A Study of Serum Ferritin Level in Patients of Dengue Fever and Its Correlation with the Severity of Dengue Fever in Tertiary Care Hospital of South Gujarat

Introduction: In more than 100 endemic countries, there are 50 to 100 million new cases reported per year, according to the WHO. The dengue pandemic has caused significant death. There is usually only supportive care offered and no effective therapy. The purpose of the study was assess any effect on the level of serum ferritin in patients of dengue. Methodology: This was an observational, Prospective study conducted at Surat Municipal Institute of Medical Education and Research General Medicine department among dengue fever cases. Result: Serum ferritin level from on admission then on day 3 and then day 5 in non-severe and severe dengue cases showed p value <0.001 which was statically significant. Conclusion: The use of a serum ferritin level alone with a cut-off value of more than 900 ng/ml is indicated.

Serum Lactate as a Predictor of Severity in Dengue Infection

Background Dengue infections caused by the four antigenically distinct dengue virus serotypes (DENV1, DENV2, DENV3, DENV4) of the family Flaviviridae are the most major arboviral diseases in humans in terms of geographic spread, morbidity, and mortality. Objective: The study was conducted to assess serum lactate in cases of dengue and correlate it with severity in dengue infection. Methodology: A prospective observational study was carried out among indoor patients admitted to the general medicine department of the tertiary care hospital SMIMER Surat. The study's duration was 15 to 18 months. Result: our study found out of total 154 cases; majority of cases were belonged from 83(53.90%) cases were from less than 30 years. male was contributed 96 (62.34%), majority of cases had duration of fever 39(25.32%), 66 (42.66%) case had high LDH, comparison of serum lactate dehydrogenase with severity of dengue mean lactate dehydrogenase of dengue without severity was mean was 148.45 and SD 11.81, while in severe dengue mean serum lactate dehydrogenase 388.23 and SD 99.47 with p value 0.001 which was statically significant. Conclusion According to this study, it is preferable to monitor serial lactate levels as opposed to using a single lactate number.

Total serum cortisol level is low in children with severe dengue shock syndrome

@#Dengue shock syndrome (DSS) is a potentially critical and life-threatening concern, especially in children of tropical countries. The serum cortisol levels in severe DSS or later stages of DSS are limited references. We prospectively studied an association between of serum cortisol as well as interleukin levels and the severity of DSS in pediatric patients. A prospective cross-sectional study of 35 consecutive DSS cases (3 months to 16 years old) admitted to our institution from July 1, 2019, to June 30, 2020 was conducted. Serum cortisol, IL-6, and IL-10 were measured at T0 (shock recognition) and T12 (12 hours after T0); their values were presented as median and interquartile ranges (25%–75%). Severe DSS included patients with impalpable pulses or systolic blood pressure < 70 mmHg, recurrent shock, and prolonged shock. In contrast, non-severe DSS presented circulatory failure without any features of severe DSS. A total of 8 (22.8%) severe DSS patients expressed the cortisol (T0) significantly lower compared to the non-severe DSS group (7.3 μg/dl versus 14.3 μg/dl, p=0.008). In severe DSS, there was a minimal change in cortisol levels between T0 and T12 (7.3 μg/dl and 4.7 μg/dl p>0.05), whereas the decrease is significant in their counterparts (14.3 μg/dl to 5.6 μg/dl, p<0.005). Additionally, there were moderate correlations between IL-6 (T0), IL-10 (T0), IL-10 (T12) and total fluid requirement (Spearman’s rho = 0.47, 0.4, and 0.36, respectively; p<0.05). Our study demonstrated that adrenal dysfunction was present in patients with severe and non-severe DSS, as noted by cortisol level at T12. In addition, IL-6 and IL-10 levels are correlated with the total fluid requirement, which is a marker of DSS severity. Further studies could reveal how adrenal dysfunction in pediatric patients with DSS can affect outcomes and the potential roles of interleukin levels in fluid management strategy.

