Comportamiento epidemiológico del Dengue en Ecuador desde su reemergencia. Periodo 1980-2020 / Epidemiological behavior of Dengue in Ecuador since its reemergence. Period 1980-2020

INTRODUCCIÓN. El dengue es una enfermedad infecciosa de origen viral, transmitida principalmente por el mosquito Aedes aegypti. Es un grave problema de salud pública a nivel mundial, en las Américas y en el Ecuador. OBJETIVOS. Analizar el comportamiento epidemiológico del dengue desde 1980 hasta el 2020, los factores de riesgo que mantienen la transmisión y las acciones que el país ha implementado para su prevención y control. METODOLOGÍA. Revisión bibliográfica narrativa, teniendo como fuente las páginas web de la Organización Mundial de la Salud, de la Organización Panamericana de la Salud, Ministerio de Salud Pública del Ecuador, artículos de revistas de bibliotecas virtuales e informes técnicos publicados en Google académico, Scielo, Biblioteca Virtual en Salud y PubMed. RESULTADOS. Los registros encontrados sobre presencia de casos de dengue datan de 1988 cuando se presentó la gran epidemia de dengue en Guayaquil. Posteriormente, mantiene un comportamiento endemo-epidémico. A partir del año 2000 se presentan casos de dengue grave. Su pico más alto de letalidad fue de 2,44% en el 2010. El serotipo DEN 1 es el más frecuente, pero a partir del 2000 circulan los 4 serotipos. Las acciones de prevención y control no han sido sostenidas. CONCLUSIONES. El dengue en Ecuador en los últimos cuarenta años mantiene una importante trasmisión, caracterizada por años epidémicos. No ha podido ser controlado el vector, el cual ha ido infestando más localidades. Las condicionantes climáticas y ecológicas, explican en parte la persistencia, pero la determinación más importante está dada por las inequidades sociales, falta de servicios básicos, y la poca continuidad e impacto de las medidas de prevención y control.

INTRODUCTION. Dengue is an infectious disease of viral origin, transmitted mainly by the Aedes aegypti mosquito. It is a serious public health problem worldwide, in the Americas and in Ecuador. OBJECTIVES: To analyze the epidemiological behavior of dengue fever from 1980 to 2020, the risk factors that maintain transmission and the actions that the country has implemented for its prevention and control. METHODOLOGY. Narrative bibliographic review, taking as sources the web pages of the World Health Organization, Pan American Health Organization, Ministry of Public Health of Ecuador, journal articles from virtual libraries and technical reports published in Google Scholar, Scielo, Virtual Health Library and PubMed. RESULTS. The records found on the presence of dengue cases date back to 1988 when the great dengue epidemic occurred in Guayaquil. Subsequently, it maintained an endemic-epidemic behavior. Beginning in 2000, severe cases of dengue fever occurred. Its highest lethality peak was 2.44% in 2010. DEN 1 serotype is the most frequent, but since 2000 all 4 serotypes have been circulating. Prevention and control actions have not been sustained. CONCLUSIONS. Dengue in Ecuador over the last forty years has maintained an important transmission, characterized by epidemic years. It has not been possible to control the vector, which has been infesting more localities. Climatic and ecological conditions partly explain its persistence, but the most important determinant is given by social inequalities, lack of basic services, and the lack of continuity and impact of prevention and control measures.

Why are children highly vulnerable to dengue infection

@#The prevalence of dengue infection poses a great public health concern among people living in tropical and subtropical countries like the Philippines. Just recently in 2019, the Philippines had a dengue virus (DENV) outbreak where nearly half of the mortalities were children between 5 and 9 years of age, and around 73% of confirmed DENV cases were under the age of 19. Children are disproportionately affected and are considered to be highly vulnerable to severe dengue infection compared to adults due to several factors. These include: immunological differences--poorly developed immune systems, making them more susceptible to the virus; smaller body sizes and weight means that they are more likely to experience severe symptoms; and their tendency to play outdoors, make them more exposed to mosquito bites. Hence, this article provides an overview of the current understanding for the vulnerability of children to severe dengue infection compared to adults

