Validation of the simple clinical risk score for the early detection of severe dengue in adult patients

Background@#In 2009, the World Health Organization revised the Dengue Fever guidelines to more accurately identify patients at risk of developing severe dengue. Despite these guidelines, early diagnosis of severe dengue remains challenging for clinicians. Several scoring systems have been developed to identify patients at highest risk for severe dengue however; these studies have a study population limited to children and did not include adult patients.@*Objective@#The purpose of this study is to validate the Simple Clinical Risk Score in predicting who will develop severe Dengue among adult patients with Dengue fever.@*Methods@#This is a prospective cohort, single-center, observational study conducted at Silliman University Medical Center from August 2019 to August 2020. A total of 481 laboratory confirmed dengue patients were included and categorized into two models based on the day of illness. Each model used a clinical risk score of 1 point as a cut-off for predicting severe Dengue. Validation was done using the risk-odds ratio and substantiated by the odds ratio, signifying that there is more likely greater association between dengue patients to develop severe dengue.@*Results@#In model 1, a total of 339 patients were analyzed with 6 patients who achieved a score of 1 developed severe Dengue. In model 2, a total of 142 patients were analyzed and 3 patients who achieved a score of 1 developed severe dengue.@*Conclusion@#The simple clinical risk score can assist clinicians in deciding and stratifying dengue patients who need hospitalization not only in resource-limited areas but also during this height of the pandemic. While the findings had a lesser number of participants, it still remained context-specific and is able to demonstrate a predictive ability for severe disease, thereby optimizing informed decisions for hospital admissions in settings with limited laboratory resources.

Caracterización y factores asociados con la atención de embarazadas con dengue en Cali, Colombia / Characterization and factors associated with the care of pregnant women with dengue in Cali, Colombia

Resumen OBJETIVO: Describir las características sociodemográficas y clínicas y determinar los factores asociados con la hospitalización y la oportunidad de consulta en embarazadas notificadas con dengue en Cali, Colombia. MATERIALES Y MÉTODOS: Estudio observacional, analítico y retrospectivo de base poblacional. Descripción de las características sociodemográficas y clínicas de las embarazadas con dengue que se notificaron al Sistema de Vigilancia en Salud Pública (SIVIGILA). Para identificar los factores asociados con la hospitalización se aplicó un modelo de regresión logística y para el procesamiento estadístico se utilizó SPSS versión 26. RESULTADOS: Se estudiaron 674 embarazadas con dengue, 63.9% (n = 431) sin signos de alarma, 36.1% (n = 243) con signos de alarma y ningún caso de dengue grave. En cuanto a la conducta, el 42.3% ( n = 285) se trató de manera ambulatoria, 39.5% (n = 266) en el hospital;12.5% (n = 84) permaneció en observación, 1.9% (n = 13) requirió el envío a otro centro de salud para su hospitalización y el 3.9% (n = 26) requirió atención en cuidados intensivos. CONCLUSIONES: En las embarazadas, la infección por dengue aumenta la morbilidad; los principales factores asociados con la hospitalización fueron: trombocitopenia, hipotensión, dolor abdominal, erupción cutánea y vómito. Por parte de las entidades de salud y la comunidad se requieren intervenciones efectivas enfocadas a la manipulación de residuos y educación e insistencia en los principales signos de alarma por los que deben solicitar la consulta médica.

Abstract OBJECTIVE: To describe the sociodemographic and clinical characteristics and to determine the factors associated with hospitalization and timeliness of consultation in pregnant women notified with dengue fever in Cali, Colombia. MATERIALS AND METHODS: Observational, analytical and retrospective population-based study. Description of the sociodemographic and clinical characteristics of pregnant women with dengue reported to the Public Health Surveillance System (SIVIGILA). A logistic regression model was applied to identify factors associated with hospitalization and SPSS version 26 was used for statistical processing. RESULTS: A total of 674 pregnant women with dengue were studied, 63.9% (n = 431) without alarm signs, 36.1% (n = 243) with alarm signs and no cases of severe dengue. In terms of behavior, 42.3% ( n = 285) were treated on an outpatient basis, 39.5% (n = 266) in hospital;12.5% (n = 84) remained under observation, 1.9% (n = 13) required referral to another health center for hospitalization and 3.9% (n = 26) required intensive care. CONCLUSIONS: In pregnant women, dengue infection increases morbidity; the main factors associated with hospitalization were: thrombocytopenia, hypotension, abdominal pain, rash, and vomiting. On the part of the health entities and the community, effective interventions focused on waste handling and education and insistence on the main warning signs for which they should seek medical consultation are required.