Whether Platelet Count Really Influences the Outcome of Dengue Patients? A Study Done at Tertiary Care Centre in North Karnataka Region

In many parts of India, Dengue has become a major public health problem and Kalaburagi District in North Karnataka region was previously not known to be an endemic area for dengue. Three clinical syndromes, classic dengue fever, dengue haemorrhagic fever and dengue shock syndrome are seen with dengue virus infection. This present study was undertaken to find out whether platelet count really influences the outcome of dengue patients in a tertiary health care centre in Kalaburagi, Karnataka.METHODSAbout hundred patients admitted in our hospital with positive Dengue NS1 and Dengue IgM were selected. The follow up of patients is done from the onset of fever to up to twelve days or until their recovery according to discharge criteria of WHO whichever of them is earlier.RESULTSIn this study, 100 cases were studied, out of which Dengue fever was seen in 73 cases, Dengue Hemorrhagic Fever in 17 cases and Dengue Shock Syndrome in 10 cases was seen based on WHO criteria. In this study, 99 percent patients had fever. In this study 73 percent of patients were Dengue NS1 Positive and 27 percent of patients were Dengue IgM Positive. In present study, continuously increasing pattern of platelet count was seen in 55 percent cases; initial fall then rise of platelet count was seen in 38 percent cases and persistently low pattern of platelet count was seen in 7 percent cases. This study showed that 30 percent of patients had bleeding manifestations and bleeding manifestations were maximum in patients having low platelet counts. In the present study, 92% cases improved and 8% cases expired.CONCLUSIONSAmong the three clinical syndromes, Dengue fever was more common than dengue haemorrhagic fever and dengue shock syndrome. It was found that platelet count influenced the outcome of dengue patients. Management of dengue case is mainly supportive

A study on awareness and prevention of dengue fever among outpatients attending a health centre in the rural area of Kancheepuram district

Background: Dengue fever has become one of the major public health problems in all developing countries. It is essential to create awareness among people as it can be prevented by simple practices. The study was conducted to find the awareness among the people thus determining the need to educate the people regarding the preventive measures of dengue fever.Methods: This was a cross-sectional community-based study conducted among the outpatients and their attenders visiting a Rural Health Training Center of private Medical College and Hospital, belonging to Alandur block in Kancheepuram district, Tamil Nadu during January 2019 to March 2019. 260 subjects within the age group of 18 to 82 years were selected by convenient sampling method. The data was collected by interviewing and by using questionnaires. Analysis of the structured data was done using SPSS software version 16.Results: The study included 260 respondents who gave their consent for the study. 60.8% of the study group were males. Mean age of the study group was 35.36 years. 58.1% of the individuals were educated more that 10th standard. Knowledge about the mode of transmission was correctly stated by 85.8%. Around 15% were not aware of breeding places of mosquitoes.Conclusions: From this study it was evident that there is a definite gap in understanding the various aspects of dengue fever. Thus, we conclude that regular awareness programs should be conducted in the form of campaigns and house visits to create awareness among all individuals.

Predictors and Outcome of Severe Dengue Illness in Children.

Dengue fever has become a major public health concern during the last few years with an alarming increase in the incidence in 2017. The state of Kerala was one among the top of the list in India reported to have severe dengue infection. The two main districts in Kerala with high prevalence were Thiruvananthapuram and Palakkad, of which latter is the main referring area to our institution. This study was conducted to evaluate the clinical and demographic profile of children affected with dengue fever and determine the predictors of severity.METHODSThis is a hospital based prospective study done at the Department of Paediatrics, Government Medical College, Trissur, during the Monsoon season in 2017. Children diagnosed to have Dengue fever and confirmed by NS1 Ag test or IgM Elisa were included. Children were classified into 3 clinical groups and compared. Comparison was also made in 2 groups as dengue with warning signs and severe dengue as per WHO 2015 clinical guidelines, to find out the predictors of severity. Qualitative data was analysed and expressed in proportions and quantitative data in mean and standard deviation. Chi-square (χ2) test was used to evaluate the association between qualitative variables and ANOVA for quantitative variables. p value less than 0.05 was considered significant. SPSS 16.0 software was used for statistical analysis.RESULTSA total of 235 children were included. 77 children (32.9%) had mild dengue fever, 106 (45.29%) had DWS and 52 (22.22%) were having DSS). Mean age was 6.61± 3.497 years. 19 cases (8.2 %) were Infants below 1 year of age. Majority of children had normal nutritional status. Myalgia, tiredness, vomiting, diarrhoea, abdominal pain, flushing, bleeding, oedema, hypotension, were found to be the common clinical manifestations. Thrombocytopenia, elevated serum hepatic enzymes both SGOT and SGPT, abnormal renal function tests, low sodium, hypoalbuminemia, hypoglycaemia, abnormal radiological findings were found to be the predictors of severity. We had many cases of expanded dengue syndrome including 3 cases of Hemophagocytic lymphohistiocytosis (HLH). The mortality was 0.6%.CONCLUSIONSDengue fever can affect children irrespective of their age or nutritional status. Older children and male sex were found to be more affected. There are definite clinical and lab parameters which can predict the severity in Dengue fever. Though severe illness is associated with high morbidity early diagnosis and timely appropriate clinical management, correction of dehydration along with proper referral system can save the children. The mortality can be reduced to zero even in patients having expanded dengue syndrome and Dengue shock syndrome. None of the comorbidities had affected the outcome.