Dengue más allá del trópico: estudio de series temporales 2015-2016 versus 2019-2020 en un hospital pediátrico de la Ciudad de Buenos Aires / Dengue beyond the tropics: a time-series study comprising 2015-2016 versus 2019-2020 at a children's hospital in the City of Buenos Aires

Introducción. El dengue es un problema de salud pública a nivel mundial. Confinado en sus orígenes a las zonas tropicales y subtropicales, en la actualidad se presenta en otras regiones como Argentina. Desde el año 2008 se presenta con brotes epidémicos en la Ciudad Autónoma de Buenos Aires, con escasos reportes en niños. Objetivo. Analizar y comparar las características clínicas, epidemiológicas, de laboratorio y evolutivas de los dos últimos brotes de dengue fuera del área endémica. Población y métodos. Estudio de series temporales. Se incluyeron pacientes menores de 18 años con dengue probable o confirmado, evaluados en un hospital pediátrico de la Ciudad de Buenos Aires durante los períodos 2015-2016 y 2019-2020. Resultados. Se incluyeron 239 pacientes, 29 (12 %) con antecedente de viaje. La mediana de edad fue de 132 meses (rango intercuartílico: 102-156). Todos tuvieron fiebre. Otros síntomas fueron: cefalea en 170 (71 %), mialgias en 129 (54 %) y exantema en 122 (51 %). Cuarenta pacientes (17 %) tenían comorbilidades. Presentaron signos de alarma 79 pacientes (33 %) y 14 (6 %) tenían dengue grave. Requirieron internación 115 pacientes (45 %) y ninguno falleció. El serotipo DENV-1 fue el más frecuente. El antecedente de viaje y la necesidad de internación predominaron en el primer período; el dengue grave y la infección previa, en el segundo. Conclusiones. Ningún paciente falleció de dengue en los períodos estudiados. Se observaron diferencias estadísticamente significativas en la frecuencia de internación; el antecedente de viaje fue más frecuente en el período 2015-2016 y el dengue grave, en el 2019-2020.

Introduction. Dengue is a public health problem worldwide. It was originally confined to tropical and subtropical areas, but it is now present in other regions, such as Argentina. Epidemic outbreaks have been observed in the City of Buenos Aires since 2008, with few reports in children. Objective. To analyze and compare the clinical, epidemiological, laboratory, and evolutionary characteristics of the latest 2 dengue outbreaks outside the endemic area. Population and methods. Time-series study. Patients under 18 years of age with probable or confirmed dengue and evaluated in a children's hospital of the City of Buenos Aires during the periods 2015-2016 and 2019-2020 were included. Results. A total of 239 patients were included; 29 (12%) had a history of travel. Their median age was 132 months (interquartile range: 102156). All had a fever. Other symptoms included headache in 170 (71%), myalgia in 129 (54%), and rash in 122 (51%). Forty patients (17%) had comorbidities. Warning signs were observed in 79 patients (33%); 14 (6%) developed severe dengue; 115 (45%) were hospitalized; none died. DENV-1 was the most common serotype. A history of travel and hospitalization prevailed in the first period; severe dengue and prior infection, in the second period. Conclusions. No patient died due to dengue in either study period. Statistically significant differences were observed in the frequency of hospitalization; a history of travel was more common in the 2015-2016 period and severe dengue, in the 2019-2020 period.

Alterações hematológicas na dengue grave ­ uma revisão sistemática / Hematological changes in serious dengue ­ a systematic review

A infecção causada pelo vírus da dengue gera quase 400 milhões de novos casos a cada ano especialmente nos países tropicais e subtropicais, sendo considerada um problema de saúde pública em todo o mundo. Trata-se de uma doença sistêmica e infectocontagiosa, que pode ser classificada como dengue com ou sem sinais de alarme, e dengue grave. As alterações hematológicas estão relacionadas com a gravidade da doença e direcionam condutas médicas. Neste estudo foram realizadas buscas nas plataformas CAPES, LILACS e PubMed no período de janeiro de 2014 a janeiro de 2021 com o objetivo de reunir e avaliar artigos publicados que traziam informações sobre as alterações hematológicas na infecção de dengue grave. Após revisão minuciosa, foram incluídos no estudo um total de 15 artigos e os principais dados observados foram: diminuição da contagem de plaquetas (66,7%), aumento do hematócrito (26,6%), aumento do tempo de tromboplastina parcial ativada (26,6%) e leucopenia (26,6%).

