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Moras E, Achappa B, Murlimanju BV, Raj GMN, Holla R, Madi D, D’Souza NV, Mahalingam S. Early diagnostic markers in predicting the severity of dengue disease. 3 Biotech 2022; 12:268. [PMID: 36091089 PMCID: PMC9461388 DOI: 10.1007/s13205-022-03334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/26/2022] [Indexed: 11/01/2022] Open
Abstract
AbstractThe aim of the present study was to determine whether the serum ferritin, the biomarker of an acute phase reactant and the gall bladder wall edema, an early indicator of capillary leakage can predict the severity of dengue fever. This study included 131 patients, who were between the age group of 18–80 years. The patients presented to our department with an acute illness, within the first four days of high temperature. The statistical analysis of this study was performed by using the Chi-square and independent Student’s t tests. The diagnostic markers are considered statistically significant, if the serum ferritin level is higher than 500 ng/ml and the gall bladder wall thickness is more than 3 mm. The present study observed that, 39 patients (89%) who had severe dengue (n = 44) revealed a significant gall bladder wall thickening, and this correlation was significant statistically (p < 0.000). It was also observed that, the ferritin levels have a highly significant positive correlation with the severity of dengue. The severe dengue patients had a mean ferritin level of 9125.34 μg/l, whereas the non-severe group had 4271 μg/l. This comparison was also statistically significant, as the p value was 0.003. We report that the serum ferritin levels have a highly significant positive correlation with the severity of dengue. The gall bladder wall edema during the third and fourth day of the illness was also associated with severe dengue. However, diffuse gall bladder wall thickening and high serum ferritin levels are also reported in various other conditions and their exact cause have to be determined by the correlation of associated clinical findings and imaging features.
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Ibrahim MA, Hamzah SS, Md Noor J, Mohamad MIK, Mokhtar MF, Isa MR, Abdul Rani MF. The association of ultrasound assessment of gallbladder wall thickness with dengue fever severity. Ultrasound J 2022; 14:13. [PMID: 35325315 PMCID: PMC8948308 DOI: 10.1186/s13089-022-00262-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate the association between ultrasound assessment of gallbladder wall thickness (GBWT) among severe dengue patients and dengue patients with warning signs to their clinical outcomes. Methods A prospective, cross-sectional study involving adult dengue patients presented to our emergency department between March until September 2018. The patients were classified based on WHO classification. A gallbladder wall scan was performed on all patients. Results A total of 44 patients were enrolled into the study; majority of the patients with GBWT had severe dengue, significantly more than the dengue patients with warning signs (90.5% sensitivity; 69.6% specificity). The sensitivity of GBWT in determining admission to critical care areas or general ward was 100% with a specificity of 62.1%. Our analysis showed that the two variables significant in determining the severity of dengue were age (p = 0.045) and GBWT (p < 0.001). Both factors together gave 81.0% sensitivity and 78.3% specificity in predicting patients for severe dengue. The receiver operator characteristic curve revealed that using variable GBWT status can discriminate 87.1% (95%CI 66.3, 93.7%) of having severe dengue or dengue with warning signs. Conclusion The finding of GBWT when consolidated with other clinical parameters may assist clinicians to perform risk stratification in the emergency department and become another adjunct to the assessment of severe dengue.
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Affiliation(s)
- Mohd Anwar Ibrahim
- Department of Emergency and Trauma, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Siti Suhaila Hamzah
- Department of Emergency and Trauma, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Julina Md Noor
- Emergency Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
| | | | - Mohd Fazrul Mokhtar
- Emergency Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mohamad Rodi Isa
- Public Health and Preventative Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mohammed Fauzi Abdul Rani
- Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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Thach TQ, Eisa HG, Hmeda AB, Faraj H, Thuan TM, Abdelrahman MM, Awadallah MG, Ha NX, Noeske M, Abdul Aziz JM, Nam NH, Nile ME, Dumre SP, Huy NT, Hirayama K. Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009808. [PMID: 34610027 PMCID: PMC8519480 DOI: 10.1371/journal.pntd.0009808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 10/15/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. METHODOLOGY We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). PRINCIPAL FINDINGS Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. CONCLUSION The findings suggest that alterations of platelet count and AST level-in the first 72 hours of fever onset-are independent markers predicting the development of severe dengue.
