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.

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)

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)

Cardiac tamponade in a patient with severe dengue fever

Abstract A 26-year-old postpartum female presented with symptoms characteristic of dengue fever on the 16th day of puerperium. On the third day of the illness, the patient presented a clinical picture consistent with shock. Tests determined primary infection with dengue virus serotype 2. Cardiac tamponade was confirmed by echocardiography. This rare manifestation is described in a patient without any associated comorbidity.

Bilateral acute angle closure in a patient with dengue fever: a case report / Fechamento de ângulo agudo bilateral em paciente com dengue: relato de um caso

ABSTRACT We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.

RESUMO Os autores relatam o caso de uma mulher de 46 anos que teve fechamento agudo de ângulo bilateral durante a infecção por dengue. O diagnóstico de dengue foi confirmado por testes sorológicos. A paciente teve configuração de íris em platô confirmada pela biomicroscopia ultrassônica. Esse é o segundo caso descrevendo essa condição durante um episódio de dengue e o primeiro a descrever as características do ângulo.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children / Sinais clínicos e laboratoriais para o dengue com evolução grave em crianças hospitalizadas

Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. Results: Of the total (n = 145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p < 0.01), but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p < 0.01). Despite statistical significance (p < 0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Resumo Objetivo Avaliar a validade dos sinais clínicos e laboratoriais para o dengue com evolução grave em crianças hospitalizadas. Métodos Coorte retrospectivo de crianças (<18 anos) internadas com dengue (2007-2008). Evolução grave foi definida como óbito ou pelo uso de terapia de suporte avançado de vida. Foram calculadas medidas de acurácia e área sob a curva ROC. Resultados Do total (n = 145), 53,1% casos eram do sexo feminino, 69% de 2 a 11 anos e 15,9% evoluíram para gravidade. Letargia obteve a melhor acurácia (razão de verossimilhança positiva RVP > 19 e RV negativa RVN < 0,6). Derrame pleural e distensão abdominal apresentaram maior sensibilidade (se = 82,6%). Relato de sangramentos (epistaxe, gengivorragia ou gastrointestinal) e hemorragia grave (pulmonar ou gastrointestinal) presente no exame físico foi mais frequente nos casos com evolução grave (p <0,01), porém com baixa acurácia (RVP = 1,89 e 3,89; RVN = 0,53 e 0,60, respectivamente). Os níveis de albumina sérica foram mais baixos nas formas graves (p <0,01). Ambos os grupos apresentaram trombocitopenia, apesar da diferença estatística (p <0,05). Contagem de plaquetas, hematócrito e hemoglobina apresentaram área sob a curva ROC < 0,5. Conclusões Letargia, distensão abdominal, derrame pleural e hipoalbuminemia foram os melhores marcadores clínicos e laboratoriais de dengue com evolução grave em crianças hospitalizadas, enquanto sangramento, hemorragia grave, hemoconcentração e trombocitopenia não tiveram boa acurácia diagnóstica. Em hospitais de referência pediátricos, a ausência de hemoconcentração não implica ausência de extravasamento plasmático, particularmente quando há reposição anterior de volume. Esses resultados podem contribuir para o manejo clínico do dengue em crianças em hospitais de referência.

Acute pancreatitis complicating dengue hemorrhagic fever

Abstract Dengue infection can have spectrum of manifestations, often with an unpredictable clinical progression and outcome. There have been increasing reports of atypical manifestations. Abdominal pain or tenderness and persistent vomiting (warning signs) are present in the majority of cases with severe dengue prior to clinical deterioration. We report a 10-year-old child who presented with fever, persistent vomiting, and abdominal pain. A diagnosis of acute pancreatitis was made. This is a very infrequently reported complication of dengue hemorrhagic fever.