The infection caused by the dengue virus generates almost 400 million new cases each year, especially in tropical and subtropical countries, being considered a public health problem worldwide. It is a systemic and infectious disease, which can be classified as dengue with or without alarm signs, and severe dengue. Hematological changes are related to the severity of the disease and may guide medical procedures. In this study, researches were carried out on the CAPES, LILACS and PubMed platforms with the aim of gathering and evaluating published articles that brought information about hematological changes in severe dengue infection from January 2014 to January 2021. After thorough review, a total of 15 articles were included in the study and the main data observed were: decreased platelet count (66.7%), increased hematocrit (26.6%), increased activated partial thromboplastin time (26.6%) and leukopenia (26.6%).

Encefalitis como complicación neurológica por dengue / Encephalitis as neurological complication due dengue

Resumen Se presenta el caso de un varón de 32 años, previamente sano, que consultó por fiebre de cinco días, cefalea, dolor retro-ocular, rash, petequias, mialgias, artralgias y dolor abdominal. Presentaba leucopenia, trombocitopenia intensa, transaminitis y tiempo de coagulación prolongado. Se diagnosticó un dengue grave con coagulopatía que requirió manejo en Unidad de Cuidados Intensivos. Evolucionó con alteración del estado de conciencia, agitación psicomotora y agresividad. Se descartaron alteraciones estructurales, isquémicohemorrágicas, infecciones bacterianas y micóticas. Se confirmó finalmente una encefalitis por dengue por una RPC para virus dengue positiva en LCR. Se brindaron medidas de soporte con una evolución favorable. La encefalitis es la complicación neurológica más grave tras la infección por virus del dengue.

Abstract We present the case of a 32-year-old male, previously healthy, with a 5-day history of fever, frontal-occipital headache, retro-ocular pain, rash, petechiae, myalgia, arthralgia, and abdominal pain. Blood tests with leukopenia, severe thrombocytopenia, transaminitis, long clotting times. Severe dengue with associated coagulopathy was diagnosed, indicating transfer to ICU. Presents torpid evolution, altered state of consciousness, psychomotor agitation, and aggressiveness. Structural, ischemic-hemorrhagic alterations, bacterial and fungal infections were ruled out. Finally diagnosing dengue encephalitis, confirmed by DENV PCR in CSF. Support measures are provided with favorable evolution. Encephalitis is the most serious neurological complication after dengue virus infection.

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)

Epidemiologia da dengue em Minas Gerais de 2009 a 2019: uma análise descritiva / Epidemiology of dengue in Minas Gerais from 2009 to 2019: a descriptive analysis

Introdução: Atualmente, a dengue gera um importante impacto sobre o bem-estar dos pacientes e a economia do sistema público de saúde. Nesse sentido, evidencia-se a necessidade da realização de estudos epidemiológicos de modo a auxiliar nas análises acerca da realidade estadual. Objetivo: Caracterizar o perfil epidemiológico da dengue em Minas Gerais, de 2009 a 2019. Material e Métodos: Estudo observacional de caráter descritivo e quantitativo utilizando dados de notificações e internações obtidos do Sistema de Informação de Agravos de Notificação e do Sistema de Informações Hospitalares, a partir do TABNET. Calcularam-se taxas de letalidade, incidência e internação, utilizando dados demográficos do Departamento de Informática do Sistema Único de Saúde para os cálculos de incidência e internação. As variáveis de estudo foram: ano de ocorrência, macrorregião de residência, faixa etária, evolução e classificação clínica da doença, sexo, escolaridade e raça. Resultados: A dengue possui um caráter cíclico de incidência, e as taxas de letalidade e internação oscilam anualmente. As macrorregiões Centro, Triângulo do Sul, Noroeste, Oeste, Triângulo do Norte e Vale do Aço obtiveram elevadas taxas de incidência, e a macrorregião Leste a maior taxa de internação. A maioria dos casos de dengue foram classificados como "dengue clássica", e a classificação "dengue grave" foi a de menor incidência. Em relação à faixa etária, o intervalo de 15 a 39 anos apresentou maior taxa de incidência e menores taxas de letalidade e de internação, quando comparado à população idosa. Ademais, a evolução a óbito ocorreu mais frequentemente em indivíduos analfabetos. Conclusão: Os achados desse estudo elucidam o perfil epidemiológico da dengue em Minas Gerais, que se caracteriza por apresentar um padrão nacional cíclico de casos, manifestando-se principalmente de forma branda, mas com um acréscimo da morbimortalidade em analfabetos e idosos.

