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

Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs

@#ed as outpatients. Ultrasonographyevidence of plasma leakage either pleural effusion,thickened gallbladder wall, ascites or pericardial effusionwere compared with clinical findings and laboratoryparameters for plasma leakage. Results: Of the 83 dengue patients, eventually 72.3% haddengue fever with warning signs and 6.0% had severedengue fever. There were 38 patients who had subclinicalplasma leakage at initial presentation, 84.2% and 7.9% ofthem then progressed to dengue fever with warning signsand severe dengue respectively. There was a minimalagreement between serial bedside ultrasound andhaematocrit level in the detection of plasma leakage(observed kappa 0.135). Conclusions: Serial bedside ultrasound is an adjunctprocedure to physical examination and may detect plasmaleakage earlier compared to haemoconcentration. The earlyusage of serial ultrasound is of paramount importance indetecting dengue patients who are at risk of progressing tosevere dengue.

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.

Factores asociados a extravasación plasmática en pacientes con dengue de Antioquia y Chocó entre el 2000 y 2013. Colombia / Associated factors to plasma leakage in dengue patients from Antioquia and Chocó between 2000 and 2013. Colombia

Introducción: la extravasación del plasma es la manifestación más severa de la enfermedad producida por los virus del dengue y que con mayor frecuencia conduce al estado de choque. Se caracteriza por derrames serosos a nivel de diversas cavidades y aumento del hematocrito. Se realizó el presente estudio con el objetivo de determinar los factores sociodemográficos, clínicos y de laboratorio que más se asocian a la presencia de extravasación plasmática en los pacientes con dengue. Materiales y métodos: estudio observacional analítico transversal, analizado bajo la metodología de casos y controles, a partir de registros clínicos de pacientes con dengue. Se utilizaron prueba Chi cuadrado de Pearson, prueba exacta de Fisher, prueba no paramétrica U de Mann-Whitney y un modelo de regresión logística multivariado de factores asociados. Fueron calculados los Odds Ratio con su intervalo de confianza al 95 %. Se consideró un nivel de significancia de 5 %. Resultados: fueron analizados un total de 350 registros, de los cuales 128 presentaron signos de extravasación plasmática (36,6 %). Después de ajustar por factores de confusión se observó que las variables que más se asocian a presencia de extravasación plasmática en los pacientes con dengue fueron el dolor abdominal, la leucopenia y las melenas. Conclusión: estos hallazgos clínicos y de laboratorio deben ser priorizados en su vigilancia en la atención al paciente con dengue, para identificar los casos con mayor probabilidad de extravasación plasmática para su manejo oportuno y adecuado.

Introduction: Plasma leakage is the most severe complication caused by dengue virus infection and is also the mechanism that frequently leads to dengue shock syndrome. Plasma leakage is characterized by ascites, pleural and pericardial effusion and increased hematocrit level. The present study was conducted to identify socio-demographic, clinical and laboratory factors that more are associated to the presence of plasma leakage in dengue infected patients. Materials and methods: A cross sectional analytic study was performed on clinical records from dengue infected patients using the casecontrol methodology. Pearson's chi-square test or Fisher's exact test, Mann-Whitney's non-parametric U test and a multivariate logistic regression model of associated factors were used to evaluate the data. Odd Ratios with 95 % confidence intervals were calculated and significance level of 5 % was considered. Results: A total of 350 clinical records were analyzed, 128 cases (36.6 %) presented signs of plasma leakage. After adjustments by confounding factors, we observed that abdominal pain, leukopenia and melena were the variables that explain the presence of plasma leakage in dengue infected patients. Conclusion: During the follow-up of dengue infected patients priority should be given to the survey of these clinical and laboratory findings in order to identify the cases with higher probabilities of developing plasma leakage, allowing achieving more timely and appropriate management.

A Case of an Imported Dengue Hemorrhagic Fever with Spontaneous Bleeding: Case Report and Review of the Literature / 소아감염

Dengue is an acute febrile viral disease which is found in tropical and sub-tropical regions around the world. Dengue fever has steadily increased in both incidence and distribution over the past 50 years. Even though Korea is not an endemic country for dengue fever, with the increasing numbers of overseas travelers in Korea, the numbers of imported dengue cases are steadily increasing. Here, we report a case of imported dengue hemorrhagic fever in a Korean child presenting with fever and epistaxis. Dengue fever should be considered if a patient who has a recent travel history to endemic areas showed classical symptoms.