Frecuencia elevada de casos de dengue grave durante la epidemia por el linaje II del DENV-2 americano/asiático en el Perú / High frequency of severe dengue cases during the American/Asian DENV-2 lineage II epidemic in Peru

RESUMEN Introducción. El ingreso del linaje II del DENV-2 americano/asiático en la región Loreto de la Amazonia Peruana, coincidió con un incremento súbito de los casos de dengue con necesidad de hospitalización. Sin embargo, las estadísticas oficiales reportaron pocos casos graves. Se postula, que existió una subnotificación de los casos graves en los reportes oficiales del Ministerio de Salud. Objetivos. Conocer la frecuencia de pacientes con signos de gravedad entre los pacientes hospitalizados por dengue probable durante el brote del 2011 en el Hospital Iquitos, Perú. Métodos. Se realizó un estudio longitudinal, aplicando una lista de chequeo diaria, sobre la presencia de signos de gravedad durante la estancia hospitalaria, a un grupo de pacientes hospitalizados en la unidad de dengue del Hospital Iquitos. Resultados. De 178 pacientes evaluados 66 (37%, IC: 29,9 - 44,6%) presentaron algún signo de gravedad, la mayor parte por shock (75,7%). Este resultado contrasta con el número de pacientes con dengue grave reportado por el Ministerio de Salud durante el año 2011 en la región Loreto. Conclusión. Aproximadamente un tercio de los pacientes que fueron hospitalizados con el diagnostico de dengue, durante el brote por el linaje II del DENV-2 americano/asiático, desarrollaron signos de gravedad durante su hospitalización.

ABSTRACT Introduction. The entry of American/Asian DENV-2 lineage II in the Loreto region of the Peruvian Amazon coincided with a sudden increase in dengue cases requiring hospitalization. However, official statistics reported few severe cases. It is postulated that there was an underreporting of severe cases in the official reports of the Ministry of Health. Objectives. To determine the frequency of patients with signs of severity among patients hospitalized for probable dengue fever during the 2011 outbreak at the Iquitos Hospital, Peru. Methods. A longitudinal study was carried out applying a daily checklist on the presence of signs of severity during hospital stay to a group of patients hospitalized in the dengue unit of the Iquitos hospital. Results. Of 178 patients evaluated, 66 (37%, CI: 29.9-44.6%) presented some sign of severity, mostly due to shock (75,7%). This result contrasts with the number of patients with severe dengue reported by the Ministry of Health during 2011 in the Loreto region. Conclusion. Approximately one third of the patients who were hospitalized with a diagnosis of dengue during the outbreak of American/Asian DENV-2 lineage II developed signs of severity during their hospitalization.

Descripción clínica de niños fallecidos por dengue hemorrágico durante la epidemia cubana de 1981

RESUMEN Introducción: El dengue es una importante arbovirosis en términos de morbilidad y mortalidad. Objetivo: Caracterizar clínica y epidemiológicamente a un grupo de fallecidos con dengue hemorrágico menores de 15 años durante la epidemia cubana de 1981. Métodos: estudio retrospectivo, descriptivo en una muestra de 67 pacientes. La información se extrajo de las historias clínicas. Resultados: La mayor parte de los pacientes estudiados tenían entre 3 y 10 años de edad, con similar distribución entre ambos sexos, de color de piel blanca en su mayoría, normopesos y con aparente estado de salud. Los síntomas predominantes fueron la fiebre, los vómitos y el sangramiento digestivo, que motivaron el ingreso a partir del 3er. día en la mayoría de las veces. El choque apareció generalmente entre el 4to. y 5to. día, precedido por los vómitos o el dolor abdominal y asociado al aumento del hematocrito y la trombocitopenia. Los referidos signos clínicos de alarma y otros menos frecuentes fueron capaces de anunciar el choque. Los signos radiográficos más encontrados fueron la opacidad y el derrame pleural derecho; en las necropsias predominó el sangramiento gastrointestinal, el derrame seroso y la necrosis hepática medio zonal. Conclusiones: La caracterización clinicoepidemiológica de los casos fallecidos por dengue durante la primera epidemia sufrida en la región de las Américas ha permitido conocer la evolución de la enfermedad y contribuido a la elaboración de las guías para su atención y tratamiento efectivo.

