Ascites, Dengue, Dengue Hemorrhagic Fever, Dengue With Warning Signs, Gut Microbiome, Intestinal Disease
Conditions
Brief summary
Dengue infections are imposing an increasing global burden of disease, particularly in tropical countries such as Bangladesh. The World Health Organization (WHO) has identified Dengue virus as a priority pathogen for the development of medical counter measures because of the high risk of it causing a Public Health Emergency of Intenational Concern (PHEIC). Warning signs for severe dengue, associated with mortality, include gastrointestinal features including abdominal pain, vomiting, and diarrhoea. Multiple alterations may occur in in the gastrointestinal tract that could lead to damaging of the gastrointestinal wall and gut leakage, the translocation of gut metabolites into the bloodstream. Study team hypothesize that gut leakage initiates inflammatory processes underlying the further development of severe dengue, including features associated with plasma leakage. This study aims to investigate intestinal barrier dysfunction (gut leakage) in dengue infection by detecting the translocation of gut-derived bacteria and their products (Lipopolysaccharides, LPS binding protein, sCD14, I-Fatty Acid Binding Protein) into the bloodstream. Study team will recruit hospitalized adult dengue patients (18 years and older) presenting with warning signs or severe disease in a tertiary care public hospital at Chattogram, Bangladesh. Circulating biomarkers indicative of gut permeability and microbial translocation will be measured to assess their presence and association with disease severity. Abdominal ultrasonography will be performed to characterize gastrointestinal alterations and determine their correlation with biochemical markers of gut leakage and clinical severity. In addition, study team will analyze the gut bacteriome from stool/ rectal swab of these patients to explore whether dengue infection induces compositional changes in intestinal microbiota and whether such alterations are linked to gut leakage or disease progression.
Interventions
None listed
Sponsors
University of Oxford
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Dengue participants * Participant/ legally authorised representative willing and able to give informed consent for participation in the study. * Male or Female, adults ≥18 years * Diagnosed as a case of Dengue on the basis of clinical features and positive NS1 antigen and/or IgM dengue antibody * Hospitalized in medicine or dengue ward in Chittagong Medical College Hospital. * Enrolled within 24 hours of hospitalization. Healthy participants * Participant/ legally authorised representative willing and able to give informed consent for participation in the study. * Male or Female, adults ≥18 years * Clinically healthy with no acute or chronic illness * Attendant of a dengue patient (not a patient)
Exclusion criteria
Dengue participants * Unable to provide consent or participate in follow-up procedures * Known chronic gastrointestinal (GI) disease affecting intestinal permeability (IBD, celiac disease), chronic liver disease, active chronic diarrhoea, short bowel loop syndrome, recent (\<3 months) major GI surgery. * Immunosuppression (for example chemotherapy, high-dose steroids), advanced chronic kidney disease, decompensated heart failure. * Drugs that can alter the level of biomarkers in blood like metformin, statin, probiotics, steroid within last 48 hours of hospitalization. * Pregnancy Healthy participants * Unable to provide consent * Known chronic gastrointestinal (GI) disease affecting intestinal permeability (IBD, celiac disease), chronic liver disease, active chronic diarrhoea, short bowel loop syndrome, recent (\<3 months) major GI surgery. * Immunosuppression (for example chemotherapy, high-dose steroids), advanced chronic kidney disease, decompensated heart failure. * Drugs that can alter the level of biomarkers in blood like metformin, statin, probiotics, steroid within last 48 hours of hospitalization. * Pregnancy * History of current or recent dengue or other arbo viral infection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Level of gut leakage marker in blood and gastrointestinal findings in POCUS | On enrollment, day of development of severity if non severe at enrolment, up to 28 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Document clinical events occurred in dengue patients | Through study completion, an average of 28 days | Demographic: Age, gender, BMI Clinical: respiratory rate, blood pressure, heart rate, ascites, pleural effusion, any major bleeding, GCS |
Countries
Bangladesh
Outcome results
None listed