Introduction: Currently, dengue has an important impact on the well-being of patients and the economy of the public health system. In this sense, the need to carry out epidemiological studies is highlighted in order to assist in the analysis of the state's reality. Objective: To characterize the epidemiological profile of dengue in Minas Gerais, from 2009 to 2019. Material and Methods: Observational descriptive and quantitative study based on data on notifications and admissions obtained from the Notifiable Diseases Information System and the Hospital Information System, from TABNET. Rates of lethality, incidence and hospitalization were calculated using demographic data from the information technology department of the Unified Health System to calculate incidence and hospitalization. The study variables were: the year of occurrence, macro-region of residence, age group, evolution and clinical classification of the disease, gender, education and race. Results: Dengue has a cyclical nature of incidence, and lethality and hospitalization rates fluctuate annually. The Central, Southern Triangle, Northwest, West, Northern Triangle and Vale do Aço macro-regions had high incidence rates, and the Eastern macro-region had the highest hospitalization rate. Most dengue cases were classified as 'classic dengue', and the classification 'severe dengue' had the lowest incidence. Regarding the age group, the 15 to 39-year age group had a higher incidence rate and lower mortality and hospitalization rates, when compared to the elderly population. Furthermore, the evolution to death occurred more frequently in illiterate individuals. Conclusion: The findings of this study elucidate the epidemiological profile of dengue in Minas Gerais, which is characterized by presenting a cyclical national pattern of cases, manifesting itself mainly in a mild form, but with an increase in morbidity and mortality in illiterate and elderly people.

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)

Significance of hypocalcemia in predicting dengue severity in the pediatric population: A systematic review and meta-analysis / The Health Sciences Journal

INTRODUCTION@#Dengue is one of the causes of morbidity and mortality among pediatric patients. Calcium has been shown to play a role in the myocardial function of the patient and is a potential cause of mortality among dengue patients. This study aimed to determine the accuracy of hypocalcemia in predicting the severity of dengue among pediatric patients.@*METHODS@#This is a systematic review and meta-analysis of published studies identified through an electronic literature search using PubMed/Medline, Cochrane Library, Herdin, Google Scholar, and hand search. Validity was assessed using the Cochrane risk of bias tool. Statistical analysis of the diagnostic test accuracy review was done using Review Manager 5.4.1 with the random effects model. Results showed sensitivity and specificity of hypocalcemia in severe dengue with a 95% confidence interval. The predictive values and likelihood ratios were also computed.@*RESULTS@#Four studies were analyzed. The mean serum total and ionized calcium levels of patients were decreased among the severe dengue group. Data showed that there is a 74% sensitivity (95% CI = 0.58, 0.84) and 75% specificity (95% CI = 0.67, 0.81) with a positive predictive value of 67% and a negative predictive value of 90.7%.@*CONCLUSION@#This systematic review and meta-analysis showed that hypocalcemia may be a useful tool to predict severe dengue fever. However, further analysis is needed to strengthen the the diagnostic accuracy of hypocalcemia.

Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis

Abstract INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

Factores asociados a la evolución a dengue grave en un hospital de tercer nivel de atención del Paraguay, 2019 a 2020 / Factors associated with the evolution to severe dengue in a third-level care hospital in Paraguay, 2019 to 2020

Introducción: El dengue (DEN), es uno de los principales problemas de salud pública en Paraguay. Identificar los factores de riesgo asociados a la evolución a dengue grave es clave principalmente para evitar un desenlace fatal y también lograr de alguna manera reducir la utilización de recursos al disminuir el número de hospitalizaciones. Objetivos: Analizar los factores asociados a la evolución a dengue grave en un hospital de tercer nivel de atención de Paraguay durante los años 2019 a 2020. Materiales y métodos: Estudio de casos y controles de hospitalizados con diagnóstico de dengue y dengue grave. Se consideró como casos a los pacientes con dengue grave y controles pareados a los pacientes con dengue hospitalizados. Relación controles a casos: 2:1=38 casos y 76 controles. Resultados: De 146 pacientes, se halló significancia estadística en las siguientes variables sexo femenino (OR 0,47 IC 0,22-0,99 p 0,045), leucopenia (OR: 0,06 IC 0.006-0,66 p 0,007), padecer diabetes mellitus (OR 13,42 IC 1,51-118,62 y p 0,003), presentar dolor abdominal intermitente (OR 2,67 IC 1,10-6,48 p 0,02), y tos (OR 21,79 IC 5,93-80,05 y p 0,00). Conclusión: Los pacientes de sexo femenino, con leucopenia y la condición de embarazo resultaron factores protectores para la evolución a dengue grave. Se asociaron con mayor probabilidad de desarrollar dengue grave, padecer diabetes mellitus, presentar dolor abdominal intermitente, tos, letargia o inquietud y leucocitos normales.

Introduction: Dengue (DEN) is one of the main public health problems in Paraguay. Identifying the risk factors associated with the evolution to severe dengue is key mainly to avoid a fatal outcome and also to somehow reduce the use of resources by reducing the number of hospitalizations. Objectives: To analyze the factors associated with the evolution to severe dengue in a tertiary care hospital in Paraguay during the years 2019 to 2020. Materials and methods: Case-control study of hospitalized patients with a diagnosis of dengue and severe dengue. Results: We included 146 patients, we found statistical significance in the following variables: female sex (OR 0.47 CI 0.22-0.99 p 0.045), leukopenia (OR: 0.06 CI 0.006-0.66 p 0.007), suffering from diabetes mellitus (OR 13.42 CI 1.51-118.62 and p 0.003), present intermittent abdominal pain (OR 2.67 CI 1.10-6.48 p 0.02), and cough (OR 21.79 CI 5, 93-80.05 and p 0.00). Conclusion: We found that female patients, with leukopenia and the condition of pregnancy were protective factors for the evolution to severe dengue. The association with the highest probability of developing severe dengue, which we found, was suffering from diabetes mellitus, presenting intermittent abdominal pain, cough, lethargy or restlessness, and normal white blood cells.

Eficacia y seguridad de la vacuna contra el dengue / Efficacy and safety of dengue vaccine

El dengue es un problema creciente para la salud pública mundial. En Argentina, los casos se han ido incrementado en los últimos años. La vacuna Dengvaxia (CYD-TDV) fue aprobada por la Agencia Nacional de Medicamentos, Alimentos y Tecnología (ANMAT) en 2017, y actualmente está indicada para personas entre los 9 y 45 años de edad que residan enzonas endémicas. A partir de la consulta de una paciente sobre la posibilidad de vacunarse contra el dengue, la autora se plantea la pertinencia de su indicación, teniendo en cuenta la eficacia y seguridad de la vacuna. Luego de una búsqueda rápida se encontró evidencia que señala que la vacuna contra el dengue CYD-TDV mostró poca eficacia en comparación con otras vacunas disponibles en el mercado, siendo más segura y eficaz en personas que ya han sido infectadas anteriormente por el virus del dengue (sujetos seropositivos). En cambio, se observó un aumento del riesgo de dengue grave en los infectados por vez primera tras la vacunación (sujetos seronegativos). Se concluye que la estrategia recomendada consiste en vacunar únicamente a las personas que hayan tenido infección por dengue con anterioridad, consistiendo en una buena práctica la toma de decisiones compartidas con cada paciente. (AU)