ABSTRACT Introduction: Dengue is an important arbovirus in terms of morbidity and mortality. Objective: Characterize clinically and epidemiologically a group of deceased with hemorrhagic dengue under 15 years of age during the Cuban epidemic of 1981. Methods: Retrospective, descriptive study in a sample of 67 patients. The information was extracted from medical records. Results: Most of the patients studied were between 3 and 10 years old, with similar distribution between both sexes, mostly white skin, normal weight and with apparent good state of health. The predominant symptoms were fever, vomiting and digestive bleeding, which motivated admission at the 3rd day in most cases. The shock usually appeared between the 4th. and 5th. day, preceded by vomiting or abdominal pain, and associated with increased hematocrit and thrombocytopenia. The most commonly found radiographic signs were opacity and right pleural effusion ; necropsies, gastrointestinal bleeding, serous effusion and zonal mid-hepatic necrosis predominated. Conclusions: The clinical-epidemiological study of the cases that died from dengue during the first epidemic suffered in the region of the Americas has made it possible to know the evolutionary particularities of the disease and contributed to the elaboration of guidelines for its care and effective treatment.

DENGUE HEPATOPATHY AND ITS CORRELATION WITH SEVERITY OF DISEASE FROM WESTERN PART OF INDIA

Background and Objectives: The global incidence of dengue hasgrown dramatically in recent decades affecting children and young adults mainly intropical and subtropical countries.Dengue has a wide spectrum of clinicalpresentations, often with unpredictable clinical evalution and outcome. While mostpatients recover following a self-limiting non-severe clinical course, a smallproportion progress to severe disease, mostly characterised by plasma leakage with orwithout haemorrhage.Methods: It is a Prospective ,observational study including 150 serologicallyconfirmed Dengue fever in a tertiary care centre. The main objective was tostudy patterns of hepatopathy in dengue fever and to determine whether thepatterns of hepatic involvement correlate with clinical , laboratory profile andoutcome in Dengue fever according to WHO classification .Results: Younger age groups were found to be more prone tohepatopathy with 46.7 % of patients having hepatopathy(transaminases >3x UNL) belonging to ages 21-30 yrs. AST levelcorrelates maximum with severe Dengue ,followed by abnormal PTand APTT value .AST is more useful than ALT and AST:ALT Ratiois even more reliable indicator than using the values alone.Riskfactors which were statistically significant for mortality :PositiveTourniquet test, Abnormal CNS Examination, BleedingManifestations, and thrombocytopenia.Hepatic dysfunction Grade 3and 4 were not directly related to mortality.Interpretation and Conclusion: Even though hepatopathy does notcorrelate with the severity of disease directly, its significantassociation with warning signs ,thrombocytopenia and bleedingmanifestations make it very important factor to predict which subsetof patients will develop severe Dengue fever.Timely diagnosis ofhepatopathy in patients with dengue fever and its management mayimprove patient survival rate

Correlation of Cardiac manifestations In Dengue

Objectives: This study was done to study the prevalence of cardiac manifestations of dengue fever in patients presenting to our hospital and to find out the correlation of cardiac manifestations with the warning signs of dengue infection The study was conducted at Government Villupuram Medical College and Hospital,a tertiary careMethods: hospital in the month of July to December 2021. One hundred consecutive patients aged 15 years or more with positive dengue serology were interviewed and examined. ECG was done for all patients and selected patients underwent echo evaluation and troponin testing. The data was analyzed using statistical significance tests Thirty-three patientsResults: had no warning signs, 59 patients had one warning sign or the other. Eight patients had severe dengue. The minimum pulse rate was 32/ minute. The most common cardiac abnormalities noted were rhythm abnormalities of which the commonest was sinus bradycardia, found in 34 percent. There was statistically significant correlation between cardiac manifestations and all the warning signs except persistent vomiting. Among severe dengue, fluid accumulation causing respiratory distress was found to have a significant correlation with the cardiac manifestations The mostConclusions: common cardiac manifestations noted were transient rhythm abnormalities, of which sinus bradycardia was the commonest. There was no evidence of Myocarditis in any of the patients .There was statistically significant correlation between cardiac manifestations and all the warning signs except persistent vomiting. Among severe dengue, fluid accumulation causing respiratory distress was found to have a significant correlation with the cardiac manifestations.

Clinical features of patients with severe dengue in Guangdong Province from 2013 to 2019 / 中华传染病杂志

