Dengue: A growing global health threat

@#Dengue infection, one of the most devastating mosquito-borne viral diseases in humans, is now a significant problem in many countries. The disease, caused by the four dengue virus serotypes, ranges from asymptomatic infection to undifferentiated fever, dengue fever (DF), and severe dengue hemorrhagic fever (DHF) with or without shock. DHF is characterized by fever, bleeding diathesis and a tendency to develop a potentially fatal shock syndrome. Dengue infection with organ impairment mainly involves central nervous system and liver. Consistent hematological Findings include vasculopathy, coagulopathy, and thrombocytopenia. Laboratory diagnosis includes virus isolation, serology, and detection of dengue ribonucleic acid. Successful treatment, which is mainly supportive, depends on early recognition of the disease and careful monitoring for shock. A severity-based revised dengue classification for medical interventions has been developed and validated in many countries. Prevent depends primarily on control of the mosquito vector. The feasibility of a dengue vaccine is high.

Initial fluid resuscitation for children with dengue shock syndrome: a systematic review

Background: Currently, there is no standard recommendation of fluid resuscitation in dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The types of fluid as initial choice for resuscitation are still questionable. It is important to review what type of fluid is used for clinical outcome improvement. Objective: To assess the effectiveness and safety of fluid for initial resuscitation of DSS in children. Methods: Randomized control trials (RCTs) of initial fluid resuscitation in 1-15 years-old DSS children were researched. Characteristics of the study (design, methods of randomization, and withdraws/dropouts), participants (age), intervention (type, dose and duration, and fluid after the ending of intervention), outcomes (types of outcome measures, timing, and adverse events), and results were extracted from three selected RCTs. Results: Moderate DSS had no significant difference between each type of crystalloids and colloids in volume of rescue colloid and pulse pressure recovery time (PPRT). In severe DSS, colloids had significantly less median PPRT than crystalloids. Additionally, no difference was found in the incidence of allergic reaction from all the RCTs in both moderate and severe DSS. Conclusion: In moderate DSS, there is no significant difference between crystalloids (Ringer’s lactate solution/normal saline solution) and colloids (dextran/hydroxyethyl starch/gelatin) in the initial fluid resuscitation. The decision in choosing the appropriate type of fluid depends on the physician’s judgment. Some data suggest colloids as the fluid of choice for the initial resuscitation in severe DSS, but there is no significant evidence to support this data. Moreover, any type of colloid is not significantly different from one another. The decision in choosing fluid also depends on the physician’s judgment.

D-dimer as an indicator of dengue severity

Background: Dengue infection is a problem of global concern. The clinical spectrum of the disease varies from an acute febrile course accompanied by mild hemorrhagic manifestations with uneventful recovery to refractory shock and massive bleeding with high mortality. Several mechanisms may be involved in the pathogenesis of bleeding, namely: vasculopathy, thrombocytopenia, coagulopathy and dissiminated intravascular coagulopathy (DIC). Objective: To determine the relationship between D-dimer (DD) levels and clinical outcome in dengue patients. Method: Children with suspected dengue infection admitted to King Chulalongkorn Memorial Hospital were enrolled. D-dimer (DD) was sequentially measured during the course of illness using whole blood and a rapid semiquantitative system (SimpliRed). Diagnosis of dengue infection was confirmed by serology and WHO criteria were used for classifying dengue severity. Results: 41 dengue patients, 22 girls and 19 boys were recruited in the study. The mean age was 9.68 years. There were 12 (29.3 %) cases of dengue fever (DF) and 29 (70.7 %) cases of dengue hemorrhagic fever (DHF). DD was more significantly present in the DHF group (87 %) than in the DF group (13%) (P

Risk factors influencing severity in pediatric dengue infection

Background: Dengue disease encompasses a wide spectrum of clinical presentations. While the severity of dengue disease can vary from patient to patient, it is, however, still unclear as to what factors determine dengue disease severity.Objective: To analyze the potential risk factors such as: sex, age, nutritional status, dengue serotypes, D-dimer positivity, and serologic responses, and study their correlation with the severity of dengue virus infection.Methods: Dengue patients at King Chulalongkorn Memorial Hospital were enrolled for the study. Dengue serotype was determined by PCR and primary or secondary infection was determined based on serological criteria. D-dimer levels were also tested using a rapid semiquantitation system. Clinical data such as age, body weight, sex, and nutritional status were also collected.Results: Forty-six patients were confirmed for dengue fever (DF), and 52 patients were confirmed for Dengue hemorrhagic fever (DHF). 77.5% of patients had secondary dengue infection, 11.3% had primary infection, and 11.2% were of inconclusive status. Gender and age of patients did not correlate with dengue disease severity (p \> 0.05). It was inconclusive as to whether nutritional status was a risk factor. Positivity of the D-dimer test was statistically significant for DHF (p=0.001). Early increasing D-dimer in the febrile stage could predict severity of dengue infection during the initial stage of the disease (positive predictive value=68.4 %).Conclusion: D-dimer is significantly correlated with dengue severity and it may be one of the prognostic factors for dengue infection in children.

Community acquired Streptococcus pneumoniae infection in Thailand

Streptococcus pneumoniae (S. pneumoniae) is the major pathogen that causes health problems worldwide. Invasive disease includes meningitis, bacteremia with or without focus and pneumonia. It causes morbidity and mortality, especially in children. In Thailand, no relevant study was done to estimate the exact incidence of invasive pneumococcal diseases. Serotypes, in children with invasive diseases, differ slightly by age; less than five years old: serotype 23F, 6B, 14, 9V, and 19F, more than five years old: serotype 4, 23F, 19F, and 9V, while the most frequent serotypes in nasopharyngeal specimens are serotype 6B, 19F, 23F, and 14. The prevalence and the level of drug resistance of S. pneumoniae (DRSP) have been increasing. A significant risk factor for S. pneumonia infections is previous antibiotic use within three months. Seven-valent pneumococcal conjugate vaccine can prevent 73.9% of the most common pneumococcal serotypes in children younger than five years of age. There is a need for cost-effectiveness studies for inclusion of this vaccine in the national children immunization programme.