Dengue is a growing problem for global public health. In Argentina, cases have been increasing in recent years. The Dengvaxia vaccine (CYD-TDV) was approved by the National Agency for Medicines, Food and Technology in 2017, and it is currently indicated for people between 9 and 45 years of age who reside in endemic areas. Based on the consultation of a patient about the possibility of being vaccinated against dengue, the author considers the relevance of its indication, taking into account the efficacy and safety of the vaccine. After a quick search, evidence was found that indicates that the CYD-TDV dengue vaccine showed little efficacy compared to other vaccines available on the market, being safer and more effective in people who have already been previously infected by the dengue virus (seropositive subjects). In contrast, an increased risk of severe dengue was observed in those infected for the first time after vaccination (seronegative subjects). It is concluded that the recommended strategy consists of vaccinating only people who have had dengue infection before, making shared decisions with each patient a good practice. (AU)

Choque por dengue interpretado inicialmente como sepsis grave / Shock by dengue initially interpreted as severe sepsis

Introducción: La forma más frecuente de dengue grave es el choque por dengue. Sin embargo, los lactantes con dengue no presentan las manifestaciones clinicas que lo caracterizan ni tienen tan a menudo esta complicación como lo hacen los pacientes con edades mayores. Objetivo: Dar a conocer las características clinicas y laboratoriales de una paciente menor de un año de edad cuyo síndrome de choque por dengue fue interpretado inicialmente como un caso de sepsis grave. Presentación del caso: Paciente femenina de 8 meses de edad con fiebre y diarreas que concurre a más de un centro hospitalario y la madre se niega a ingresarla. Al quinto dia de enfermedad apareció exantema y ya estando afebril presenta cianosis y otros signos de hipoperfusión tissular, haciéndole diagnóstico inicial de choque por sepsis. Responde satisfactoriamente a la reposición de líquidos cristaloides por via intravenosa administrados inicialmente y es enviada despues a una unidad de terapia intensiva pediátrica donde continua recibiendo tratamiento de rehidratacion y se inicia antibioticoterapia. Posteriormente, la sepsis fue descartada por la evolución del caso y los resultados de laboratorio clinico y microbiológicos, asi como una serología positiva a dengue. Conclusiones. El choque por dengue en el lactante puede expresarse sin su cuadro clinico típico y para su diagnostico es imprescindible considerar el antecedente epidemiológico(AU).

Introduction: The most common form of severe dengue is the dengue shock syndrome. However, infants with dengue don´t present the clinical manifestations that characterize it neither have this complication as often as older patients do. Objective: To know the clinical and laboratory characteristics of a patient of less than one-year-old whose dengue shock syndrome was initially interpreted as a case of severe sepsis. Case presentation: 8-months-old female patient with fever and diarrhea that was checked in more than one hospital and the mother refuses to hospitalize her. In the fifth day of being ill appeared exanthem, and having fever she presented cyanosis and other signs of tisular hypoperfusion, being initially diagnosed a sepsis shock. She responded satisfactorily to the replacement of crystalloid fluids intravenously administered initially and she was sent to a pediatric intensive care unit where she continued receiving rehydration treatment and antibiotic therapy was started. Subsequently, sepsis was ruled out due to the case´s evolutions and the clinical and microbiological laboratory´s results, as well as a serology positive to dengue fever. Conclusions: Dengue shock syndrome in an infant can present without its typical clinical manifestations and for its diagnosis is essential to consider the epidemiological history(AU)

Acute Kidney Injury in Non-Shock Dengue Hemorrhagic Fever

@#INTRODUCTION: Acute kidney injury (AKI) is one of the severe complications in dengue hemorrhagic fever, usually occurred in shock. We report an interesting case of AKI in a hemodynamically stable dengue hemorrhagic fever patient. CASE PRESENTATION: An 18-year-old male dengue fever patient referred to our institution in his day eight of illness due to three days of decreased urine output. He was hemodynamically stable with thrombocytopenia, increase in creatinine, positive for Anti dengue IgM, proteinuria, and hematuria. Ultrasound examination showed ascites. He was diagnosed with AKI stage III related to dengue hemorrhagic fever and underwent hemodialysis. A total of four series of hemodialysis and furosemide drip were performed during 12 days of admission and he was finally improved. CONCLUSION: Renal injury might occur in hemodynamically stable dengue hemorrhagic patients. It is a reversible condition; hence, appropriate treatment and close monitoring result in good outcomes