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Affiliation(s)
- Tran Quang Thach
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
| | - Heba Gamal Eisa
- Faculty of Medicine, Menoufia University, Shebin El-Koum, Egypt
| | | | - Hazem Faraj
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Nam Xuan Ha
- Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Michael Noeske
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | | | - Nguyen Hai Nam
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Asghar MS, Yasmin F, Tahir MJ, Anwar S, Yaseen R, Yousaf Z. Predictive analysis on gall bladder wall thickness as a marker for bleeding risk and need of transfusion in dengue patients. Jpn J Infect Dis 2021; 75:234-240. [PMID: 34588363 DOI: 10.7883/yoken.jjid.2021.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased gallbladder wall thickening (GBWT) is one manifestation of increased capillary permeability caused by severe dengue. This study was carried out to link the severity of GBWT with the bleeding risk and the need for transfusion. It was conducted retrospectively including all the patients with a diagnosis of dengue infection either via Dengue nonstructural protein-1 (NS-1) antigen or IgM antibody. Pearson's correlation, linear regression and receiver operating characteristic (ROC) curves were used for predictive analysis of GBWT with event of bleeding and need for transfusion of platelets during the hospital stay. A total of 177 participants met the inclusion criteria with a mean age of 33.17 ± 13.63 years. Mean GBWT was found to be 0.37 ± 0.15 cm, with 46.3% of patients had a thickness greater than 0.30 cm. A total of 16 patients were documented with bleeding events out of which 7.3% had minor bleeding and 1.7% had a major bleeding event. Linear regression analysis showed increased GBWT was found associated with decreased platelet count on admission (p=0.002) and lowest platelet counts (p=0.004). GBWT was found predictive of bleeding event and transfusion of platelets at higher sensitivity and specificity than platelet count on admission and lowest platelet counts.
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Affiliation(s)
- Muhammad Sohaib Asghar
- Internal Medicine at Dow University Hospital-Ojha Campus, Dow University of Health Sciences, Pakistan
| | - Farah Yasmin
- Dow Medical College, Dow University of Health Sciences, Pakistan
| | | | - Saira Anwar
- Internal Medicine at Dow University Hospital-Ojha Campus, Dow University of Health Sciences, Pakistan
| | - Rabail Yaseen
- Internal Medicine at Dow University Hospital-Ojha Campus, Dow University of Health Sciences, Pakistan
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Parmar J, Vora M, Mohan C, Shah S, Mahajan H, Patel T. "Honeycomb" pattern of gallbladder wall thickening - A forward step in early diagnosis of "Severe Dengue Fever". Indian J Radiol Imaging 2021; 29:14-18. [PMID: 31000936 PMCID: PMC6467033 DOI: 10.4103/ijri.ijri_363_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims and Objectives To study "Honeycomb" pattern of gallbladder wall thickening (GBWT) in dengue fever (DF) and to assess its clinical significance in early diagnosis of severe DF. Materials and Methods A total 244 patients of DF were studied, 84 patients were classified as severe DF, 61 patients as DF with warning signs, and 99 patients as DF without warning signs. Abdominal ultrasound was performed for assessment of GBWT patterns, hepatomegaly, splenomegaly, pancreatic enlargement, ascites, pleural effusion, and other additional findings were recorded in severe DF cases. Statistical comparison between "Honeycomb" pattern of GBWT and clinically severe DF was done using Pearson correlation test. Results Out of 244 patients, 145 patients were males and 99 patients were females, belonging to various age groups ranging from 1 to 81 years and 14.34% (35 patients) among them included in pediatric group. In total, 65.57% (160 patients) were non-severe DF cases and 34.42% (84 patients) were severe DF cases. A total of 84 patients of severe DF, 92.85% patients showed GBWT, and out of which, 71.42% patients had "Honeycomb" pattern, whereas a total of 160 patients of non-severe DF patients, 45% patients had GBWT and out of which, only 5.6% patients showed "Honeycomb" pattern. "Honeycomb" pattern of GBWT shows sensitivity of 71.4%, 94.37%, Positive predictive value of 86.95%, and Negative predictive value of 86.28% in severe DF. Conclusion "Honeycomb" pattern of GBWT is significant finding in severe DF. Its sensitivity and specificity are high in severe DF with significant statistical correlation. It can aid in early diagnosis of severe DF.