Utility of the Pediatric Shock Index as a predictor of outcomes in cases of Dengue in a pediatric tertiary children's hospital

@#<p><strong>BACKGROUND:</strong> Despite extensive studies on dengue fever, there is still limited knowledge about factors associated with poor outcomes in cases of dengue fever. The shock index (SI) is a bedside tool previously used in the adult population, adopted as a marker for poor outcomes in many shock states. There are limited studies applying the SI in children. There are also no known local studies applying an age-adjusted version as a marker or predictor of poor outcomes in severe acute illness, such as dengue.</p><p><strong>OBJECTIVES:</strong> To determine the diagnostic ability of the age-adjusted pediatric shock index in predicting outcomes in cases of dengue admitted at a tertiary children's hospital.</p><p><strong>METHODS:</strong> This is a prospective cohort study performed in a pediatric tertiary hospital over a period of 30 days. Admitting heart rate (HR) and systolic blood pressure (SBP) were taken to determine their shock index. This was then grouped according to age groups based on known literature and corresponding acceptable age-adjusted shock indices (ASI), and compared with outcomes such as final dengue classification (non-severe vs severe), use of inotropes, and mortality.</p><p><strong>RESULTS:</strong> A total of 90 patients were identified for the study. Three were excluded due to exclusion criteria. 87 cases were followed up after admission from the ER. Unadjusted Shock Index (USI) was found not to be associated with both final dengue classification (as severe dengue) and use of inotropic support. In contrast, ASI was associated with both final dengue classification (p < 0.001) and use of inotropes (p < 0.039). The ASI had a fairly accurate capability of predicting poor outcomes for both final dengue classifications, with an area under the ROC curve of 0.7122, and eventual use of inotropes, with an area under the ROC curve of 0.6435.</p><p><strong>CONCLUSIONS AND RECOMMENDATIONS:</strong> SI was found to be a helpful tool in predicting poor outcomes, but only when the Age-adjusted Shock Index (ASI) was used. A longer data collection period is recommended to be able to include mortality as an outcome. The predictive value of the tool can be tested against various other markers of poor outcome to widen the application of this non-invasive measure of hemodynamic status.</p>

Clinical and hematological profile in dengue

Background: Dengue is the most rapidly spreading mosquito-borne viral disease. The spectrum ranges from a nonspecific febrile illness to severe disease, i.e., dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) with the development of hematological complications. Since the death in these patients is due to hematological complications, their study would have a substantial impact on reducing the mortality and morbidity associated with dengue. Objective: The objective of this study was to evaluate the hematological changes in serologically positive dengue patients and to correlate the same with different stages of serology and clinical outcome. Materials and Methods: Evaluation of the hematological parameters and peripheral smear study in clinically suspected cases of dengue with serological confirmation was carried out. Clinical data along with the outcome were collected from medical records. Chi-square test, somatosensory evoked potential, and logistic regression analysis were applied to analyze the results. Results: Three hundred and forty-eight serologically positive dengue cases were analyzed. The disease manifested as dengue fever (DF) in 83.5% of cases, DHF in 10.6% of cases, and DSS in 4.9% of cases. Thrombocytopenia was the most common hematological finding followed by anemia, leukopenia, leukocytosis, and increased hematocrit. Peripheral smears showed atypical lymphocytes, neutrophilic toxic granules, giant platelets, and granulocytic shift to left. About 94.26% of patients recovered and 3.45% had fatal outcome. Conclusion: Platelet count and hematocrit play a crucial role in predicting prognosis of DHF and DSS. Thrombocytopenia was associated more with DHF and DSS than DF. There was a significant association between decreased platelet count and mortality rate.

