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Salazar Flórez JE, Marín Velasquez K, Segura Cardona ÁM, Restrepo Jaramillo BN, Ortega Díaz YE, Giraldo Cardona LS, Arboleda Naranjo M. Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia. Am J Trop Med Hyg 2024; 110:971-978. [PMID: 38507814 PMCID: PMC11066339 DOI: 10.4269/ajtmh.23-0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/30/2023] [Indexed: 03/22/2024] Open
Abstract
Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.
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Affiliation(s)
- Jorge Emilio Salazar Flórez
- Epidemiology and Biostatistics Group, CES University, Medellín, Colombia
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Sabaneta, Colombia
| | | | | | | | | | - Luz Stella Giraldo Cardona
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Sabaneta, Colombia
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Prattay KMR, Sarkar MR, Shafiullah AZM, Islam MS, Raihan SZ, Sharmin N. A retrospective study on the socio-demographic factors and clinical parameters of dengue disease and their effects on the clinical course and recovery of the patients in a tertiary care hospital of Bangladesh. PLoS Negl Trop Dis 2022; 16:e0010297. [PMID: 35377886 PMCID: PMC8979461 DOI: 10.1371/journal.pntd.0010297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Dengue, a mosquito transmitted febrile viral disease, is a serious public health concern in Bangladesh. Despite significant number of incidences and reported deaths each year, there are inadequate number of studies relating the temporal trends of the clinical parameters as well as socio-demographic factors with the clinical course of the disease. Therefore, this study aims to associate the clinical parameters, demographic and behavioral factors of the dengue patients admitted in a tertiary care hospital in Dhaka, Bangladesh during the 2019 outbreak of dengue with the clinical course of the disease. Data were collected from the 336 confirmed dengue in-patients and analyzed using SPSS 26.0 software. Majority of the patients were male (2.2 times higher than female) who required longer time to recover compared to females (p < 0.01), urban resident (54.35%) and belonged to the age group of 18–40 years (73.33%). Dengue fever (90.77%) and dengue hemorrhagic fever (5.95%) were reported in most of the dengue patients while fever (98%) was the most frequently observed symptom. A significantly positive association was found between patient’s age and number of manifested symptoms (p = 0.013). Average duration of stay in the hospital was 4.9 days (SD = 1.652) and patient’s recovery time was positively correlated with delayed hospitalization (p < 0.01). Additionally, recovery time was negatively correlated with initial blood pressure (both systolic (p = 0.001, and diastolic (p = 0.023)) and platelet count (p = 0.003) of the patients recorded on the first day of hospitalization. Finally, a statistical model was developed which predicted that, hospital stay could be positively associated with an increasing trend of temperature, systolic blood pressure and reduced platelets count. Findings of this study may be beneficial to better understand the clinical course of the disease, identify the potential risk factors and ensure improved patient management during future dengue outbreaks.
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Affiliation(s)
| | - Md. Raihan Sarkar
- Department of Pharmaceutical Technology, University of Dhaka, Dhaka, Bangladesh
| | | | - Md. Saiful Islam
- Department of Pharmaceutical Chemistry, University of Dhaka, Dhaka, Bangladesh
| | - Sheikh Zahir Raihan
- Department of Clinical Pharmacy & Pharmacology, University of Dhaka, Dhaka, Bangladesh
| | - Nahid Sharmin
- Department of Pharmaceutical Technology, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
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Brijwal M, Ningombam A, Acharya S, Sarkar A, Kumar K, Routray S, Sachdev J, Srigyan D, Choudhary A, Subramanian A, Dar L. Evaluation of sensitivity and specificity of high fluorescence lymphocyte count percentage of sysmex XN analyzer in diagnosis of dengue. JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_204_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes. J Trop Med 2021; 2021:3296448. [PMID: 34764996 PMCID: PMC8577943 DOI: 10.1155/2021/3296448] [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: 04/22/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender (p=0.049), lower normal mean platelet (p=0.02), and high mean hematocrit (p=0.001) were associated with disease progression. Conclusion The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.
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Hasan MJ, Tabassum T, Sharif M, Khan MAS, Bipasha AR, Basher A, Islam MR, Amin MR, Gozal D. Clinico-epidemiologic characteristics of the 2019 dengue outbreak in Bangladesh. Trans R Soc Trop Med Hyg 2021; 115:733-740. [PMID: 33190156 DOI: 10.1093/trstmh/traa126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/11/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dengue fever shows a broad range of clinical presentations worldwide. Here we report on our clinical findings during the 2019 dengue outbreak in one of the largest tertiary care hospitals in Dhaka, the capital of Bangladesh. METHODS A total of 747 suspected dengue cases (553 confirmed and 194 probable) were interviewed with a pro forma case record form. Statistical analyses were conducted using SPSS 20.0. Ethical clearance was obtained from the Dhaka Medical College. RESULTS The mean age of the dengue cases was 27 y and approximately two-thirds were male. Positive tests for NS1 and anti-dengue immunoglobulin M antibody were present in 91.9% and 59.4% of the cases, respectively. Thrombocytopenia was present in 69% of cases and fever was present in 99.1% of cases. Gastrointestinal (GI) features, including anorexia and/or vomiting (69.4%), abdominal pain (39.8%) and diarrhoea (25.6%), were more prevalent than typical rash and pain symptoms. Hypotension was present in approximately one-quarter of patients (25.4%). Probable and confirmed dengue cases have shown similar clinical characteristics and laboratory findings. CONCLUSIONS The 2019 outbreak of dengue fever in Bangladesh was characterized by increased presentation with GI features. Recognition of this trend would permit early diagnosis and proper management of patients.
