Mortalidad en pacientes con dengue en la epidemia 2012-2013 / Mortality during an outbreak of dengue 2012 - 2013

Introducción: el dengue presenta diversas formas clínicas, desde asintomáticas hasta fatales. Existen diversos factores de riesgo asociados a la mortalidad por dengue. Objetivo: determinar los factores de riesgo asociados a la mortalidad por dengue. Metodología: estudio de casos (adultos fallecidos por dengue) y controles (adultos sobrevivientes al dengue), durante la epidemia verano 2012-2013 en Paraguay. Resultados: los factores de riesgo asociados significativamente a la mortalidad por dengue fueron: presencia de comorbilidades, hemorragias, hepatitis, hipoproteinemia e hipoalbuminemia. El choque por dengue fue la causa de óbito más frecuente (49%). Conclusiones: los factores asociados a la mortalidad por dengue son inherentes al paciente (comorbilidades) y a la gravedad de la infección, resultante de las manifestaciones hemorrágicas, afectación sistémica y fuga capilar.

Introduction: Dengue has several clinical forms, from asymptomatic to fatal. There are several risk factors associated with mortality from dengue. Objective: To determine the risk factors associated with mortality from dengue. Methodology: case studies (death of dengue adults) and controls (survivors dengue adults) during summer 2012-2013 epidemic in Paraguay. Results: Risk factors significantly associated with mortality from dengue were: presence of comorbidities, hemorrhage, hepatitis, hypoproteinemia and hypoalbuminemia. Dengue shock syndrome was the most common cause of death (49%). Conclusions: The mortality associated with dengue factors are inherent to the patient (comorbidities) and the severity of infection, resulting in hemorrhagic manifestations, systemic involvement and capillary leak.osus reaction.

Formas de apresentação e evolução clínica dos óbitos por dengue em residentes no município do Rio de Janeiro em 2012 / Forms of clinical presentation and course of the deaths from dengue in the municipality of Rio de Janeiro in 2012

Objetivo: A dengue tem importância mundial por sua morbidadee abrangência. O presente artigo teve como objetivo descrever as principais características dos óbitos por dengue,ocorridos no Município do Rio de Janeiro (MRJ), durante aepidemia de 2012. Métodos: Foram descritos os 35 casosde óbitos por dengue ocorridos em 2012 neste município. Asvariáveis estudadas foram coletadas a partir das fichas de investigaçãode óbitos por dengue, padronizadas pelo Ministério daSaúde. Resultados: Encontrou-se maior proporção de óbitosentre 50 e 59 e acima de 70 anos, presença de comorbidadesem 77,8%, ligeiro predomínio do sexo masculino e da raça/corpreta. Principais achados hematológicos: leucopenia em 46,8%,leucocitose em 78,1%, hemoconcentração em 39,4% e plaquetopeniaem 87,9%. Na parte bioquímica: aumento de amilaseem 50%, gama GT em 92,8%, transaminase glutâmico oxaloacética(TGO) em 95,2%, transaminase glutâmico pirúvica(TGP) em 80,9%, bilirrubinas em 69,2%, creatina-fosfoquinase(CPK) em 50% e lactato desidrogenase (LDH) em 100%. Derramecavitário foi descrito em 64,3% e espessamento de parededa vesícula biliar em 37,5%. Manifestações atípicas evidenciadas:neurológicas 8,6%, insuficiência hepática 11,4%, insuficiênciarenal 25,7% e sangramento 22,8%. Conclusão: Oacompanhamento de exames laboratoriais e de imagem auxilia omanejo clínico e a predição da gravidade da dengue. Este acompanhamento,juntamente com a estabilização das morbidadespreexistentes, pode reduzir sua letalidade.(AU)

Objectives: Dengue has global significance for its morbidityand scope. This article aims to describe the main features of deathsdue to dengue, during the dengue epidemic in Rio de Janeiro(MRJ) in 2012. Methods: The 35 cases of obit by dengueoccurred in 2012 in this municipality were described. The studiedvariables were collected from the records of investigation of obitby dengue, standardized by the Ministry of Health. Results:Review of 35 deaths due to dengue that occurred in the city ofRio de Janeiro in 2012 showed a higher proportion between agesof 50 and 59 and also greater than 70 years old, the presence ofcomorbidities in 77.8% and a slight prevalence in male gender andin race/color black. Major hematologic findings were leukopenia(46.8%), leukocytosis (78.1%), hemoconcentration (39.4%)and thrombocytopenia (87.9%). Other lab abnormalities wereamylase (50%), gamma GT (92.8%), aspartate aminotransferase(AST) (95.2%), serum glutamate pyruvate transaminase (SGPT)alanine transferase (ALT) in 80.9%, bilirubin in 69.2%, creatinephosphokinase in 50% (5/10) and lactate dehydrogenase in100%. Cavity effusions were described in 60% and thickenedgallbladder in 37.5%. Atypical symptoms that were evident:neurological 8.6%, liver failure, 11.4%, kidney failure, 25.7%and bleeding 22.8%. Conclusion: Monitoring the levelsof hematocrit, platelets, aminotransferases and imaging tests helpthe clinical management and prediction of severity of dengueand, along with the stabilization of preexisting comorbidities,may reduce its lethality.(AU)

