection, antibody-dependent enhancement, best explains the correlation of the vascular permeability syndrome with second heterotypic DENV infections and infection in the presence of passively acquired antibodies. Based on growing evidence in vivo and in vitro, the tissue-damaging DENV non-structural protein 1 (NS1) is responsible for most of the pathophysiological features of severe dengue. This review considers the contribution of hemophagocytic histiocytosis syndrome to cases of severe dengue, the role of movement of humans in dengue epidemiology, and modeling and planning control programs and describes a country-wide survey for dengue infections in Bangladesh and efforts to learn what controls the clinical outcome of dengue infections. Progress and problems with three tetravalent live-attenuated vaccines are reviewed. Several research mysteries remain: why is the risk of severe disease during second heterotypic DENV infection so low, why is the onset of vascular permeability correlated with defervescence, and what are the crucial components of protective immunity?