Presentation in last year/years:
Fever with bone and joint pain. Hemorrhage was a common complication and used to occur during afebrile period.
Presentation in present year:
Fever, usually no bone or joint pain. Organ involvement specially cardiac and neurologic involvement is common, Hemorrhage is less common. Complications occur during febrile period. What is /are the factor/factors behind these changes in characteristics?
I don't know the answer, but avenues to explore might include:
- has the DENV type circulating in your area changed (eg. maybe DENV-1 and DENV-2 have different common symptoms)?
- has the seroprevalence of other flaviviruses changed following recent outbreaks (eg. possible antibody-dependent effects with pre-existing antibodies to chikungunya, Zika or Japanese encephalitis viruses)?
- have the characteristics of the patients also changed (eg. previously more adults, now more children)?
I think the immune system is the main factor as well as whether primary or secondary infection
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