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Affiliation(s)
- Jitendra Parmar
- Department of Radiology, Apollo Hospitals International Limited, Gandhinagar, India
| | - Maulik Vora
- Department of Radiology, Institute of Neuroscience, Surat, India
| | - Chander Mohan
- Department of Interventional Radiology, Dr. B. L. Kapur Hospital, New Delhi, India
| | - Sandip Shah
- Department of Radiology, Apollo Hospitals International Limited, Gandhinagar, India
| | - Harsh Mahajan
- Department of Radiology, Dr. B. L. Kapur Hospital, New Delhi, India
| | - Tapan Patel
- Department of Radiology, Apollo Hospitals International Limited, Gandhinagar, India
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Donaldson CD, de Mel S, Clarice CSH, Thilakawardana BU, de Mel P, Shalindi M, Samarasinghe U, de Mel C, Chandrasena L, Wijesinha RS, Wijesinha ANI, Yip C, Yap ES, Seneviratne SL, Abeysuriya V. Admission ultrasonography as a predictive tool for thrombocytopenia and disease severity in dengue infection. Trans R Soc Trop Med Hyg 2021; 115:1396-1402. [PMID: 33885813 DOI: 10.1093/trstmh/trab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ultrasound (US) is an investigation available in many acute care settings. Thrombocytopenia is a well-described complication of dengue infection and has been shown to correlate with disease severity. The purpose of this study was to assess the utility of admission ultrasonography in predicting thrombocytopenia and disease severity in patients infected with dengue virus. METHODS Data were collected prospectively on 176 patients (male, n=86; female, n=90) admitted to the Nawaloka Hospital, Sri Lanka with dengue infection between December 2016 and August 2018. All patients had an US scan on admission and disease severity was determined using the World Health Organization 2009 classification. RESULTS There were 106 (60.2%) cases of dengue with/without warning signs and 70 (39.8%) cases of severe dengue. Patients with an abnormal US on admission were more likely to have severe dengue. Gallbladder wall thickening was the most common US abnormality. Abnormal US findings significantly correlated with more pronounced thrombocytopenia from day 2 of admission. CONCLUSIONS An abnormal US scan on admission can aid in identification of patients at risk of developing severe dengue and can be used as a novel clinical tool to identify patients at risk of severe thrombocytopenia.
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Affiliation(s)
- Callum D Donaldson
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Sanjay de Mel
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore
| | - Choong Shi Hui Clarice
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore
| | | | - Primesh de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Malka Shalindi
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - U Samarasinghe
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka.,Department of Radiology, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Chandima de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Lal Chandrasena
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Rasanga S Wijesinha
- Princess Alexandra Hospital, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | | | - Christina Yip
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Eng-Soo Yap
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore.,Department of Laboratory Medicine, National University Health System, Singapore
| | - Suranjith L Seneviratne
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka.,Institute of Immunity and Transplantation, Royal Free Hospital and University College London, London, UK
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
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Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam. J Clin Virol 2021; 138:104758. [PMID: 33862538 DOI: 10.1016/j.jcv.2021.104758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
Objectives Neonatal dengue has been reported in the literature with contradictory findings of clinical characteristics and diagnosis; thereby, misdiagnosis of neonatal dengue has been frequently reported. We aim to delve into the epidemiology, clinical features, and outcomes of neonatal dengue, thus avoid misdiagnosis and obtain early intervention. Study design A retrospective study was conducted at Children's Hospital 1, Ho Chi Minh, Vietnam with laboratory-confirmed dengue in neonates by positive viral antigen nonstructural protein one rapid test (NS1) and positive IgM antibody for dengue by MAC-ELISA. Results We have included 32 neonates in this study with 25% cases were misdiagnosed with neonatal sepsis, and 12.5% cases were misdiagnosed with neonatal immune thrombocytopenia at the beginning. The median time between the first day of the mother's onset of fever and childbirth was -1 days (IQR: -2, 2). The patient's clinical manifestation included: petechiae 87.5% (28/32), pharyngeal mucosal hemorrhage 6.3% (2/32), and hepatomegaly occurred 75% (24/32). In the febrile phase (day of illness 1-3), the mean white blood cell (WBC) counts were 7800 ± 800/mm3 and platelets were 97,111 ± 37,826/mm3. In the critical phase (day of illness 4-6), the mean WBC counts were 13,400 ± 2800/mm3, and platelets were 30,100 ± 5749/mm3. All mothers (100%) had laboratory-confirmed dengue by NS1 positive in the perinatal period. Conclusions The findings emphasize that early diagnosis of neonatal dengue should be based on a history of maternal illness, NS1 rapid test, and clinical presentation such as petechiae, hepatomegaly, and low platelet counts in the febrile phase.
