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)

Primary dengue haemorrhagic fever in patients from northeast of Brazil is associated with high levels of interferon-β during acute phase

Dengue is an acute febrile disease caused by the mosquito-borne dengue virus (DENV) that according to clinical manifestations can be classified as asymptomatic, mild or severe dengue. Severe dengue cases have been associated with an unbalanced immune response characterised by an over secretion of inflammatory cytokines. In the present study we measured type I interferon (IFN-I) transcript and circulating levels in primary and secondary DENV infected patients. We observed that dengue fever (DF) and dengue haemorrhagic fever (DHF) patients express IFN-I differently. While DF and DHF patients express interferon-α similarly (52,71 ± 7,40 and 49,05 ± 7,70, respectively), IFN- β were associated with primary DHF patients. On the other hand, secondary DHF patients were not able to secrete large amounts of IFN- β which in turn may have influenced the high-level of viraemia. Our results suggest that, in patients from our cohort, infection by DENV serotype 3 elicits an innate response characterised by higher levels of IFN- β in the DHF patients with primary infection, which could contribute to control infection evidenced by the low-level of viraemia in these patients. The present findings may contribute to shed light in the role of innate immune response in dengue pathogenesis.

Primary dengue virus infections induce differential cytokine production in Mexican patients

Severe dengue pathogenesis is not fully understood, but high levels of proinflammatory cytokines have been associated with dengue disease severity. In this study, the cytokine levels in 171 sera from Mexican patients with primary dengue fever (DF) and dengue haemorrhagic fever (DHF) from dengue virus (DENV) 1 (n = 116) or 2 (n = 55) were compared. DF and DHF were defined according to the patient’s clinical condition, the primary infections as indicated by IgG enzymatic immunoassay negative results, and the infecting serotype as assessed by real-time reverse transcription-polymerase chain reaction. Samples were analysed for circulating levels of interleukin (IL)-12p70, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, IL-6, and IL-8 using a commercial cytometric bead array. Significantly higher IFN-γ levels were found in patients with DHF than those with DF. However, significantly higher IL-12p70, TNF-α, and IL-6 levels were associated with DHF only in patients who were infected with DENV2 but not with DENV1. Moreover, patients with DF who were infected with DENV1 showed higher levels of IL-12p70, TNF-α, and IL-6 than patients with DHF early after-fever onset. The IL-8 levels were similar in all cases regardless of the clinical condition or infection serotype. These results suggest that the association between high proinflammatory cytokine levels and dengue disease severity does not always stand, and it once again highlights the complex nature of DHF pathogenesis.

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.

Títulos de anticuerpos neutralizantes en sueros de individuos posconvalescientes con dengue / Neutralizing antibody titers in sera from patients post-convalescing from dengue

Introducción: la inmunidad del hospedero desempeña un papel importante en determinar el desarrollo de las infecciones por dengue y del cuadro severo de la enfermedad. Sin embargo, otros factores intervienen en el complejo mecanismo de la patogénesis, como la variación entre las cepas virales. Objetivos: evaluación de la capacidad neutralizante de un grupo de sueros de posconvalescientes frente a 2 cepas de dengue 4 pertenecientes a un mismo genotipo. Métodos: se emplearon sueros de 68 individuos con un cuadro de fiebre del dengue y 35 con un cuadro clínico de fiebre hemorrágica del dengue. Resultados: los títulos de anticuerpos neutralizantes en los sueros estudiados fueron bajos y se observó una capacidad neutralizante diferente entre las 2 cepas de dengue 4 del genotipo II. Se observaron diferencias significativas en los títulos de anticuerpos neutralizantes de los sueros procedentes de individuos con infección secundaria y con la forma severa de la enfermedad. Conclusiones: estos resultados demuestran la complejidad de los anticuerpos neutralizantes, que se producen después de una infección por el virus dengue con diferentes cepas de un mismo serotipo, lo cual conduce a obtener resultados diversos por esta técnica que podría ser la causa de la trasmisión continuada de múltiples cepas de dengue.

Introduction: host immunity plays an important role in determining the development of dengue infections and the severe form of the disease. However, other factors, such as the variation between viral strains, are also involved in this complex pathogenesis mechanism. Objectives: evaluate the neutralizing capacity of a number of sera from post-convalescing patients against two dengue 4 strains from the same genotype. Methods: examination was conducted of sera from 68 individuals with dengue fever and 35 with dengue hemorrhagic fever. Results: neutralizing antibody titers were low in the sera analyzed. Different neutralizing capacity was found between the two dengue 4 strains from genotype II. Significant differences were observed between neutralizing antibody titers in sera from individuals with secondary infection and with the severe form of the disease. Conclusions: results reveal the complex nature of the neutralizing antibodies produced after a dengue infection with different strains of the same serotype, leading to diverse results by this technique, which could be the cause of the continued transmission of multiple dengue strains.

