RESUMO
Introducción: La expresión clínica de la infección por el virus del dengue (DENV) varía desde formas leves a graves, cuyo predominio puede variar en cada epidemia. Objetivo: Caracterizar el comportamiento clínico del dengue en niños hospitalizados en un centro de referencia del Paraguay, durante los brotes (2007, 2009-10 y 2011). Materiales y métodos: Estudio descriptivo, retrospectivo (años 2007-2009) y prospectivo (2011) basado en la revisión de las historias clínicas de pacientes (pts) internados en el Instituto de Medicina Tropical (IMT) con diagnóstico de egreso de dengue confirmado por laboratorio (IgM Elisa, NS1, RT-PCR) o nexo epidemiológico. Se analizaron y compararon datos demográficos, clínicos, laboratoriales y las complicaciones. Resultados: Se hospitalizaron 270 niños con diagnóstico de dengue, correspondiendo 98 pts (36%) al brote del 2007, 49 pts (18%) al brote de 2009-10 y 123 pts (46%) al brote de 2011. Los serotipos predominantes por periodo fueron DENV-3, DENV-1 y DENV-2 respectivamente. No hubo diferencia significativa en cuanto a la edad de los pacientes por periodo (13 ± 3 años, 12,5 ± 3,6 años y 11 ± 3 años, respectivamente). La incidencia de complicaciones viscerales (encefalitis/miocarditis/hepatitis) fueron mayores en los brotes 2011 (54/123, 44%) y 2.007 (24/98, 24%) respecto al 2009-10 (5/49,10%) (p <0,01), así como la frecuencia de hemorragia severa [18/123 pts (14,6%) en 2011 vs 1/49 (2%) en 2009/10, p <0,05] y la trombocitopenia <50000 (29% en el 2011 vs 12% en 2009/10, p <0,05). La mortalidad fue baja en los tres periodos (1%, 2% y el 1,6%). Conclusiones: La presente serie revela las características particulares de cada brote en relación a la severidad. Durante la circulación del DENV-3 y DENV-2 se observó mayor frecuencia de casos graves incluyendo mayor afectación visceral.
Abstract Introduction: The clinical expression of infection with dengue virus (DENV) varies from mild to severe, the prevalence vary epidemic. Objective: To characterize the clinical behavior of dengue in children hospitalized in a referral center of Paraguay, during outbreaks (2007, 2009-10 and 2011). Materials and Methods: A descriptive, retrospective study based on a review of medical records of patients (pts) hospitalized at the Institute of Tropical Medicine (IMT) with discharge diagnosis of dengue confirmed (2007-2009) and prospective (2011) by lab (IgM Elisa, NS1, RT-PCR) or epidemiological link. They were analyzed and compared demographic, clinical, laboratory data and complications. Results: 270 children were hospitalized with a diagnosis of dengue, corresponding 98 pts (36%) of the 2007 outbreak, 49 pts (18%) the outbreak of 2009-10 and 123 pts (46%) outbreak of 2011. The predominant serotypes by period were DENV-3, DENV-1 and DENV-2 respectively. There was no significant difference in age of patients per period (13 ± 3 years, 12.5 ± 3.6 years and 11 ± 3 years, respectively). The incidence of visceral complications (encephalitis / myocarditis / hepatitis) were higher in 2011 outbreaks (54/123, 44%) and 2,007 (24/98, 24%) compared to 2009-10 (5 / 49,10%) (p <0.01), and the frequency of severe bleeding [18/123 pts (14.6%) in 2011 vs. 1/49 (2%) in 2009/10, p <0.05] and thrombocytopenia < 50000 (29% in 2011 vs. 12% in 2009/10, p <0.05). Mortality was low in all three periods (1%, 2% and 1.6%). Conclusions: This series reveals the particular characteristics of each sprout in relation to the severity. During the circulation of DENV-3 and DENV-2 more frequently more severe cases including visceral involvement it was observed.
RESUMO
BACKGROUND: To evaluate the efficacy of the 2009 revised dengue classification system proposed by the World Health Organization (WHO) for early detection of dengue cases requiring intervention. METHODS: Children <15 years of age with dengue [confirmed by laboratory testing (IgM enzyme-linked immunosorbent assay, NS1 Ag or reverse transcriptase polymerase chain reaction) or by epidemiologic link] who were admitted to the Institute of Tropical Medicine during the 2011 dengue outbreak in Paraguay were prospectively included. Each case was classified according to the 1997 WHO dengue criteria and by the 2009 WHO revised criteria, which categorize dengue patients using a set of clinical finding into dengue with/without warning signs and severe dengue. The management of all cases followed the new recommendations. RESULTS: During the 2011 dengue outbreak, 123 children were admitted with a mean age of 11 ± 3 years. By the 2009 classification system, 119 cases (97%) were classified as dengue requiring intervention [89 patients (75%) with warning signs and 30 patients (25%) with severe signs], whereas by the old system 67 patients (54%) were classified as dengue requiring intervention (P < 0.001). Further, by the 1997 classification, only 13 patients (10%) were classified as dengue hemorrhagic fever III/IV (severe cases), whereas with the 2009 classification 30 patients (24%) were considered as having severe dengue infection (P < 0.05) CONCLUSIONS:: This study confirms that the 2009 WHO dengue classification provides better detection of severe cases of dengue than the earlier 1997 WHO dengue system.