Objective:To analyze the clinical features of patients with severe dengue (SD) in Guangdong Province, and to improve the understanding of the diagnosis and treatment of SD in China.Methods:The clinical data, laboratory examination and etiological test results of 257 SD cases from 29 dengue fever designated hospitals in Guangdong Province from January 1, 2013 to December 31, 2019 were respectively collected. The relevant indicators of the criteria for severe organ involvement were quantified. Logistic regression analysis was performed to analyze the risk factors for the development of multiple organ failure in SD patients.Results:Among the 257 SD patients, age was (64.1±20.1) years old, with 65.4%(168/257) of them ≥60 years old, 142 were male and 115 were female. One hundred and fifty-two (59.1%) patients had underlying conditions, including 115(44.7%) patients with hypertension. The clinical manifestations were mainly fever (98.4%(253/257)), fatigue (70.0%(180/257)), cough or expectoration (44.4%(114/257)), lethargy or irritability (39.3%(101/257)), vomiting (30.4%(78/257)), abdominal pain or tenderness (20.6%(53/257)), hepatomegaly (2.3%(6/257)), bleeding tendency (59.5%(153/257)), and pleural effusion or ascites (43.6%(112/257)). Platelet count levels were decreased in 90.9%(231/254) of the cases, and 97.1%(234/241) of patients had normal or decreased hematocrit. The most common of severe manifestations were severe organ involvement (61.1%(157/257)), followed by severe bleeding (37.0%(95/257)) and severe plasma leakage (30.0%(77/257)). Severe organ involvements were more common in the kidney (27.6%(71/257)) and heart (26.8%(69/257)). Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.051, 95% confidence interval ( CI) 1.004 to 1.100, P=0.035), hypertension ( OR=5.224, 95% CI 1.272 to 21.462, P=0.022), elevated aspartate aminotransferase (AST) level ( OR=1.002, 95% CI 1.001 to 1.003, P=0.001), blood urea nitrogen (BUN) ( OR=1.050, 95% CI 1.005 to 1.098, P=0.030), and international normalized ratio (INR) ( OR=4.604, 95% CI 1.601 to 13.238, P=0.005) were risk factors for the development of multiple organ failure in SD patients. The detection results of serum samples form 113 SD patients in acute phase showed that dengue virus (DENV)-1 accounted for 89.4%(101/113), DENV-2 accounted for 9.7%(11/113), and DENV-3 accounted for 0.9% (1/113). Conclusions:Elderly and those with co-existing conditions such as hypertension in SD patients in Guangdong Province are more common. Severe organ involvement such as kidney and heart is the main cause of SD. DENV-1 infection is predominant. Significant elevated levels of AST, BUN and INR may be related to a poor prognosis.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study

ABSTRACT Background: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. Methods: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. Results: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). Conclusions: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Síndrome hemofagocítico secundario a infección por virus del dengue / Hemophagocytic syndrome secondary to dengue virus infection

Introducción: El síndrome hemofagocítico se presenta como un cuadro clínico grave, provocado por una respuesta inadecuada del sistema inmunológico a un desencadenante infeccioso, neoplásico, reumatológico o metabólico, que origina una reacción inflamatoria no controlada; presenta una incidencia baja pero la letalidad sin el manejo adecuado es muy elevada. Objetivo: Destacar la importancia de diagnóstico oportuno del síndrome hemofagocítico en pacientes con dengue que presentan evolución tórpida. Presentación del caso: Paciente de 7 años de edad, con dengue grave dado por shock, hepatomegalia con elevación de transaminasas, con mala evolución clínica, quien cumple criterios de Síndrome hemofagocítico. Recibió manejo con inmunomoduladores con evolución satisfactoria. Conclusiones: Es importante considerar el Síndrome hemofagocítico como causa ante enfermedades con evolución tórpida a pesar de tener un manejo médico correcto(AU)

Introduction: Hemophagocytic syndrome is a severe clinical picture with an uncontrolled inflammatory reaction caused by an inadequate immune system response to an infectious, neoplastic, rheumatological, or metabolic trigger. The syndrome has low incidence but high fatality when the management is not adequate. Objective: To highlight the importance of a prompt diagnosis of hemophagocytic syndrome in patients with dengue who present a torpid evolution. Case presentation: Seven-year-old patient with severe dengue caused by shock, hepatomegaly with elevated transaminase levels and poor clinical evolution who meets hemophagocytic syndrome criteria. The patient had satisfactory progression after receiving immunomodulatory treatment. Conclusions: Hemophagocytic syndrome must be considered as a cause of pathologies in dengue patients with torpid evolution, even when correct medical management is made(AU)

Comportamiento clínico y de laboratorio del choque por dengue en pacientes pediátricos / Clinical and laboratory behavior of dengue shock among pediatric patients