Dengue epidemiology in Thanjavur and Trichy district, Tamilnadu - Jan 2011-Dec 2011.

Background: Dengue infection is emerging as a serious public health problem in Tamil Nadu. An enhanced surveillance system can generate information on the epidemiology of the disease, which is essential for planning and development of relevant control/preventive measures against Dengue. Materials and Methods: A prospective descriptive study was undertaken between January 2011 to December 2011, by testing suspected Dengue patients attending Thanjavur Medical College and Trichy Hospital (TMCH, a major Government referral hospital in Thanjavur District, Tamil Nadu, India) to define the magnitude of Dengue burden, the natural history of this disease in terms of clinical presentation and outcome of the infections in hospitalized Dengue patients. The sera collected from suspected patients were analyzed for Dengue specific IgM and IgG antibodies by IgM antibody capture enzyme linked immunosorbent assay (ELISA) using NIV kit and IgGPanBio Duo Rapid Immunochromatographic Card Test (Brisbane, Australia). The clinical case definition by World Health Organization was adopted to categorize the Dengue cases. Results: The total number of samples screened during the period was 200, out of which 79 (39.5%) were positive for IgM and IgG antibodies and 65 (32%) for IgM antibodies only. By clinical evaluation, Dengue fever was diagnosed in 43 patients, 18 had hemorrhagic manifestations and four patients had progressed to DSS. Though (DSS + DHF) was present in 22 patients, all of them recovered well. Conclusion: In developing countries like India, building of laboratory with advanced capacity for diagnosis and combat-mode ready preparedness for the management of Dengue cases in emergency situation may reduce Dengue-related mortality.

Steroid responsive prolonged thrombocytopenia in dengue.

Prolonged thrombocytopenia in a usual case of dengue virus infection is uncommon. Dengue-related thrombocytopenia is self-limiting and responds within 3-5 days. An underlying immunological disorder may be responsible for delayed return of platelet count to a normal level. We present a case of prolonged thrombocytopenia in a case of dengue hemorrhagic fever. The response to steroids suggests a possible immunological dysfunction.

Consecuencias del dengue hemorrágico en niños / Impact of dengue hemorrhagic fever in children

En los niños, el dengue se presenta con una variabilidad sintomática caracterizado por manifestaciones de extravasación vascular que pueden conllevar a consecuencias severas en términos de mortalidad y de costos. Estudio prospectivo y descriptivo realizado en Pediatría Médica Infecciosa (PMI) del hospital Universitario de Caracas (HUC), en niños de un mes a 12 años, con criterios de dengue hemorrágico (DH) y evidencia por laboratorio de infección aguda o reciente, que ingresaron entre enero 2000 y junio 2008, con el objetivo de evaluar las consecuencias en términos de mortalidad y costos por hospitalización. De 4 386/930 hospitalizados que ingresaron con diagnóstico de dengue, 453 cumplieron con los criterios de inclusión representando el 10 por ciento de las hospitalizaciones en PMI. El DH se presentó con mayor frecuencia entre los 5 y 9 años de edad y en el segundo semestre de cada año. El promedio de hospitalización fue de 6 días. Las consecuencias se evaluaron en términos de pérdidas de vidas (3 niños), con una tasa de letalidad 0,6 por ciento y egresos monetarios por concepto de hospitalización (exceptuando de la definición, costos/medicamentos y pruebas de laboratorio). Los gastos/hospitalización/día oscilaron entre 100 y 350$. Un 15 por ciento de los pacientes recibieron antibióticos por diagnósticos diferenciales. Ha habido un incremento progresivo de hospitalizaciones por DH en PMI, desde el 2000, predominando en la época de lluvia, con registros de casos fatales. Se generaron costos hospitalarios elevados por hospitalización que pudieran ser derivados a campañas de prevención.

Serum levels of interleukin-6, tumor necrosis factor-alpha and interferon-gama in infants with and without dengue

This study compared the serum levels of IL-6, TNF-alpha and IFN-gamma, in children under 1 year of age with and without dengue. Sera were collected from a total of 41 children living in the Department of Antioquia, Colombia (27 patients with dengue and 14 controls). The results showed higher cytokine levels in children with dengue than without dengue, with statistically significant differences for IL-6 and IFN-gamma. No statistically significant differences were found between clinical forms, although IL-6 and IFN-gamma levels were higher in dengue fever cases than in dengue hemorrhagic fever cases. On the other hand, TNF-alpha levels were higher in dengue hemorrhagic fever than in dengue fever. The levels of IL-6 and TNF-alpha were higher in secondary infection than in primary infection, although IFN-gamma levels were higher in primary infection. These results suggest that IL-6, TNF-alpha and IFN-gamma are involved in dengue infection independently of the clinical form.

