Viral Immune Evasion in Dengue: Toward Evidence-Based Revisions of Clinical Practice Guidelines

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Title	Viral Immune Evasion in Dengue: Toward Evidence-Based Revisions of Clinical Practice Guidelines
Authors	Francesco Chiappelli^1,2*, Silvana Maria Eloi Santos^2,3, Xenia Maria Caldeira Brant², Andre Bakhordarian^1,2, April D Thames⁴, Carl A Maida^1,5, Angela M Du¹, Allison L Jan¹, Melissa Nahcivan¹, Mia T Nguyen¹, Nateli Sama¹
Affiliation	¹UCLA Center for the Health Sciences 63-090, 10833 Le Conte Avenue, Los Angeles, CA 90095-16682; ²Evidence-Based Decision Practice-Based Research Network; ³Faculdade de Medicina. Universidade Federal de Minas Gerais; ⁴UCLA David Geffen School of Medicine (Psychiatry); ⁵UCLA School of Dentistry (Public Health Dentistry), UCLA Institute of the Environment and Sustainability, UCLA Center for Tropical Research
Email	fchiappelli@dentistry.ucla.edu; *Corresponding author
Article Type	Hypothesis
Date	Received November 24, 2014; Accepted November 26, 2014; Published December 31, 2014
Abstract	Dengue, a leading cause of illness and death in the tropics and subtropics since the 1950’s, is fast spreading in the Western hemisphere. Over 30% of the world’s 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.
Citation	Chiappelli et al. Bioinformation 10(12): 726-733 (2014)
Edited by	P Kangueane
ISSN	0973-2063
Publisher	Biomedical Informatics
License	This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. This is distributed under the terms of the Creative Commons Attribution License.