Introducción: El dengue es la enfermedad viral transmitida por artrópodos que más morbilidad y mortalidad ocasiona mundialmente. En el mundo actual, esta arbovirosis se considera la décima causa de muerte sobre todo en edades pediátricas. Objetivo: Caracterizar el comportamiento clínico y de laboratorio del choque por dengue en niños a partir de un año de edad. Métodos: Se realizó un estudio de corte transversal. Se estudiaron 19 pacientes con diagnóstico de choque por dengue. Para el análisis estadístico se utilizaron medidas de resumen como frecuencias, porcentaje, rango, mediana y moda. Resultados: Los signos de choque por dengue predominaron en los pacientes mayores de 5 años, femeninos y blancos, normopesos con antecedentes de salud. La mayoría ingresó al cuarto día; la fiebre fue el principal motivo de ingreso. El aumento progresivo del hematocrito fue el principal signo de alarma, y la hipotensión sin otra manifestación de choque constituyó la manifestación clínica más frecuente. Las soluciones cristaloides fueron las más utilizadas con muy buena respuesta clínica. Conclusiones: Todos los pacientes evolucionaron satisfactoriamente; no hubo ningún fallecimiento por dengue a pesar de que la mayoría fueron hospitalizados durante la fase crítica de la enfermedad, existiendo una identificación adecuada de los signos de alarma, y un adecuado control y tratamiento de las formas clínicas de choque por dengue(AU)

Introduction: Dengue is the arthropod-borne disease causing the highest morbidity and mortality worldwide. This condition is currently considered the tenth leading cause of death in the world, mainly in pediatric ages. Objective: Characterize the clinical and laboratory behavior of dengue shock in children aged one year and over. Methods: A cross-sectional study was conducted of 19 patients diagnosed with dengue shock. Statistical analysis was based on the summary measurements frequency, percentage, range, median and mode. Results: Dengue shock signs prevailed in white female patients aged over five years, of normal weight and with a history of good health. Most were admitted on the fourth day; fever was the main reason for admission. Gradual hematocrit increase was the main warning sign, whereas hypotension without any other shock symptom was the most common clinical manifestation. Crystalloid solutions were the most frequently used, with a very good clinical response. Conclusions: All the patients evolved satisfactorily; no death occurred due to dengue, despite the fact that many patients were admitted during the critical stage of the disease; warning signs were appropriately identified and clinical manifestations of dengue shock were controlled and treated(AU)

Factores clínicos y demográficos asociados con la mortalidad por dengue en Colombia: estudio de casos y controles / Demographic and clinical factors associated with dengue mortality in Colombia: a case-control study

Resumen: Objetivo: Identificar factores demográficos y clínicos asociados con la mortalidad por dengue grave en cinco departamentos de Colombia. Material y métodos: Análisis secundario de un estudio de casos y controles basado en pacientes admitidos de 2009 a 2013. Los casos fueron pacientes que murieron por dengue y los controles fueron pacientes con dengue grave sobrevivientes a la enfermedad. Se utilizó el procedimiento de Mantel-Haenszel para identificar los factores. Resultados: Analizando 58 casos y 121 controles, cuatro factores fueron asociados con la mortalidad por dengue: administración hospitalaria de dipirona (RMa=6.38 IC95% 2.41-16.86) y de acetaminofén (RMa=0.25 IC95% 0.10-0.61), presencia de comorbilidad (RMa=3.52 IC95% 1.51-8.18) y consulta previa por el mismo padecimiento (RMa=3.99 IC95% 1.63-9.77). Conclusiones: La administración de dipirona en pacientes con dengue grave se asoció con un aumento del riesgo de mortalidad. Si se considera que la dipirona fue retirada del mercado en 20 países por sus efectos secundarios, se puede desaconsejar su uso en el manejo del dengue.

Abstract: Objective: To identify demographic and clinical factors associated with mortality due to severe dengue in five departments in Colombia. Materials and methods: Case-control study with patients admitted between 2009 and 2013. The cases were patients who died from dengue and the controls where patients with severe dengue who survived the disease. A multivariate analysis using the Mantel-Haenszel procedure identified risk factors associated with dengue mortality. Results: We analyzed 58 cases and 121 controls and identified four factors: in-hospital administration of dypirone (ORa=6.38 95%CI 2.41-16.86) and paracetamol (ORa=0.25 95%CI 0.10-0.61), comorbidities (ORa=3.52 95%CI 1.51-8.18), and a prior visit to the hospital (ORa=3.99 95%CI 1.63-9.77). Conclusions: Administration of dypirone in patients with severe dengue was associated with a higher risk of mortality. Considering that 20 countries have banned dipyrone because of its adverse effects, we advise against its use.