Dengue With Severe Plasma Leakage: A New Monitoring Approach / Dengue con extravasación grave de plasma: un nuevo abordaje de evaluación

Abstract:AimTo describe a simple and efficacious monitoring system for patients presenting with severe dengue with severe plasma leakage.Method: We reviewed sixty-one out of 110 records of patients presenting with dengue in August and September of 1999 at the Hospital Tony Facio, Limón province, Costa Rica.Results: Dengue virus 3 was the cause of the epidemic. Thirty one (51%) patients presented with warning sings, and thirty (49%) had severe dengue with severe plasma leakage. Those patients presenting with hypotension (low mean arterial blood pressure) were treated with an intravenous polyelectrolyte solution in order to maintain the mean arterial pressure between the lower and mean range. When the mean arterial pressure presented a tendency to rise over the normal range, the infusion was withdrawn. The hematocrit was not the parameter used to monitor the treatment of the patients. There were no deaths.Conclusions: Monitoring the mean arterial blood pressure instead of the hematocrit values in patients with severe dengue with severe plasma leakage represents an easier and more efficacious way of treating this patient population.

Resumen:Objetivo:describir un sistema de monitoreo más simple y eficiente para pacientes con dengue grave con extravasación de plasma severa.Método:se revisaron 61 de 110 expedientes de pacientes que presentaban dengue, entre agosto y setiembre de 1999, en el Hospital Tony Facio de la provincia de Limón en Costa Rica.Resultados:el virus de dengue tipo 3 causó la epidemia. Treinta y uno (51%) de los pacientes presentaron signos de alarma, treinta (49%) presentaron dengue grave con extravasación de plasma severa. Los pacientes que presentaban hipotensión (baja presión sanguínea media) fueron tratados con solución de polielectrolitos intravenosa para mantener la presión arterial media entre el rango inferior y la media. En cuanto la presión arterial media presentaba una tendencia a incrementar sobre el rango normal, la infusión era retirada. El hematocrito no fue un parámetro para monitorear el manejo de los pacientes. No hubo muertes.Conclusiones:El monitorear la presión arterial media, en lugar de los valores de hematocritos, en pacientes con dengue grave con extravasación severa representa una manera más fácil y eficiente de tratar a esta población de pacientes.

Severe dengue in the early postoperative period after kidney transplantation: two case reports from Hospital Geral de Fortaleza

Abstract: Dengue is an arbovirosis that ranges from an asymptomatic presentation to a more severe disease, which is characterized by a vascular leakage syndrome where abdominal pain is a major symptom. Transplant recipients are immunosuppressed and are less likely to develop a severe form of the disease because of a reduction in immune-mediated responses that trigger plasma extravasation events. Herein, we report two cases of severe dengue in the early postoperative period of two kidney transplant recipients. Considering the severity of the cases, we emphasize the importance of dengue screening immediately before transplantation in areas endemic for the disease.

Intervenciones de enfermería para la atención del paciente con dengue grave en el segundo y tercer nivel de atención / Nursing interventions for the care of the patient with dengre grave in the second and third level

Introducción. El dengue es una enfermedad infecciosa sistémica, viral transmitida por el mosquito “Aedes”. La OMS calcula que cada año se producen entre 50 y 100 millones de infecciones por este virus en el mundo. En México en el transcurso de la última década ha habido un incremento de casos, especialmente de tipo hemorrágico.Métodos. Se realizó una búsqueda sistemática de artículos en cuatro etapas, retrospectiva a 10 años relacionada a dengue grave en PubMed, BVS, Tripdatabase y sitios Web; obteniendo 149 resultados, siendo útiles 40 para el desarrollo de esta guía: revisiones sistemáticas, meta análisis, ensayos clínicos aleatorizados, estudios observacionales y Guías de Práctica Clínica.Resultados. Revisiones sistemáticas mencionan que la desnutrición grado 2 o 3 proteico calórica severa protege contra la vasculopatía del dengue y que la fase crítica comienza alrededor del período de desaparición de fiebre, la leucopenia avanza y hay una rápida disminución de plaquetas, esto precede a la manifestación más específica y potencialmente mortal de esta fase: incrementa la permeabilidad capilar conduciendo a la pérdida de plasma y aumento en él hematocrito; un estudio transversal prospectivo encontró que infecciones sucesivas del virus del dengue aumentan el riesgo de dengue grave y un estudio multicéntrico refiere que las fallas orgánicas más desarrolladas fueron respiratorias, cardiovasculares, neurológicas y hepáticas.Conclusiones. La implementación de las recomendaciones están dirigidas principalmente a las intervenciones de enfermería que contribuyen a la prevención, recuperación, disminución de complicaciones y limitación de daños para el paciente con dengue grave.

