Viral immune evasion in dengue: toward evidence-based revisions of clinical practice guidelines

Journal Name: 
Bioinformation.
Authors: 
Chiappelli,F.
Santos,S.M.
Caldeira Brant,X.M.
Bakhordarian,A.
Thames,A.D.
Maida,C.A.
Du,A.M.
Jan,A.L.
Nahcivan,M.
Nguyen,M.T.
Sama,N.
Abstract: 
Dengue, a leading cause of illness and death in the tropics and subtropics since the 1950s, is fast spreading in the Western hemisphere. Over 30% of the worlds population is at risk for the mosquitoes that transmit any one of four related Dengue viruses (DENV). Infection induces lifetime protection to a particular serotype, but successive exposure to a different DENV increases the likelihood of severe form of dengue fever (DF), dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS). Prompt supportive treatment lowers the risk of developing the severe spectrum of Dengue-associated physiopathology. Vaccines are not available, and the most effective protective measure is to prevent mosquito bites. Here, we discuss selected aspects of the syndemic nature of Dengue, including its potential for pathologies of the central nervous system (CNS). We examine the fundamental mechanisms of cell-mediated and humoral immunity to viral infection in general, and the specific implications of these processes in the regulatory control of DENV infection, including DENV evasion from immune surveillance. In line with the emerging model of translational science in health care, which integrates translational research (viz., going from the patient to the bench and back to the patient) and translational effectiveness (viz., integrating and utilizing the best available evidence in clinical settings), we examine novel and timely evidence-based revisions of clinical practice guidelines critical in optimizing the management of DENV infection and Dengue pathologies. We examine the role of tele-medicine and stakeholder engagement in the contemporary model of patient centered, effectiveness-focused and evidence-based health care. ABBREVIATIONS:
2014
Volume: 
10
Pages: 
726-733
Keywords: 
1950, Central Nervous System, clinical, Death, decision, Dentistry, electronic, Environment, Fever, Guidelines, Health, health care, Immunity, Infection, Los Angeles, Medicine, pathology, patient, physiopathology, population, Practice Guidelines, practice-based research, Psychiatry, Public Health, Public Health Dentistry, Research, Risk, Role, Shock, system, Telemedicine, Translational Research