Asociación entre la magnitud del viraje del hematocrito y otros indicadores de severidad en dengue / Correlation between variation of hematocrit and other indicators of severity in dengue

Objetivos: Establecer la asociación entre la magnitud del viraje del hematocrito y otros hallazgos de severidad en dengue. Diseño: Estudio observacional analítico de corte transversal. Población y métodos: Pacientes con diagnóstico clínico y serológico (IgM positiva) de dengue, hospitalizados en instituciones de Santander (Colombia), durante 1993-1998. Se evaluó la asociación entre la intensidad de la hemoconcentración y complicaciones como hemorragias espontáneas, efusiones pleurales y trombocitopenia (<50,000 plt/µl). Resultados: Se incluyeron 780 pacientes. En un análisis multivariado, las variables asociadas con una mayor hemoconcentración fueron: edad <15 años, hematemesis y trombocitopenia. Hubo 363 pacientes con hemoconcentración <10%; 226 entre 10% y 20%; y 191 con un viraje del hematocrito >20%. La frecuencia de efusiones pleurales no fue diferente entre estos grupos. La hematemesis y la trombocitopenia fueron menos frecuentes en el grupo con hemoconcentración <10%. Además, estas complicaciones fueron más frecuentes con hemoconcentración >20% vs. 10%-20% (p<0.05). Comparado con un viraje >20%, un criterio más flexible de hemoconcentración (>10%) se asoció con un aumento de la sensibilidad de 31% a 63% y una disminución de la especificidad de 88.5% a 66.3%, para detectar alguna complicación (hematemesis, trombocitopenia o efusión pleural). Conclusión: Este estudio sugiere una fuerte correlación entre la intensidad de la hemoconcentración y la severidad del dengue. Además, sugiere que al emplearse un criterio más flexible para definir la extravasación plasmática, se obtiene un importante incremento en la sensibilidad con una aceptable disminución en la especificidad. Estos resultados deben evaluarse prospectivamente, en un estudio de cohortes.

Objectives: To determine the association of hemoconcentration with other signs of severity of dengue.Design: Cross sectional study. Population and methods: Patients with clinical and serologic diagnosis (IgM positive test) of dengue, who consulted hospitals in Santander (Colombia), during 1993-1998. The clinical findings and laboratory tests were registered. Associations among hemoconcentration and complications, such as spontaneous hemorrhages (petechiae, ecchymoses, bleeding from gums, epistaxis, hematemesis, hematuria and metrorrhagia), pleural effusions and thrombocytopenia (<50,000 plt/µl), were evaluated. Results: A sampling of 780 patients was included. In a multi-varied analysis, thrombocytopenia (p <0.001), hematemesis (p=0.04), and age under 15 years (p=0.02) were associated to greater hemoconcentration. There were 363 patients with hemoconcentration <10%; 226 with 10%-20%; and 191 with >20%. There were no significant differences in frequency of pleural effusions within these groups. Hematemesis and thrombocytopenia were less frequent in patients with hemoconcentration <10% compared with both, 10%-20% and >20% groups. Moreover, patients with hemoconcentration >20% had more complications than the group with hemoconcentration of 10%-20% (p<0.05). Compared with >20%, a hematocrit change >10% was associated to increasing sensitivity from 31% to 63.4% and diminishing of specificity from 88.5% to 66.3%, to detect some complications (hematemesis, thrombocytopenia, or pleural effusion). Conclusions: This study suggests a strong correlation between hemoconcentration and severity of dengue. Also, more liberal criteria to define plasma leakage could be used. The present results should be prospectively evaluated in cohort studies.

Plasma leakage monitoring for the blood circle treatment system / 医疗卫生装备

This paper introduces the working principle of the blood circle treatment system outside the body. A monitoring instrument of plasma leakage suited for the blood circle treatment system outside the body is developed based on the absorption spectrum experiments of plasma leakage. Photoelectric detection technology and virtual instrumentation are utilized in the development. A series of detecting experiments of waste solution containing plasma with continuously changing concentration show the monitoring system possesses a relatively high sensitivity. Moreover, the experiments of continual detection with plasma concentration at one certain point indicate the monitoring system has a quite good stability. The monitoring instrument is adapted to dynamically detecting the plasma leakage when the blood circle treatment system outside the body is working.