Introduction. Dengue fever is a systemic, viral infectious disease transmitted by the ""Aedes"" mosquito. WHO estimates that each year occur between 50 and 100 million infections by this virus in the world. In Mexico over the course of the last decade, there has been an increase in cases, especially of hemorrhagic type. Methods. A systematic search of articles was carried out in four stages, back at 10 years related to severe dengue in PubMed, VHL, Tripdatabase and Web sites; 149 results, being useful 40 for the development of this guide: systematic reviews, meta analysis, clinical trials randomized, observational studies and clinical practice guidelines. Results. Systematic reviews mentioned malnutrition grade 2 or severe caloric protein 3 protects against vascular disease of dengue and the critical phase begins around the time of the disappearance of fever, leukopenia advances and there is a rapid decrease in platelets, this precedes the manifestation more specific and potentially deadly this phase: increases capillary permeability, leading to the loss of plasma and increase the hematocrit; a prospective cross-sectional study found that successive infections of the dengue virus increases the risk of serious dengue and a multicenter study concerns that more developed organic failures were respiratory, cardiovascular, neurological and hepatic.Conclusions. The implementation of the recommendations are directed mainly to the nursing interventions that contribute to the prevention, recovery, reduction of complications and limitation of patient with severe dengue.

Introdução. Dengue é uma doença infecciosa sistêmica, viral transmitida pelo mosquito ""Aedes"". O que estima-se que cada ano produzirá entre 50 e 100 milhões de infecções por este vírus no mundo. No México, durante a última década tem sido um aumento de casos, especialmente do tipo hemorrágico. Métodos. Uma busca sistemática dos artigos foi realizada em quatro etapas, em 10 anos relacionados com graves da dengue no PubMed, BVS, Tripdatabase e Web sites; 149 resultados, sendo 40 útil para o desenvolvimento deste guia: revisões sistemáticas, meta análise, ensaios clínicos randomizados, estudos observacionais e diretrizes de prática clínica.Resultados. Revisões sistemáticas mencionado o grau de desnutrição 2 ou proteína calórica grave 3 protege contra doença vascular de dengue e a fase crítica começa na época do desaparecimento da febre, leucopenia avança e há uma rápida diminuição de plaquetas, isto precede a manifestação mais específica e potencialmente mortal nesta fase: aumenta a permeabilidade capilar, levando à perda de plasma e aumento do hematócrito; um estudo transversal prospectivo descobriu que infecções sucessivas do vírus da dengue a aumentam o risco de dengue grave e um estudo multicêntrico refere-se que os defeitos orgânicos mais específica e potencialmente mortal nesta fase: aumenta a permeabilidade capilar, levando à perda de plasma e aumento do hematócrito; um estudo transversal prospectivo descobriu que infecções sucessivas do vírus da dengue a aumentam o risco de dengue grave e um estudo multicêntrico refere-se que os defeitos orgânicos mais desenvolvidos eram respiratórias, cardiovasculares, neurológicas e hepáticas. Conclusões. A implementação das recomendações são direcionados principalmente para eles, as intervenções de enfermagem que contribuem para a prevenção, recuperação, redução de complicações e a limitação de danos para o paciente com dengue grave.

Fiebre Chikungunya / Chikungunya fever

Antecedentes: La fiebre Chikungunya es causada por un alfavirus (CHIKV) ARN pertene- ciente a la familia Togaviridae. Fue descrito en 1953, a partir de entonces se han presentado epidemias desde África, Asia y últimamente casos en las Antillas en América. Ante el riesgo de importación y transmisión del virus, esta entidad ha adquirido importancia, antes poco conocida en nuestro continente. La presente revisión bibliográfica tiene como objetivo la actualización de conocimientos acerca de la fiebre Chikungunya. El CHIKV es transmitido por dos vectores, Aedes aegypti y albopictus, los humanos son el reservorio principal en los periodos epidémicos. Después de 3 a 7 días de incubación, aparece la fiebre, artralgias, cefalea. Laboratorialmente, se observa trombocitope- nia leve, leucopenia con linfopenia. Los indivi- duos no infectados previamente están en riesgo de adquirir la infección y desarrollar la enfermedad, siendo los neonatos y los ancianos más propensos a desarrollar formas más graves. La transmisión de madre a hijo es frecuente en la viremia materna intraparto, y conduce a la infección. La mortalidad es baja, pero la artral- gia inflamatoria con artropatía/artritis destruc- tiva puede comprometer la calidad de vida del paciente afectado. Dada la introducción del CHIKV en la Región, la detección oportuna, una respuesta apropiada y rápida, son necesarias para minimizar el riesgo de importación y transmisión del CHIKV...(AU)

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial. .