Clinical spectrum of dengue at a tertiary care hospital in Eastern India

Background: Dengue is a vector borne disease by four different serotypes of dengue virus transmitted by bite of female Aedes mosquito. It is an acute febrile illness characterised by myalgia, joint pain, gastrointestinal manifestations. Complications like dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) , Extended Dengue Syndrome(EDS) may be fatal for patients. Authors analyse different clinical spectrum of of manifestations, complications and correlation bleeding to platelet level.Methods: This study conducted from July 2017 to December 2018 comprising of 100 dengue patients of age more than 15 years in IMS & SUM Hospital.Result: Out of 100 dengue patients’ males 73% and females 27%. From the patients 57% were NS1 Antigen positive, 29% IgM positive, 9% NS1 and IgM positive, 4% IgM and IgG positive and 2 % with all NS1, IgM, IgG positive. In our series in clinical manifestations, all cases (100%) presented with fever, myalgia (78%), headache (53%), rashes (14%), nausea, pain abdomen (21%) loose motion (17%), and Retro-orbital pain (6%). Bleeding manifestations in any form was seen in 39% cases like Purpura or Petechie (23%), malena (18%), hematemesis ( 2% ), epixtasis (6%), Gum bleeding (2%), Hematuria (1%), and Ophthalmic bleeding like sub conjunctival hemorrhage, intra-vitreal hemorrhage in 8% cases. Complications detected e.g. hepatopathy in 53%, nephropathy. 4%, ascites 8%, pneumonia 7%, DSS (4%), Multi Organ Dysfunction (MODS) (4%), DHF (8%) and EDS in 2% cases. It was observed that 95.8% of patients with platelet counts between 20,000-50,000/cu.mm and 61% of patients less than 25000 had bleeding manifestations.Conclusion: Wide clinical spectrum of manifestations and complications makes it common differential diagnosis of acute febrile illnesses and bleeding manifestation does not always corelate with lower platelet count.

A study on the outbreak of dengue fever in a tertiary care children's hospital in southern Tamil Nadu, India

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study's objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.

Effect of co morbidities on the clinical outcome of Dengue fever

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).Methods: A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.Results: Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.Conclusions: Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.

Clinical profile of dengue fever in children presented at a tertiary care hospital

Background: Dengue fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, and arthralgia, rash, leucopenia, and lymphadenopathy. Dengue hemorrhagic fever and dengue shock syndrome are a severe, often fatal febrile disease caused by 1 of 4 dengue virus. It is characterized by increased capillary permeability, abnormalities of hemostasis and protein-losing shock syndrome. The aim of this study was to assess the clinical profile, complications and outcome of dengue infection in children.Methods: All children attending the hospital with symptoms and signs suggestive of dengue fever were tested for NS1 antigen and IgM/ IgG dengue antibody serology (depending on the day of fever) by enzyme-linked immunosorbent assay (ELISA) technique.Results: Of the 174-dengue serology positive children, fever was the most common major symptom (97.7%) followed by vomiting (85.6%), loss of appetite (81.6%), abdominal pain (77%), body pain/leg pain (62.6%). Severe dengue as per WHO criteria was seen in 29 (16.7%) children. Thrombocytopenia (platelet count less 1,00,000) was observed in 82 children (47%), Platelet count less than 20,000 in 8 children (4.5%). Dengue shock syndrome was seen it 26 children (15%). Mortality was nil.Conclusions: In children, if symptoms like fever, vomiting, loss of appetite, abdominal pain and body pain are present, a strong possibility of dengue fever is present especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

Immature platelet fraction in children infected with dengue fever

Background: Millions are infected with dengue every year.' Early diagnosis of dengue infection is important for proper treatment of DHF and DSS to avoid fatal outcome. Thrombocytopenia is a common hematological abnormality in dengue, which demands platelet transfusion in most of the severe dengue cases. Platelet transfusion though life-saving has its own hazards. Hence, we can use some new parameter like immature platelet fraction (IPF) which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. The risk of platelet transfusion may be decreased by rapid identification of immature platelet fraction. This study was performed to establish reference of IPF values for the assessment of thrombopoiesis.Methods: Blood samples from 150 children were obtained on day of illness 3, 5 and 7. The IPF is identified by sysmex XE2100 hematology analyser in the reticulocyte channel using a fluorescent dye and a carefully designed gating system and counted by a special software termed IPF master7. IPF values against platelet count were assessed separately on day 3, 5 and 7.Results: The reference intervals of IPF > 8 % and IPF < 8 % were assessed against platelet count. Increase in IPF favored increase in platelet count on day 5 which was statistically significant with the p value <0.001.Conclusions: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. From the study it can be concluded that IPF is an important predictor of increase in platelet count.' Increase in IPF>8 % suggests that platelet count will be increased in next 24 to 48hrs indicating that further blood transfusion will not be required.