Este estudo comparou os níveis séricos de IL-6, TNF-alfa e IFN-gama, em crianças menores de um ano com e sem dengue. Os soros foram coletados de um total de 41 crianças residentes no Departamento de Antioquia, Colômbia (27 pacientes com dengue e 14 controles). Os resultados mostraram níveis de citoquinas mais elevadas em crianças com dengue do que naquelas sem dengue, com diferenças estatisticamente significativas para IL-6 and IFN-gama. Não houve diferenças estatisticamente significativas entre formas clínicas, embora os níveis de IL-6 e IFN-gama estivessem mais elevados nos casos de febre do dengue que nos casos de febre hemorrágica do dengue. Por outro lado, os níveis de TNF-alfa estavam mais elevados na febre hemorrágica do dengue que na febre do dengue. Os níveis de IL-6 and TNF-alfa estavam mais elevados em infecções secundárias que em infecções primarias, embora os níveis de IFN-gama estivessem mais elevados em infecções primárias. Estes resultados sugerem que IL-6, TNF-alfa e IFN-gama estejam envolvidos na infecção do dengue, independentemente da forma clínica.

Serotipo, Patrón de Infección y Dengue Hemorrágico en Area Endémica Colombiana / Dengue hemorrhagic fever serotype and infection pattern in a Colombian endemic area

Objetivo: La relación entre serotipo del virus, patrón de infección y dengue hemorrágico es presentada. Métodos: Se estudiaron 1 545 pacientes febriles de municipios del Departamento de Santander, Colombia, entre 1998-2004. El dengue se confirmó por ELISA-IgM y el aislamiento viral se hizo en células C6/36. El patrón de infección se estableció investigando anticuerpos IgG en suero agudo. El título de anticuerpos neutralizantes se determinó usando la prueba de neutralización por reducción de placa (PRNT). Resultados: Predominancia del DEN-1 en 1998 y re-introducción del DEN-3 en 2001 coincidieron con epidemias. El dengue hemorrágico fue más frecuente en infecciones por virus DEN-2 que DEN-3 (24,5 por ciento vs 11,2 por ciento; p<0,05). El DEN-2 se asoció más con infección secundaria que el DEN-3 (56,8 por ciento vs 15,7 por ciento; p< 0,001). Disminución anual del DH correlacionó con disminución de la dominancia del DEN-2 (r = 0,95, p=0,01) y de la infección secundaria (r=0,9; p=0,03) e incremento de la dominancia del DEN-3 (r=-0,91; p=0,03). No se encontraron diferencias en el título de anticuerpos neutralizantes en los casos analizados. Los anticuerpos neutralizantes del DEN-1 fueron los de mayor título. Conclusión: Cambios en la abundancia relativa de serotipos del virus se asociaron con cambios en el patrón de infección y frecuencia del dengue hemorrágico. La vigilancia virológica permanente deberá ser prioridad para la prevención del dengue hemorrágico en áreas endémicas.

Objective: Describing the relationship between viral serotypes, infection pattern and dengue hemorrhagic fever. Methods: 1 545 febrile patients were studied from 1998-2004 in the Santander department of Colombia. Dengue infection was confirmed by IgM ELISA and the virus was isolated in C6/36 cells. Infection pattern was established by detecting IgG antibodies in acute serum. Neutralising antibody titres were investigated in dengue cases occurring during years when less (1998) and more (2001) dengue hemorrhagic cases were reported by using PRNT. Results: DEN-1 predominance in 1998 and the re-introduction of DEN-3 in 2001 coincided with an epidemic. DEN-2 infection caused more hemorrhagic cases than DEN-3 infection (24,5 percent cf 11,2 percent; p<0.05). DEN-2 was more associated with secondary infection than DEN-3 (56,8 percent cf 15,7 percent; p<0.001). An annual decrease of DHF was correlated with decreased DEN-2 dominance (r=0.95; p= 0.01), and secondary infection (r=0.9; p=0.03) and increased DEN-3 predominance (r=-0.91; p=0.03). There were no differences in neutralising antibody titres amongst analysed cases. DEN-1 neutralising antibodies presented the highest titres. Conclusions: Change in relative dengue virus serotype abundance was associated with changed infection pattern and DHF frequency. Continuing virological surveillance should become a priority for preventing dengue hemorrhagic fever in endemic areas.

El dengue y el dengue hemorrágico: prioridades de investigación / Dengue and dengue hemorrhagic fever: research priorities

Dengue is one of the most important infectious diseases in tropical and subtropical countries. At present, the only strategy available to reduce the incidence of dengue is vector control. The World Health Organization and the Pan American Health Organization have called on all nations to take the needed steps to help diminish the burden of this disease and its medical and socioeconomic impact. It is hoped that it will be possible to reverse the increase in dengue and help control its spread through a coordinated, effective international response, along with epidemiological, clinical, and virological research that brings together the most advanced methods and techniques. This piece summarizes the most up-to-date information on dengue, analyzes current epidemiologic trends in the Region of the Americas, discusses the main global and Western Hemisphere initiatives to control the disease, and presents the main areas of research that should be developed in the immediate future.