The relationship between level of cytokines and onset of severe dengue and their role as early warning signs / 中华微生物学和免疫学杂志

Objective:To compare the levels of cytokines in patients with dengue fever (DF) and severe dengue (SD) at different time points during the course of disease, to seek the cytokines that can be used as early warning signs of SD, and to explore the relationship between the immune response and the pathogenesis of SD.Methods:Plasma samples at different time points were collected from 60 hospitalized patients including 48 mild cases and 12 severe cases in Guangzhou Eighth People′s Hospital during June to December, 2014. Levels of 19 cytokines including TNF-α, IL-6, IL-8, IL-10, IL-15, IL-17A, IFN-α2, IP-10, MCP-1, RANTES, GRO-α, PDGF-AA, PDGF-AB/BB, MIF, VEGF, sVCAM-1, sICAM-1, sFas and sFasL were determined by a multiplex Luminex system.The viral loads were determined by using fluorescence quantitative RT-PCR and the correlation between viral loads and cytokine level were analyzed.Results:The levels of TNF-α, IL-6, IL-8, IL-10, IL-15, IFN-α2, IP-10, MCP-1 and sVCAM-1 increased in dengue patients, while RANTES, GRO-α and PDGF decreased.The levels of IL-17A, MIF, VEGF, sICAM-1, sFas and sFasL did not change. The levels of TNF-α, IL-6, IFN-α2, IP-10 and sVCAM-1 in SD patients were significantly higher than those in DF patients at the early stage (Day 2-5 after disease onset), and the differences were statistically significant. On day 6-10, the levels of TNF-α, IL-6, IL-8, IL-10, IL-15, PDGF, RANTES, IFN-α2, IP-10 and sVCAM-1 were significantly different between DF and SD patients. The results of correlation analysis showed that the level of IL-15 was moderately correlated with viral load, while other cytokines was only weakly correlated or not.Conclusions:TNF-α, IL-6, IFN-α2, IP-10 and sVCAM-1 can be used as early warning signs of SD. The level of cytokines is related to the severity of dengue fever.

Incidence and spatial distribution of cases of dengue, from 2010 to 2019: an ecological study

ABSTRACT BACKGROUND: Dengue is an arbovirus that has caused serious problem in Brazil, putting the public health system under severe stress. Understanding its incidence and spatial distribution is essential for disease control and prevention. OBJECTIVE: To perform an analysis on dengue incidence and spatial distribution in a medium-sized, cool-climate and high-altitude city. DESIGN AND SETTING: Ecological study carried out in a public institution in the city of Garanhuns, Pernambuco, Brazil. METHODS: Secondary data provided by specific agencies in each area were used for spatial analysis and elaboration of kernel maps, incidence calculations, correlations and percentages of dengue occurrence. The Geocentric Reference System for the Americas (Sistema de Referência Geocêntrico para as Américas, SIRGAS), 2000, was the software of choice. RESULTS: The incidence rates were calculated per 100,000 inhabitants. Between 2010 and 2019, there were 6,504 cases and the incidence was 474.92. From 2010 to 2014, the incidence was 161.46 for a total of 1,069 cases. The highest incidence occurred in the period from 2015 to 2019: out of a total of 5,435 cases, the incidence was 748.65, representing an increase of 485.97%. Population density and the interaction between two climatic factors, i.e. atypical temperature above 31 °C and relative humidity above 31.4%, contributed to the peak incidence of dengue, although these variables were not statistically significant (P > 0.05). CONCLUSION: The dengue incidence levels and spatial distribution reflected virus and vector adjustment to the local climate. However, there was no correlation between climatic factors and occurrences of dengue in this city.

Caracterización clínica de pacientes internados por Dengue en el Hospital Regional de Encarnación 2018

Resumen Introducción: El Dengue ha sido prominente entre las enfermedades reemergentes y se considera la más importante de las enfermedades virales transmitidas por artrópodos, siendo la arbovirosis más común y distribuida en el mundo. En Paraguay posee una de las tasas de incidencias de dengue más altas de la región, con 444.5 casos por cada 100.000 habitantes, en el 2018 se registraron un total de 29.162 casos. Objetivo: Caracterizar clínicamente los pacientes internados por Dengue en el Hospital Regional de Encarnación año 2018. Materiales y Métodos: Estudio de tipo observacional, descriptivo de corte trasversal, con muestreo intencional, se incluyeron a todos los pacientes internados con diagnostico confirmado de dengue en el servicio de clínica médica, fueron incluidas las fichas clínicas de pacientes con diagnostico confirmado de dengue. Resultados: El total de casos confirmados por dengue internados en el Hospital Regional de Encarnación en el servicio de clínica médica, año de 2018 fue de 47 pacientes. El rango etario con mayor número de casos fue >45 años con el 36,1%. Tuvo picos relevantes de casos en el mes de marzo, 38%, y mayo con 43%. En el análisis de las formas clínicas de presentación, prevalecieron los pacientes clasificados con clase C: Dengue con signos de alarma Conclusión: La prevalencia de la clasificación de la forma grave con signos de alarma de dengue fue alta, significando una relación entre el manejo clínico precoz y una evolución satisfactoria, por los tanto la caracterización clínica constituye una herramienta eficaz para la toma de decisiones.