Cardiac involvement in adult patients with febrile thrombocytopenia diagnosed by bedside 2-D echocardiography

Background: Febrile thrombocytopenia due to various etiologies is very common in India. Its clinical manifestations range from asymptomatic infections to severe disease. Cardiac involvement in such systemic illness should be evaluated. Aim of present study is to evaluate cardiac involvement in patients with Febrile thrombocytopenia with platelets count less than 50,000/µL with the help of handheld echocardiography.Methods: Two hundred patients who had fever with thrombocytopenia were enrolled in the study. ECG and echocardiogram were done to all the patients. One-way ANOVA, Chi square test and correlation coefficient from Pearson correlation and P value of < 0.05 was taken as significant.Results: Out of 200 patients there were 146 males and 56 females. The mean age was 24.12yrs in males 28.32yrs in females .Rhythm abnormalities were present in 60 patients and the most common abnormality was sinus tachycardia; 17 patients had ascites and right pleural effusion; 24 patients presented with pericardial effusion and incidental diagnosis of CHD, RHD, and CAD were made; two patients had myocarditis as evidenced by global hypokinesia of left ventricle. All of those cardiac manifestations were common in Dengue Shock Syndrome.Conclusions: Cardiovascular manifestation in Febrile thrombocytopenia is relatively common ranging from pericarditis to myocarditis. Clinician should routinely screen patients with pyrexia with thrombocytopenia for cardiac manifestations. Early diagnosis at bed side may improve the outcome. Management of patients with pre-existing cardiac diseases should be individualized.

Contribución de Cuba y del Instituto de Medicina Tropical "Pedro Kourí" para evitar las muertes por dengue / Contribution of Cuba and Pedro Kouri Tropical Medicine Institute to preventing mortality from dengue

El dengue es una enfermedad viral transmitida por mosquitos que puede ser causa de gravedad y muerte. No existe droga antiviral reconocida como eficaz. Sin embargo, las regularidades de esta enfermedad han permitido la identificación de signos de alarma que anuncian extravasación de plasma e inminencia del choque. El inicio precoz del tratamiento de los pacientes mediante la reposición de líquidos cristaloides por vía intravenosa ha demostrado ser una medida efectiva y salvadora. Se necesita capacitación sistemática y acciones de reorganización de la atención médica en función de la epidemia. Se expone la contribución de los profesionales del Instituto de Medicina Tropical Pedro Kourí y otras instituciones cubanas a ese empeño(AU)

Dengue is a viral disease transmitted by mosquitoes which may be severe and cause death. No antiviral drug has been recognized as effective. However, the regularities of this condition have made it possible to identify warning signs announcing plasma leakage and the imminence of shock. Early start of treatment with intravenous crystalloid fluid replacement has proven to be an effective, life-saving measure. Systematic training actions and reorganization of medical care are required during an epidemic. The paper describes the contribution of professionals from Pedro Kouri Tropical Medicine Institute and other Cuban institutions to this effort(AU)

Factores de riesgo asociados a mortalidad por Dengue en menores de 15 años. Paraguay, periodo 2010-2013