Correlación de la Respuesta de Aedes aegypti (Linnaeus, 1762) al Insecticida Organofosforado Malathión con la Incidencia y la Mortalidad de Dengue en cinco estados de Venezuela: 1995 / Correlation in the responce Aedes aegypti (Linnaeus, 1762) vs. organophosphourous insecticide Malathion (R) and the Incidence and Mortality in Dengue in five States of Venezuela: 1995

La presente investigación corresponde a un estudio ecológico o correlacional cuyo objetivo fue medir la asociación de los grados de resistencia en fase larvaria de Ae. aegypti vector principal del Dengue en Venezuela, al insecticida organofosforado malathión, con la incidencia y mortalidad por Dengue en cinco (5) estados de Venezuela. Los datos calculados sobre Concentración Letal (CL50) y Factor de Resistencia (FR50) se utilizaron como variables que se presume influyen en la incidencia y mortalidad por Dengue. La correlación de los parámetros de resistencia indicados y la enfermedad por dengue se realizó a través del método de regresión lineal simple; para medir la correlación individual de cada factor e índice de morbi - mortalidad, se usaron los coeficientes de correlación y determinación simple. Posteriormente, se incluyeron todos los Factores de Resistencia (FR50) y se determinó la correlación múltiple con cada uno de los índices de morbi - mortalidad por dengue; los resultados demostraron que existen asociaciones entre las respuestas del vector al malatión en Venezuela. El factor de resistencia 50 (FR50) se encontró asociado a fiebre dengue, dengue hemorrágico y mortalidad, el cual fue estadísticamente significativo con fiebre dengue y mortalidad más no para dengue hemorrágico; al utilizar los modelos de regresión lineal y Poisson varía el aumento y la disminución de la incidencia y mortalidad por cada unidad de cambio en el factor de resistencia 50 (FR50). La concentración letal 50 (CL50) se encontró asociada con fiebre dengue, dengue hemorrágico y mortalidad y resultó estadísticamente significativo para fiebre dengue y mortalidad más no para dengue hemorrágico . Al utilizar los modelos de regresión lineal y poisson corregidos, varía el aumento y la disminución de la incidencia y la mortalidad, por cada unidad de cambio en la concentración letal 50 (CL50). Estos resultados ofrecen una nueva modalidad referencial de análisis por medio de la cual se podrá predecir posibles aumentos en la incidencia de enfermedades metaxénicas, priorizando las acciones de control de vectores.

The present research concerns an ecological or correlational study aimed to measure the association of degrees of resistance of the larval phase of Aedes aegypti (main vector of Dengue in Venezuela) in front of MalathionR (an organophosphoroate insecticide) and Dengue incidence and mortality in five states of Venezuela. Data calculated on lethal concentration (CL50) and resistance factor (FR50) were used as variables presumably influential on Dengue incidence and mortality. Correlation of the indicated parameters of resistance and Dengue disease were performed through simple lineal regresión method. To measure the individual correlation of each factor and index of morbi-mortality correlation coefficients and a simple determination was performed. Subsequently, every resistance factor was included (FR50) and multiple correlation was determine on each morbidity and mortality dengue index. Results achieved demostrated an association between the responses of the vector foward MalathionR in Venezuela. Resistance factor 50 (FR50), was found to be associated to dengue fever, hemorrhagic dengue and mortality, as being statistically significant for dengue fever and mortality while not for hemorrhagic dengue. When lineal regresión and poisson tests were applied, there is a variation of values and the decrease of incidence and mortality for each unito f variation in resistance factor 50 (FR50). Lethal concentration 50 (CL50), appars to be associated with dengue fever, hemorrhagic dengue and mortality and appears statistically significant as for as dengue and mortality concerns while not the same for hemorrhagic dengue. When corrected lineal regresión and Poisson models were used, increase and decrease of incidence and mortality show an apparent variation in relation with lethal concentrations 50 (CL50). These results offer a new referential mode of análisis through which predict possible increases in incidence of methaxenic diseases, thus priorizing vector control actions.