Abstract Introduction: Dengue has been prominent among reemerging diseases and it is considered the most important of the viral diseases transmitted by arthropods, being the most common and distributed arbovirosis in the world. Paraguay has one of the highest incidence rates of dengue in the region, with 444.5 cases per 100,000 inhabitants, in 2018 a total of 29,162 cases were recorded. Objective: To clinically characterize the patients admitted by Dengue in the Encarnacion Regional Hospital year 2018. Materials and Methods: An observational, descriptive, cross-sectional study, with intentional sampling, all hospitalized patients with a confirmed diagnosis of dengue were included in the medical clinic service, the clinical records of patients with a confirmed diagnosis of dengue were included. Results: The total hospitalized cases of dengue confirmed in the Encarnacion Regional Hospital in the medical clinic service, year of 2018 was 47 patients. The age range with the highest number of cases was> 45 years old with 36.1%. Tube relevant peaks of cases in the month of March, 38%, and May with 43%. In the analysis of the clinical forms of presentation, patients classified with class C prevailed: Dengue with warning signs Conclusion: The prevalence of the classification of the severe form with dengue alarm signs was high, meaning a relationship between early clinical management and a satisfactory evolution, therefore clinical characterization is an effective tool for decision making.

The paradigmatic shift in the clinical profile of dengue patients: a prospective observational study from a tertiary care center in north India

Background: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk. Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019. Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated. Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (<100,000) was noted in (85.85%) patients. Fever was the presenting complaint in the majority of the patients (99.3%). Fever was followed by myalgia (91.9%), headache (58.8%), arthralgia (28.2%). Conclusions: Patients of dengue presented with fever, headache, myalgia, nausea, vomiting. Bleeding manifestations were looked for. Lab findings like leucopenia and deranged liver function test were more than other studies.

Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and 'Severe Dengue' (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

Serum Albumin Levels in Patients with Dengue Fever – A Longitudinal Study

Background and Objectives: Dengue is an arboviral disease that is a major public health threat globally. In the past 50 years, the incidence of dengue has increased about 30-fold. Clinical manifestations may range from asymptomatic patients to dengue shock syndrome. It is very important to know early, which patient will go on to develop complications for planning management. Like any other disease, dengue also has various biomarkers which are used to find out dengue infection and severity of dengue infection. Serum albumin is a negative acute-phase reactant whose level decreases during many infections. Serum albumin was found to be an independent factor associated with severe dengue and dengue mortality in various studies. The aim of this study is to compare serum albumin levels among severe and non-severe cases of dengue and to find any association. Materials and Methods: This study was done on 120 dengue patients admitted in Government Medical College Ernakulam from January 2017 to December 2017. The clinical features and investigations results were noted. Serum albumin was done on the day of admission and the 3rd day of admission. Patients were classified into mild, moderate, and severe based on the severity of dengue. Serum albumin levels were compared with the different severity groups. Results and Discussion: Of the 120 patients studied, 84 were male and 36 were female. The mean serum albumin of dengue patients on the day of admission was 3.61 g/dl and on the 3rd day of admission was 3.48 g/dl. The mean albumin on the day of admission was 3.71 g/dl, 3.60 g/dl, and 3.34 g/dl for mild, moderate, and severe dengue, respectively (P = 0.005). The mean albumin on the 3rd day of admission was 3.62 g/dl, 3.47 g/dl, and 3.19 g/dl for mild, moderate, and severe dengue patients, respectively (P = 0.001). As the severity of dengue increases, the mean day 1 and day 3 albumin levels decrease, which is statistically significant. Hypoalbuminemia (<3.5 g/dl) was seen on day 1 in 34.8%, 34%, and 57.1% among mild, moderate, and severe dengue patients, respectively (P = 0.148). There was no significant association of hypoalbuminemia on day 1 with the severity of dengue. Hypoalbuminemia was seen on day 3 in 26.1%, 47.2%, and 81% of mild, moderate, and severe dengue patients. There is a significant association between hypoalbuminemia on day 3 and severity of dengue. On 3rd day of admission, hypoalbuminemia was seen more as the severity of dengue increased. Conclusions: As the severity of dengue increased, there was a fall in serum albumin levels and it was statistically significant. Serum albumin can be used as a prognostic marker for dengue.