Introducción: El dengue es la enfermedad transmitida por vectores más importante en las Américas, y principalmente en Paraguay, habiéndose observado en los últimos 10 años un incremento sostenido de los casos ambulatorios, las hospitalizaciones y muertes por dengue, afectando a todos los grupos de la edad pediátrica. Objetivo: Identificar los factores asociados a mortalidad en niños menores de 15 años con diagnóstico de dengue en el periodo 2010-2013. Materiales y Métodos: Estudio observacional, descriptivo, retrospectivo. Los datos fueron obtenidos de los boletines de epidemiología del Ministerio de Salud Pública, de donde se obtuvieron las características demográficas y clínicas de todos los casos de dengue en menores de 15 años. Resultados: Durante el periodo 2010 al 2013, se han reportado 57.483 niños menores de 15 años con diagnostico de dengue, requirieron hospitalización el 12,2% (7.029/57.483). La letalidad (Nº de muertes/ Nº de casos totales) en el periodo de estudio fue de 0.055% (32/57.483), variando la letalidad por año de estudio de 0,03%, 0,05%, 1,3% y 0,05%, respectivamente, en los años 2010 al 2013 respectivamente. Los factores asociados con incremento de la mortalidad fueron edad <1 año (p<0.001; RR=6,22, IC 95% 3-12,9), manifestaciones clínicas hemorrágicas (p<0,01, RR 4,5, 95% CI 1,6 - 12,8), presencia de Síndrome de shock por dengue (p<0,01, RR 83,5, 95% CI 40,6 - 172,1) y pacientes con patologías de base (p<0.001; RR=86,32, IC 95% 38,2-194,8). La mayor frecuencia de hospitalización se observó en el grupo etario <1 año (591/3475, 17%), significativamente mayor comparado con los grupos de 1 a 4 años (6,5%) y 5 a 14 años (5687/42455. 13.4%) (p<0.00001; RR=2,51; IC 95% 2,3 -2,7). Conclusiones: Los factores de riesgo asociados con el incremento de la mortalidad fueron la edad <1 año, las manifestaciones clínicas hemorrágicas, la presencia de síndrome de choque por dengue al ingreso y las patologías de base. El presente estudio muestra el gran impacto del dengue en Paraguay en términos de morbilidad y mortalidad. La identificación de factores asociados a mortalidad puede contribuir a la detección oportuna de los grupos de alto riesgo, buscando disminución de la mortalidad.

Introduction: Dengue is the most important vector-borne disease in the Americas, and especially in Paraguay, with a sustained increase in outpatient cases, hospitalizations, and dengue deaths in the last 10 years, affecting all groups of the pediatric age group. Objective: To identify factors associated with mortality in children less than 15 years of age with diagnosis of dengue in the period 2010-2013. Materials and Methods: An observational, descriptive, retrospective study. The data were obtained from the weekly epidemiological bulletin of the Ministry of Public Health. Results: During the period 2010 to 2013, 57,483 children under the age of 15 years were diagnosed with dengue, requiring hospitalization in 12.2% (7,029 / 57,483). The mortality (number of deaths / number of total cases) in the study period was 0.055% (32 / 57,483), with a case-fatality rate of 0.03%, 0.05%, 1.3% and 0.05%, respectively, in the years 2010 to 2013 respectively. The factors associated with increased mortality were age <1 year (p <0.001, RR = 6.22, 95% CI 3-12.9), hemorrhagic clinical manifestations (p <0.01, RR 4.5, 95 % CI 1.6 - 12.8), presence of dengue shock syndrome (p <0.01, RR 83.5, 95% CI 40.6 - 172.1) and patients with baseline pathologies (p < 0.001, RR = 86.32, 95% CI 38.2-194.8). The highest frequency of hospitalization was observed in the age group <1 year (591/3475, 17%), significantly higher compared to the groups of 1 to 4 years (6.5%) and 5 to 14 years (5687/42455. 13.4%) (p <0.00001; RR = 2.51; 95% CI 2.3-2.7). Conclusions: Risk factors associated with increased mortality were age <1 year, clinical manifestations of hemorrhagic fever, presence of shock syndrome due to dengue on admission, and underlying pathologies. The present study shows the great impact of dengue in Paraguay in terms of morbidity and mortality. The identification of factors associated with mortality may contribute to the timely detection of high-risk groups, seeking to reduce mortality.

Dengue, presentación inusual en un lactante: reporte de un caso / Dengue with unusual clinical features in an infant: case report

El estado de Yucatán (México) es un área endémica para dengue. Durante el 2015 hubo un incremento en el número de casos esperados. OBJETIVO: Describir y analizar la presentación clínica, evolución y manejo de un caso de infección por dengue con manifestaciones clínicas inespecíficas en un lactante menor, que derivaron en síndrome de choque por dengue. CASO CLÍNICO: Lactante de un mes que consulta por eritema generalizado y antecedente de picadura de insecto. Su manejo hospitalario se basó en la resolución del episodio agudo de anafilaxia. Durante su estadía presentó hipotensión, taquicardia, anemia y dificultad respiratoria. Se derivó a terapia intensiva pediátrica, pero al quinto día de estancia falleció debido a síndrome de choque. La RPC y serología de anticuerpos IgG confirmaron etiología por dengue. CONCLUSIONES: Las infecciones por dengue en el lactante menor pueden cursar afebriles, por lo cual es importante sospecharlas oportunamente ante la presencia de eritema generalizado, taquicardia e hipotensión, con la finalidad de evitar las consecuencias letales del choque por dengue.