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Dewan N, Zuluaga D, Osorio L, Krienke ME, Bakker C, Kirsch J. Ultrasound in Dengue: A Scoping Review. Am J Trop Med Hyg 2021; 104:826-835. [PMID: 33534759 PMCID: PMC7941833 DOI: 10.4269/ajtmh.20-0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023] Open
Abstract
To improve dengue triage and treatment decisions, the WHO recommends classifying the disease as dengue with or without warning signs or severe dengue. Vascular leakage is a key component of the pathophysiology of severe dengue and is detectable by ultrasound. The objective of this scoping review is to describe the primary literature on the use of ultrasound in dengue, summarize the findings, and identify knowledge gaps. Our database search retrieved 1,489 records which were reduced to 177 studies following eligibility screening. Descriptive analyses were conducted. Results showed most studies are from South Asia (n = 92, 52%) and assessed hospitalized dengue patients (130, 82%). Radiologists were the most reported ultrasonographers (14, 8%), and conventional ultrasound (39, 68%) was preferred over portable (9, 16%). The most common ultrasound findings in dengue were ascites (107, 60%), pleural effusion (102, 58%), and gallbladder wall thickening (97, 55%). However, the lack of a standard protocol to perform the ultrasound examination in dengue patients hinders conclusions about the frequency of ultrasound findings in dengue. Given the progress of current ultrasound technology, a focused point-of-care ultrasound protocol for early detection of vascular leakage in dengue is needed to generate the evidence required for its implementation in routine care.
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Affiliation(s)
- Neelesh Dewan
- University of Miami Miller School of Medicine, Miami, Florida
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniela Zuluaga
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | - Lyda Osorio
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | | | - Caitlin Bakker
- University of Minnesota, Health Sciences Libraries, Minneapolis, Minnesota
| | - Jonathan Kirsch
- Section of Hospital Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Adil B, Rabbani A, Ahmed S, Arshad I, Khalid MA. Gall Bladder Wall Thickening in Dengue Fever - Aid in Labelling Dengue Hemorrhagic Fever and a Marker of Severity. Cureus 2020; 12:e11331. [PMID: 33304669 PMCID: PMC7719471 DOI: 10.7759/cureus.11331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Dengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in South-East Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count. Materials and methods This prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and ˃3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA). Results Out of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%) - dengue hemorrhagic fever, and six (3.3%) - dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity. Conclusion Gall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.
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Affiliation(s)
- Benish Adil
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Arshad Rabbani
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Sualeha Ahmed
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Imran Arshad
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
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Kaminstein D. Point-of-Care Ultrasound for Tropical Disease: Implications for Clinical Decision-Making. Am J Trop Med Hyg 2020; 103:542-543. [PMID: 32372745 PMCID: PMC7410431 DOI: 10.4269/ajtmh.20-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daniel Kaminstein
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
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Rathore APS, Senanayake M, Athapathu AS, Gunasena S, Karunaratna I, Leong WY, Lim T, Mantri CK, Wilder-Smith A, St John AL. Serum chymase levels correlate with severe dengue warning signs and clinical fluid accumulation in hospitalized pediatric patients. Sci Rep 2020; 10:11856. [PMID: 32678248 PMCID: PMC7367272 DOI: 10.1038/s41598-020-68844-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
Dengue induces a spectrum of severity in humans from the milder dengue fever to severe disease, or dengue hemorrhagic fever (DHF). Chymase is a candidate biomarker that may aid dengue prognosis. This prospective study aimed to identify whether warning signs of severe dengue, including hypovolemia and fluid accumulation, were associated with elevated chymase. Serum chymase levels were quantified prospectively and longitudinally in hospitalized pediatric dengue patients in Sri Lanka. Warning signs were determined based on daily clinical assessments, laboratory tests and ultrasound findings. Chymase was significantly elevated during the acute phase of disease in DHF or Severe dengue, defined by either the 1997 or 2009 WHO diagnosis guidelines, and persisted longer in the most severe patients. Chymase levels were higher in patients with narrow pulse pressure and clinical warning signs such as severe leakage, fluid accumulation, pleural effusion, gall-bladder wall thickening and rapid haematocrit rise concurrent with thrombocytopenia. No association between chymase and liver enlargement was observed. This study confirms that serum chymase levels are associated with DHF/Severe dengue disease in hospitalized pediatric patients. Chymase levels correlate with warning signs of vascular dysfunction highlighting the possible functional role of chymase in vascular leakage during dengue.