Vacinas para a dengue: perspectivas / Dengue vaccines: perspectives

Objetivo: avaliar o desenvolvimento das vacinas para prevenção da dengue. Fontes pesquisadas: as bases de dados Medline, Cochrane Library e sites da Internet, utilizando-se a palavra chave dengue, no período de 01/1998 a 03/2004. Destes textos foram extraidas as informações relativas ao desenvolvimento de vacinas para a dengue...

Detection of circulant tumor necrosis factor-alpha, soluble tumor necrosis factor p75 and interferon-gamma in Brazilian patients with dengue fever and dengue hemorrhagic fever

Pro-inflammatory cytokines are believed to play an important role in the pathogenesis of dengue infection. This study reports cytokine levels in a total of 54 patients examined in Recife, State of Pernambuco, Brazil. Five out of eight patients who had hemorrhagic manifestations presented tumor necrosis factor-alpha (TNF-alpha) levels in sera which were statistically higher than those recorded for controls. In contrast, only one out of 16 patients with mild manifestations had elevated TNF-alpha levels. The levels of interleukin-6 (IL), IL-1beta tested in 24 samples and IL-12 in 30 samples were not significantly increased. Interferon-g was present in 10 out of 30 patients with dengue. The data support the concept that the increased level of TNF-alpha is related to the severity of the disease. Soluble TNF receptor p75 was found in most patients but it is unlikely to be related to severity since it was found with an equivalent frequency and levels in 15 patients with dengue fever and another 15 with dengue hemorrhagic fever

Dengue virus specific T cell responses to live attenuated monovalent dengue-2 and tetravalent dengue vaccines.

The proliferative T cell responses to dengue vaccines were studied using the parental strains of dengue vaccines as antigens in 26 dengue immune individuals who resided in Bangkok which is the endemic area of dengue infection. The magnitude of the T cell responses in subjects with flavivirus cross-reactive neutralizing antibody was much higher and the cross-reactivity was broader than in those with dengue serotype-specific neutralizing antibodies, Japanese encephalitis (JE) specific antibodies or dengue cross-reactive antibodies. The T cell response in those with neutralizing antibody against a single serotype or in those who had dengue cross-reactive neutralizing antibody was relatively low, independent of the level or degree of cross-reactivity of the antibody. Evaluation of the proliferative T cell responses in 8 recipients of the monovalent dengue-2 (16681-PDK53) or the tetravalent dengue vaccines demonstrated that both vaccines induced high levels of neutralizing antibody as well as high levels of T cell responses to all serotypes of dengue virus. These results indicate that the evaluated dengue vaccines efficiently induced humoral and cell mediated immunity comparable to natural infection with dengue virus.

A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue fever.

The impact of dengue on liver function was studied on fifty serologically confirmed dengue cases admitted to Hospital Universiti Kebangsaan Malaysia (HUKM). Twenty-five of these patients had classic dengue fever (DF) and 25 had grade 1 or 2 dengue hemorrhagic fever (DHF). There were more (60%) DHF patients with hepatomegaly compared to DF (40%) but the difference was not statistically significant. Analysis of the liver profile showed that liver dysfunction was commoner in DHF compared to DF, indicating that the degree of liver impairment may be related to the severity of DHF. Hyperbilirubinemia was noted in 3 (12%) DHF and 2 (8%) DF patients. The mean (range) serum bilirubin was higher in DHF [14.2(5-50) micromol/l] compared to DF [10.9(5-30) micromol/l)] (p > 0.05). Elevated levels of serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were observed more frequently in DHF (20 and 12 patients respectively) compared to DF (16 and 8 patients respectively). Nine (36%) DHF and 6 (24%) DF patients had concomitant elevation of ALT and ALP levels. The mean (range) serum ALT levels were 109.3(23-325) U/l in DHF and 90.8(13-352) U/l in DF (p > 0.05). The mean (range) serum ALP levels were 102.2(15-319) U/l in DHF and 93.3(34-258) U/l in DF (p > 0.05). The ALT and ALP levels were significantly higher in DHF patients with spontaneous bleeding than those without bleeding (p < 0.05) None of the patients developed fulminant hepatitis. The immunoregulatory cells, which include the T (CD3), B (CD 19), CD4, CD8, CD5 and natural killer (NK) cells were significantly lower in DHF compared to DF patients (p < 0.05). However, the reduction in these cell counts did not correlate with the liver dysfunction seen in DHF patients. In conclusion, hepatomegaly and liver dysfunction were commoner in DHF compared to DF.