The state of Yucatan, in Mexico, is an endemic area for dengue. During 2015, there was an unpredicted increase in the number of expected cases of dengue fever. OBJECTIVE: To describe and analyse the clinical presentation, progress, and management of a case of dengue infection with non-specific clinical manifestations in an infant which resulted in a dengue shock syndrome. CASE REPORT: One month old infant admitted to hospital with a generalised rash and a history of being bitten by an insect. He was diagnosed with anaphylaxis based on clinical manifestations and anamnesis. While in hospital, he developed hypotension, tachycardia, anaemia, and respiratory distress. He was transferred to the intensive care unit, but died on the fifth day. He tested positive to dengue virus in the PCR test and for IgG antibodies using Elisa. The basic cause of death was dengue shock syndrome. CONCLUSIONS: Dengue fever in young infant infections may be afebrile, so it is important to suspect them appropriately in the presence of a generalised rash, tachycardia, and hypotension, in order to avoid the deadly consequences of dengue shock.

IgG antibodies against Dengue virus non-structure protein 1 mediate passive sys-temic anaphylaxis in mice / 中国免疫学杂志

Objective:To ascertain whether the immune complexes (ICs) formed by Dengue virus 1 non-structure protein 1 (DENV1 NS1)and its IgG antibodies could mediate passive systemic anaphylaxis (PSA) and to explain the pathogenesis of Dengue hemorrhagic fever or Dengue shock syndrome (DHF/DSS).Methods:The monoclonal antibodies (mAbs) or mAb cocktails from 20 IgG mAbs of DENV1 NS1 prepared in this lab were screened to initiate PSA and passive cutaneous anaphylaxis (PCA) in mice.Meanwhile, the effects of GdCl3 and platelet activating factor ( PAF) antagonist CV-3988 on PSA induced by the NS1-IgG ICs were observed.Results:Two groups of monoclonal antibody cocktails with purified NS 1 were proved to be capable of provoking PCA and PSA in mice,whereas the other mAbs or mAb cocktails could be not .The murine PSA initiated by NS1-IgG(5D25+3B1) ICs could be sig-nificantly inhibited by in vivo treatment with GdCl3 or PAF antagonist CV-3988.Conclusion: The NS1-IgG ICs formed with DENV1 NS1 and IgG mAb cocktails can mediate PSA and PCA ,but not all of ICs formed by DENV 1 NS1 mAbs or mAb cocktails with DENV 1 NS1 can induce PSA ,indicating that it may be related to the special epitopes of DENV 1 NS1.The monocyte/macrophages and PAF may be as major effector cells and the major mediator for PSA induced by NS 1-IgG ICs,respectively.

Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization

A 53-year-old lady was admitted with decompensated dengue shock syndrome during the febrile phase, complicated by massive retroperitoneal bleeding requiring angioembolization. She was initially stabilized by fluid resuscitation at emergency department prior to ICU admission. While in ICU, her haemoglobin level plummeted from 17.5 g/dL to 5.8 g/dL without any obvious source of bleeding. She had hemodynamic instability and worsening acidosis. The abdominal ultrasound performed showed complex ascites and CT abdomen revealed a large right retroperitoneal hematoma with ongoing bleeding. The patient’s hemodynamic was restored and bleeding resolved after angioembolization of the right L2 lumbar artery and right phrenic artery.

Research Progress of Chemical Drugs Against Dengue Virus / 中国药学杂志

Dengue fever is one of the most important vector-borne human diseases caused by mosquito vectorAedes aegypti and Aedes albopictus. Dengue virus can cause dengue fever, dengue hemorrhagic fever and dengue shock syndrome. There are no approved drugs for the treatment of dengue disease so far. According to the mechanism of anti-dengue virus(anti-DENV) action, drugs under development for dengue disease can be divided into two categories: viral replication inhibitors and anti-cell factor pathway inhibitors. The former is further divided into DENV entry inhibitors, capsid protein inhibitors, NS3 protein inhibitors, NS5 protein inhibitors, and NS4B protein inhibitors; the latter is further divided into cell receptor inhibitors, lipid synthesis and metabolism inhibitors, and glucosidase inhibitors. The R&D of anti-DENV drugs is facing enormous challenges. Development of effective drugs which can be used for the treatment of four serotypes of dengue has a broad application prospect, and it will bring new hopes for dengue fever prevention and therapy.