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Affiliation(s)
- Abhay P S Rathore
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Manouri Senanayake
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Children's Hospital, Colombo, Sri Lanka
| | | | - Sunethra Gunasena
- Department of Virology, Medical Research Institute (MRI), Colombo, Sri Lanka
| | | | - Wei Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ting Lim
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore
| | - Chinmay Kumar Mantri
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore
| | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ashley L St John
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore.
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore.
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Shah S, Rolfe R, Henostroza G, Seas C. Ultrasound Findings of Plasma Leakage in Dengue Fever. Am J Trop Med Hyg 2019; 99:1362-1363. [PMID: 30851024 PMCID: PMC6283506 DOI: 10.4269/ajtmh.18-0422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sachita Shah
- Department of Emergency Medicine, University of Washington School of Medicine and Harborview Medical Center, Seattle, Washington
| | - Robert Rolfe
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - German Henostroza
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Carlos Seas
- Department of Tropical and Infectious Diseases, Cayetano Heredia National Hospital, Lima, Peru
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Correa R, Ortega-Loubon C, Zapata-Castro LE, Armién B, Culquichicón C. Dengue with Hemorrhagic Manifestations and Acute Pancreatitis: Case Report and Review. Cureus 2019; 11:e4895. [PMID: 31423374 PMCID: PMC6689496 DOI: 10.7759/cureus.4895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Dengue fever is an acute viral disease transmitted by arthropods, which has become a major public health problem, especially in tropical and subtropical areas. We found 17 reported cases of dengue complicated with pancreatitis in the world literature, 13 cases were found in Asia, one in Europe, and two in Latin America. This is the first and an unusual case of dengue with hemorrhagic manifestations complicated with acute pancreatitis in Panama. A 37-year-old woman with an unknown past medical history presented to Santo Tomas Hospital (Panama City, Panama) with sudden abdominal pain in the epigastrium and left hypochondrium, described as a burning-like pain radiating towards the back. Five days before the admission, the patient had fever, chills, headache, retro-orbital pain, dizziness, arthralgia, loss of appetite, and fatigue. In the emergency room, a diagnosis of acute pancreatitis was made and the patient was hospitalized. Physical examination showed bleeding gums, and laboratory tests show leukopenia and thrombocytopenia, which suggested an infection caused by the dengue virus. The dengue infection was confirmed using quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). The patient received supportive treatment and the symptoms resolved. She was discharged on the ninth day of hospitalization without any sequela. The final diagnosis was hemorrhagic dengue complicated by acute pancreatitis.
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Affiliation(s)
- Ricardo Correa
- Endocrinology, Diabetes and Metabolism, University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | | | - Luis E Zapata-Castro
- Emerge Piura, Emerging Diseases and Climate Change Research Unit, School of Health Sciences, Universidad Nacional de Piura, Piura, PER
| | - Blas Armién
- Vectors and Transmissible Diseases, Gorgas Memorial Institute of Health Studies, Panama City, PAN
| | - Carlos Culquichicón
- Emerge Piura, Emerging Diseases and Climate Change Research Unit, Universidad Nacional de Piura, Piura, PER
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Perspectives on Point-of-Care Ultrasound Use in Pediatric Tropical Infectious Disease. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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