Persistent Community-acquired Ochrobactrum anthropi Bacteremia in Severe Dengue Infection: A Case Report

@#We report a rare case of Ochrobactrum anthropi bacteremia in a previously healthy young man who was admitted for severe dengue. O. anthropi is a rarely encountered Gram negative organism which is resistant to commonly used beta-lactam antibiotics. This organism is usually interpreted as a contaminant as it is ubiquitous in the environment. Isolation of this organism upon admission suggested a community-acquired infection. He had persistent bacteremia and had to be treated with a prolonged course of meropenem and ciprofloxacin. This case report highlights the importance of early diagnosis and prompt treatment of this otherwise contaminant as previous reports showed this organism can be an opportunistic pathogen which may lead to severe infection.

Antibody-dependent enhancement in the immunopathogenesis of severe dengue, implications for the development and use of vaccines / Amplificación de la infección dependiente de anticuerpos en la inmunopatogénesis del dengue grave, implicaciones para el desarrollo y uso de las vacunas

RESUMEN Actualmente, la infección por el virus de dengue (DENV) es uno de los problemas más importantes de salud pública en países tropicales y endémicos como Colombia, pues en tanto puede ser producida por cuatro diferentes serotipos virales, durante las infecciones secundarias se presentan frecuentemente cuadros más severos que incluso pueden llevar a desenlaces fatales. El centro de la fisiopatología del dengue grave es el daño producido al endotelio, que se traduce en un aumento en la permeabilidad vascular que se evidencia como fuga plasmática, descontrol en la coagulación y daño de órganos. Aunque hay varias teorías que explican la enfermedad severa, el fenómeno denominado amplificación de la infección dependiente de anticuerpos (antibody dependent enhancement, ADE) es el más conocido. En este, se postula que el virus causante de una infección secundaria es reconocido, pero no neutralizado, por anticuerpos generados en la infección previa e internalizado en las células susceptibles usando receptores Fc-gamma, lo cual aumenta la replicación viral e induce modificaciones en la respuesta inmune celular que contribuyen al desarrollo de dengue grave. En este escrito, se realiza una revisión de los hallazgos sobre los mecanismos involucrados en el fenómeno de ADE y cómo pueden contribuir a la progresión hacia dengue grave, describiendo los conceptos de ADE extrínseco e intrínseco, además de como este fenómeno debe ser tenido en cuenta para el diseño, desarrollo e implementación de una vacuna para dengue, en tanto es capaz de afectar su eficacia y seguridad.

ABSTRACT Dengue virus infection is the most important vector transmitted disease in tropical countries such as Colombia, where all the four dengue virus serotypes are circulating and are involved in successive secondary infections which induce severe or even fatal cases. The central key to understanding the severe dengue cases is the endothelial function damage which appears as plasma leakage, coagulation impairment, and organ compromise. Severe dengue could be explained by different theories, among them the antibody-dependent enhancement (ADE) phenomenon is the best known. This theory postulates that the second heterotypic virus causing a secondary infection is recognized by antibodies raised during the first infection but are ineffective to neutralize the virus. Instead this virus-antibody complex is internalized by Fc-gamma receptor-bearing cells increasing the viral replication and inducing an aberrant immune response that contributes to severe dengue presentation. This manuscript is aimed to review the evidence about the ADE phenomenon and its involvement in the severe evolution of dengue cases. Here, it will be described the extrinsic and intrinsic ADE concepts and how these phenomena must be considered to the design, development, and implementation of a dengue vaccine because the evidence indicates that ADE affects both efficacy and safety of vaccine prototypes.

Hepatic Dysfunction in Children Suffering from Dengue Fever

Background: Dengue infections are associated with liver involvement leading to the occasional occurrence of liver failure ofsevere variety and even death. Dengue is almost endemic throughout India and it is much more serious and deleterious inchildren. We have, therefore, tried to estimate the prevalence of derangement of liver function in children affected with denguevirus infection.Materials and Methods: This study was done in admitted dengue patients in our medical college in the age group of1 month–12 years. Only 81 children of NS1 positive for dengue virus were included in the study. In all of these complete bloodcount and liver function tests were performed on the day of admission and every alternate date as long as they were admitted.Results: All the parameters that are serum glutamic-oxaloacetic transaminase (SGOT), serum glutamate-pyruvatetransaminase (SGPT), and gamma glutamyl transferase (GGT) raised throughout the whole period of dengue illness andthe serum albumin level were reduced. However, these changes were most marked on the 5th–6th days of fever after whichthey again slowly waned.Conclusion: Dengue fever causes hepatic injury in children, which is reflected by raised SGOT, SGPT, and GGT and reducedserum albumin. More the severity of the dengue infection more pronounced are the changes in liver derangement.