Dengue: guía de manejo clínico / Dengue: clinical management guide

El dengue es una sola enfermedad, con diferentes presentaciones clínicas y con evolu-ción clínica impredecible. La infección es causada por un arbovirus, el virus del dengue, con cuatro serotipos denominados 1, 2, 3 y 4. Cada uno de los serotipos puede causar infección en una misma persona. La infección por un serotipo deja inmunidad de por vida contra ese serotipo, pero solo por algunos meses contra los demás serotipos.El virus es transmitido por la picadura de la mosquito hembra Aedes aegypti, el cual a su vez se infecta tras picar a una persona que está cursando el periodo virémico de la enfer-medad (habitualmente los primeros 5 días desde el inicio de la fiebre). Tras un periodo de incubación de 10-12 días en el intestino de la mosquita, el virus aparece en la saliva de la misma y a partir de ese momento puede transmitir la enfermedad a los seres humanos.

Clinical and laboratory findings in patients with dengue associated with hepatopathy / Achados clínicos e laboratoriais em pacientes com dengue associada à hepatopatia

INTRODUCTION: Hepatic disorders caused by dengue infection may progress to severe manifestations, including mortality and morbidity. Cytokines are involved in it, such as the migration inhibitory factor of macrophages (MIF), tumor necrosis factor (TNF), natural killer cells (NK), B lymphocytes, and macrophages. METHODS: This study was carried out from January to April 2007 at a public hospital from the Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Sixty-eight patients were studied concerning hepatic alterations, with 56 reported having classic dengue, 6 with hemorrhagic dengue grade I, and 6 with hemorrhagic dengue grade II. RESULTS: Among the 56 with classic dengue, 83.3 percent had aspartate aminotransferase (AST) alterations, and 69.6 percent had altered alanine aminotransferase (ALT). For those with hemorrhagic dengue grade I, 100 percent had AST alterations, and 83.3 percent had altered ALT. All the patients with hemorrhagic dengue grade II had AST and ALT alterations. AST variations reached 22.0 and 907.0, with an average value of 164.6. For ALT, we found variations between 25.0 and 867.0, with an average value of 166.07. There had been statistical significance between dengue clinical shapes and hepatic function markers. CONCLUSIONS: We conclude that the infection was predominant in adults, females, and in those with low income and education. The liver enzymes were of larger amount in hemorrhagic dengue, but there was weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, severe pain behind the eyes, and rashes.

INTRODUÇÃO: Afecções hepáticas causadas pela infecção da dengue podem evoluir para quadro grave, incluindo mortalidade e morbidade. O mecanismo de lesão do fígado está relacionado com a exacerbação da resposta imune. As citocinas estão envolvidas nele como fator inibidor da migração de macrófagos (MIF), fator de necrose tumoral (TNF), células natural killer (NK), B linfócitos e macrófagos. MÉTODOS: Este estudo foi realizado em um hospital público da Universidade Federal do Mato Grosso do Sul. As alterações hepáticas pelo dengue podem evoluir com quadros graves e potencialmente letais. Foram avaliados exames de 68 pacientes atendidos e confirmados com dengue, onde 56 foram classificados como dengue clássico, seis, como dengue hemorrágico grau I e seis como dengue hemorrágico grau II. RESULTADOS: Do dengue clássico, 83,3 por cento tiveram alterações de aspartato aminotransferase (AST) e 69,6 por cento alterações para alanino aminotransferase (ALT). No dengue hemorrágico grau I, AST elevou-se 100 por cento e para ALT 83,3 por cento. No dengue hemorrágico grau II observou-se 100 por cento de alterações tanto para AST, quanto para ALT. A variação de AST ficou entre 22,0 e 907,0 com média de 164,6. A alanino aminotransferase variou entre 25,0 e 867,0 com média de 166,07. Houve significância entre formas clínicas do dengue e marcadores de função hepática. CONCLUSÕES: Conclui-se que a infecção predominou em adultos do sexo feminino, de baixa renda e escolaridade. As enzimas hepáticas elevam-se mais no dengue hemorrágico, fraca evidência estatística entre as manifestações clínicas e as transaminases. Os mais prevalentes sinais/sintomas clínicos foram febre, cefaléia, mialgia, artralgia, fraqueza, dor retrorbitária e exantema.

