ABSTRACT
Preface@#The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent and current recommendations based on evidence from local and international data. The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG. Individual members were identified from each society as content experts to form the Steering Committee along with a clinical epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel. There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and PIDSP societies. The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the years. As identified in the previous CPG updates, there is lack of local data hence most of the evidences gathered came from international studies. The applicability of such data to the local setting needs to be critically assessed for its value and relevance. Corollary to this, several gaps in knowledge are identified and these may serve as a guide for future research.
ABSTRACT
Background@#Dengue, a mosquito-borne flavivirus, is hyperendemic in the Philippines. One of its rare complication is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. Previously known as non-neurotropic, dengue presents with an increasing incidence of neurologic manifestations. @*Objective@#To describe the clinico-demographic profile and outcome of laboratory-confirmed dengue encephalitis patients. @*Methods@#This is a retrospective study that used purposive sampling to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years. The clinico-demographic profiles and outcomes were collected using chart review, and variables were analyzed using descriptive statistics. @*Results@#14 laboratory-confirmed cases were reviewed. Most (57%) were males aged 3 days-15 years. Fever lasted 3-11 days. Following nonspecific signs and symptoms, neurological manifestations developed within 1-5 days, the most common being seizures (71%). Majority (57%) had anemia. All, except one, exhibited leukopenia and thrombocytopenia. Elevated liver enzymes, bleeding parameter derangements, electrolyte, and glucose imbalances were noted. All were seropositive for dengue IgM, and 5 dengue IgM in the CSF. Most common EEG findings showed generalized slowing. Neuroimaging reports were normal in some or showed cerebral edema in the others. Half of the patients recovered fully, 3 showing partial recovery from neurologic changes, and 3 others had neurologic sequelae. One infant expired. @*Conclusions and Recommendations@#Dengue encephalitis should be considered in patients living in an endemic country, presenting with fever with neurologic changes or elevated liver enzymes, with a risk for developing neurologic sequelae or death.
Subject(s)
Severe DengueABSTRACT
BACKGROUND@#Dengue, a mosquito-borne flavivirus infection, is hyperendemic in the Philippines. One of the rare complications is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. The actual incidence of dengue encephalitis is underestimated due to problems of pathogen detection. To address this, an integrated surveillance system has been in place since 2007, which detects laboratory-confirmed dengue meningoencephalitis from blood and CSF samples via IgM capture ELISA.@*OBJECTIVES@# To describe the clinico-demographic profile and outcome upon hospital discharge of laboratory-confirmed dengue encephalitis patients admitted at the Philippine Children’s Medical Center (PCMC) from January 2011 to June 2017.@*METHODS@#This is a retrospective observational study to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years at PCMC from January 2011 to June 2017.The clinico-demographic profiles and outcomes of patients were collected using chart review, and variables were analyzed using descriptive statistics.@*RESULTS@#14 cases of laboratory-confirmed dengue encephalitis children were reviewed. None had known previous dengue infection nor received dengue vaccination. Following nonspecific signs and symptoms, neurological manifestations developed with a median of 2 days, the most common being seizures, most of which were generalized, and decreased sensorium. Most common abnormal EEG waveforms were generalized background slowing; neuroimaging was normal or showed cerebral edema. Full recovery upon discharge was seen in half the patients reviewed, 3 showing partial recovery from neurologic signs and symptoms, and 3 others were discharged with neurologic sequelae. One infant expired.@*RECOMMENDATIONS@#Prospective studies with larger sample sizes that will follow-up on the patient’s long-term outcome are recommended.