Caracterización clínica y de laboratorio en pacientes pediátricos en la etapa crítica del dengue / Clinical and laboratory characterization in pediatric patients at the critical stage of dengue

Introducción: El dengue es una enfermedad aguda, infecciosa, transmitida por el mosquito Aedes aegypti, que puede ser de variada intensidad y afecta fundamentalmente a la población pediátrica. Objetivo: Describir las manifestaciones clínicas y de laboratorio en la fase crítica del dengue en niños de un año o más. Método: Estudio de corte transversal. Se estudiaron 195 pacientes con diagnóstico de infección por dengue, ingresados en la Unidad de Cuidados Intensivos del Hospital Pediátrico Docente del Cerro entre enero-diciembre de 2013. Los resultados se expresaron en frecuencias absolutas y relativas y rango. Para el análisis de la relación entre los diferentes síntomas y signos clínicos, se aplicó la prueba ji-cuadrada, con valores de p significativo menor de 0,005. Resultados: Los signos de alarma presentados con mayor frecuencia fueron el dolor abdominal, los vómitos y el sangramiento vaginal en las adolescentes femeninas. La mayoría clasificó como dengue no grave con signos de alarma. No se produjo ninguna defunción por esta causa. Conclusiones: La presentación clínica del dengue en los pacientes pediátricos examinados corrobora que existen síntomas y signos generales, así como signos de alarma que caracterizan la enfermedad; sin embargo los exámenes de laboratorio no apoyan las evidencias clínicas de dicha enfermedad. La prevalencia de las distintas formas graves de dengue fue baja, lo que apunta hacia una relación entre el manejo clínico precoz y una evolución satisfactoria y sugiere que el método clínico constituye una herramienta eficaz para la toma de decisiones(AU)

Introduction: Dengue is an acute infectious disease transmitted by Aedes aegypti mosquito, which can be of varying intensity and it mainly affects the children population. Objective: To describe clinical and laboratory manifestations in the critical phase of dengue in children of one year or more. Method: A cross-sectional study was performed with an analytical component. 195 patients diagnosed with dengue infection and admitted to the intensive care unit of the Pediatric Teaching Hospital of Cerro were studied from January to December 2013. The results were expressed in absolute and relative frequencies, and range. For the analysis of the relationship between the different symptoms and clinical signs, the chi-square test was applied, with significant p-values of more less; 0.005. Results: Warning signs that appeared more frequently were abdominal pain vomiting and vaginal bleeding in female adolescents. Most of them classified as non-severe dengue with warning signs. No death was caused by this. Conclusions: The clinical presentation of dengue in the examined pediatric patients corroborates that there are general symptoms and signs, as well as signs of alarm that characterize the disease. However, laboratory tests do not support the clinical evidences of the disease. The prevalence of the various severe types of dengue was low, which points towards a relationship between early clinical management and satisfactory evolution, and suggests that the clinical method constitutes an effective tool for decision-making(AU)

Utilidad de la identificación de los signos de alarma en niños y adolescentes con dengue / Usefulness of warning signs´ identification in children and adolescents with dengue