Dengue hemorrhagic fever complicated by pancreatitis

Acute pancreatitis is an atypical complication of dengue fever and is rarely described. We are reporting a case of dengue hemorrhagic fever complicated by acute pancreatitis in a patient with history of diabetes mellitus type 1 and end stage renal disease on hemodialysis.

Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss.

Dengue hemorrhagic fever leading to hemorrhage in pituitary adenoma is not reported till date: We herein report the first case of bilateral visual loss secondary to pituitary adenoma hemorrhage associated with dengue hemorrhagic fever. Urgent transnasal trans sphenoidal decompression of the macroadenoma prevented permanent visual loss in this patient. Pituitary apoplexy should be considered as differential diagnosis of visual deterioration apart from retinal hemorrhage, maculopathy, and optic neuropathy in cases of dengue hemorrhagic fever. Early decompression of optic nerves helped in the restoration of vision.

Fisiopatología y diagnóstico del dengue / Pathophysiology and diagnosis of dengue

Introducción. El dengue apareció en Honduras en el año 1977. Han habido brotes epidémicos en 1978, 1987, 1988, 1989, 2002 y 2007. Hasta junio del 2010 se han reportado 8,650 casos sospechosos. Fuente. Se hizo revisión de aspectos fisiopatológicos y diagnósticos en la literatura internacional y local, a través de las bases Hinari, OPS, Biblioteca Virtual en Salud y el Centro de Información Sobre Desastres y Salud (CIDBIMENA) Desarrollo. El agente causal del dengue es un arbovirus ARN trasmitido por el vector Aedes aegypti. La enfermedad puede manifestarse desde una infección asintomática o como fiebre inespecífica en el 50%-80% de casos, hasta una enfermedad hemorrágica y un síndrome de choque que puede causar la muerte. Los hallazgos patológicos en casos fatales muestran en cerebro edema, necrosis en hígado, edema y hemorragias pulmonares, necrosis tubular aguda en riñones, y tumefacción endotelial de capilares y arteriolas. Conclusión. Dado que los casos en el país van en aumento actualmente, todo médico debe estar actualizado con la presentación clínica, fisiopatología y métodos diagnósticos del dengue para identificar tempranamente los casos, dar el manejo oportuno y evitar la mortalidad...

Situación epidemiológica del dengue en Honduras período 1991-2010 / Epidemiological situation of dengue in Honduras during the 1991-2010 period

El dengue es la enfermedad viral transmitida por mosquitos de más rápida diseminación en el mundo. En los últimos 50 años, la incidencia se ha incrementado más de 30 veces. En Honduras, los primeros casos se presentaron durante la epidemia de 1978. Actualmente, constituye un problema de salud pública mayor en nuestro país. Se revisa la situación epidemiológica del dengue en el periodo 1991-2010, los principales hitos alcanzados y las recomendaciones a ser aplicadas para el control del problema. Fuentes. Se realizó revisión de las estadísticas epidemiológicas sobre el dengue en Honduras publicadas por la Secretaría de Salud, publicaciones especiales de la Organización Mundial de la Salud, así como la literatura médica internacional y nacional de las últimas tres décadas. Desarrollo. El patrón epidemiológico de la fiebre del dengue en Honduras durante los últimos 32 años ha mostrado dos distintas etapas: 1) brotes epidémicos en áreas localizadas (1978-1994) y 2) circulación viral endémica o epidémica a nivel nacional con predominio de las Regiones Sanitarias Metropolitanas del Distrito Central y San Pedro Sula (1995–2010). Estas regiones han representado más del 50% de los casos de dengue del país en los últimos cuatro años. Conclusiones. Las lecciones aprendidas más relevantes en este periodo nos muestran que el control de este problema parte de un compromiso político decidido de los tomadores de decisiones, el involucramiento de los diversos sectores gubernamentales y no gubernamentales y la adopción de una campaña continua de educación en salud...