Introducción: El dengue es una enfermedad capaz de producir extravasación importante de plasma con hipovolemia y choque, signos frecuentes de gravedad y causa de muerte. Objetivo: Valorar la utilidad de la identificación de los signos de alarma en niños y adolescentes con dengue. Métodos: Estudio prospectivo de 110 pacientes (0-18 años de edad y de ambos sexos) quienes presentaron signos de alarma de dengue grave y se trataron con soluciones cristaloides por vía intravenosa durante su ingreso hospitalario y un número igual de pacientes que no tuvieron esos signos y no requirieron dicho tratamiento. Se aplicó retrospectivamente la clasificación de la OMS 2009 y se comparó con la precedente de1977. Resultados: Los signos de alarma encontrados con mayor frecuencia fueron: dolor abdominal intenso y mantenido (50 por ciento) y vómitos repetidos 3 o más en 4 horas (34,3 por ciento, que aparecieron durante el dia de la defervescencia en 46 por ciento de los pacientes y la mitad mostró ascitis. Después de seis horas de tratamiento con soluciones cristaloides por vía intravenosa, el porcentaje de pacientes con dolor abdominal disminuyó a 30 por ciento, y el de pacientes con signos de bajo gasto cardiaco (hipotensión) disminuyó de 30 a 10 por ciento. No hubo fallecidos. Conclusiones: Los signos alarma del dengue grave cuya identificación ha sido recomendada por OMS y OPS y tambien en las Guías Cubanas, tienen especial importancia en la atención de niños y adolescentes hospitalizados y demostrada su utilidad tanto en la prevencion del agravamiento como en la mejoria del cuadro grave cuando fue tratado en sus inicios(AU)

Introduction: Dengue is a disease that is capable of producing an important plasma extravasation with hypovolaemia and shock, which are frequent signs of seriousness and causes of death. Objective: To value the usefulness of warning signs identification in children and adolescents with dengue. Methods: A prospective study was carried out to 110 children (0-18 years old, both sexes) at Dr. Angel A. Aballi University Pediatric Hospital who had confirmed dengue´s warning signs and were admitted to the Intensive Care Unit and treated with crystalloids solutions by intravenous route. An equivalent number of confirmed dengue patients who did not have warning signs nor received that treatment were the control group. Clinical data and the results of laboratory tests were recorded since patients were admitted in the Intensive Care (ICU) and after 6 hours of treatment. The 2009 World Health Organization (WHO) Dengue Classification was used to classify patients retrospectively and a comparison was made with the WHO 1977 Dengue Classification. Results: Clinical warning signs that were more frequently identified were: intensive and continuous abdominal pain (50 percent) and frequent vomiting (3 or more in 4 hours) (34.3 percent) that appeared during defervescence (46 percent of patients), and half of them presented ascites. After 6 hours of treatment with the crystalloids solutions, the number of patients with abdominal pain decreased to 30 percent and those with low cardiac output (hypotension) from 35 percent to 10 percent. No fatalities occurred. Conclusions: Warning signs of severe dengue, which identification has been recommended by WHO and PAHO and also in the Cuban Guidelines, has special importance in the care of hospitalized children and adolescents; and it was demonstrated its usefulness in the prevention of severity as in the improvement of the signs of severity when those were treated in the onset period(AU)

Upregulation of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in renal tissue in severe dengue in humans: Effects on endothelial activation/dysfunction

Abstract INTRODUCTION: Dengue is an important mosquito-borne disease in tropical and subtropical regions. Adhesion molecules have not been systematically characterized in the renal tissue of patients with severe dengue (SD). The objective of this study was to detect viral antigens in samples from patients that evolved with SD, correlating with the expression of ICAM-1, VCAM-1, VE-cadherin, and E-selectin to contribute to a better understanding of the pathophysiology of SD. METHODS: Kidney specimens from patients with SD were selected according to clinical and laboratorial data and submitted to histological and immunohistochemistry analysis. A semiquantitative evaluation was performed considering positive immunostaining in 20 glomeruli. RESULTS: Viral antigens were mainly detected in distal tubules. The intense immunostaining of VCAM-1 and ICAM-1 was observed. The expression of E-selectin was discrete, and VE-cadherin expression varied from mild to moderate. VCAM-1 was slightly intense in the glomerular capsule; the expression of ICAM-1 was diffuse. E-selectin was diffuse, and VE-cadherin varied from mild to moderate. The most frequent histological findings were glomerular congestion, mild glomerulitis, acute renal injury, and glomerular atrophy. CONCLUSIONS: The results appear to demonstrate an imbalance between vascular endothelial permeability regulating events in renal lesions in SD. The increase in the expression of ICAM-1 and VCAM-1 is an in-situ indicator of higher permeability with a consequent influx of cells favoring the inflammation of the endothelium. These molecules are important in the pathophysiology of the disease and provide the possibility of developing new markers for the evaluation, clinical follow-up, and therapeutic response of patients with SD.