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Affiliation(s)
| | | | - Mohiuddin Sharif
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | | | | | | | | | | | - David Gozal
- Department of Child Health, MU Women's and Children's Hospital University of Missouri School of Medicine, Columbia, MO, USA
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Abdul Bari AB, Samuel PJ. Road toward universal COVID-19 testing method - A review. J Immunoassay Immunochem 2021; 42:335-346. [PMID: 33689569 DOI: 10.1080/15321819.2021.1895214] [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: 01/11/2023]
Abstract
Patients infected with novel coronavirus exhibit a wide range of symptoms from common cold to pneumonia. Furthermore, several cases have been reported as asymptomatic across the globe. Since there are no conclusive clinical manifestations, clinicians have to rely more on laboratory diagnostic methods for confirmation of coronavirus disease. Hematological and biochemical tests are found to be of more prognostic value. Genetic assays by means of rRT-PCR technique is time-consuming but seems to be a more sensitive and specific test among the available testing methods for diagnosis of the coronavirus disease. Radiological imaging of the CT chest of the confirmed positive patients taken during the initial few days doesn't show any significant changes. However, from the second week onward a ground glass lesion pattern is observed. The immunological tests which are being used as a rapid testing method are found to be more false test negative. Hence, based on the effectiveness of various testing methods, it can be concluded that either rRT-PCR or mass antibody testing has to be done, and it has to be compared with CT chest in order to avoid false negatives across the globe which may help in the prevention of community spread of the disease.
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Gupta A, Rijhwani P, Pahadia MR, Kalia A, Choudhary S, Bansal DP, Gupta D, Agarwal P, Jat RK. Prevalence of Dengue Serotypes and Its Correlation With the Laboratory Profile at a Tertiary Care Hospital in Northwestern India. Cureus 2021; 13:e15029. [PMID: 34136322 PMCID: PMC8199925 DOI: 10.7759/cureus.15029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and aim Dengue fever is an emerging arboviral public health problem in a large endemic population in the tropical and sub-tropical areas of the world, with varying degrees of clinical presentation. This study was aimed at analyzing the clinical and laboratory dynamics of the four dengue serotypes. Methods This institutional review board (IRB)-approved hospital-based observational study was performed with 100 in-patients with dengue infection above 12 years of age, without co-morbidities or known malignancy, in a tertiary care center in Northern India. Results Out of 100 patients, four had concurrent infection with two serotypes. Dengue virus serotype-2 (DENV 2) was the most common serotype (34%) and had the maximum percentage of cases of severe dengue (20.6%). The mean total leukocyte count did not differ between the serotypes. DENV 4 had a significantly higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively), with a higher percentage of cases of severe dengue (20% vs 14.3%, non-significant). Thrombocytopenia was present in all serotypes of infection. There was a significant difference in the derangement of liver function in DENV 2, 3, and 4 as compared to DENV 1. Mean serum albumin levels were significantly lower in DENV 3 and 4 infections. Cases with co-infection had a much higher derangement of liver function and lower mean serum albumin than infections with a single serotype. The mean blood urea and creatinine levels were in the normal range for all serotypes. No mortality occurred in our study. Conclusion DENV 2 is the most common serotype with maximum severity at our hospital. DENV 2 and DENV 4 have a high percentage of cases with severe dengue (20.6% and 20%, respectively). The mean lymphocyte percentage was significantly lower while hepatic involvement and hypoalbuminemia were greater in DENV 4. Initial serotyping in patients with dengue can help monitor the epidemiological trends and help estimate the clinical and laboratory trends of the different serotypes of dengue infection. Particular care should be taken in patients with co-infection.
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Affiliation(s)
- Aviral Gupta
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Puneet Rijhwani
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Manish R Pahadia
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Anchin Kalia
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Shrikant Choudhary
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Dharam P Bansal
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Deepak Gupta
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Pradeep Agarwal
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
| | - Ram K Jat
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, IND
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Rafi A, Mousumi AN, Ahmed R, Chowdhury RH, Wadood A, Hossain G. Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients. PLoS Negl Trop Dis 2020; 14:e0008567. [PMID: 33048921 PMCID: PMC7553334 DOI: 10.1371/journal.pntd.0008567] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUNDS Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic. METHODS This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients' clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study. RESULTS Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue. CONCLUSION The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.
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Affiliation(s)
- Abdur Rafi
- Rajshahi Medical College, Rajshahi, Rajshahi, Bangladesh
| | | | - Reejvi Ahmed
- Sir Salimullah Medical College, Dhaka, Dhaka, Bangladesh
| | | | - Abdul Wadood
- Medical Centre, University of Rajshahi, Rajshahi, Bangladesh
| | - Golam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail:
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Arishi HM, Ageel AA, Al najmi MI, Khawaji TK, Al guridi HI, Mashhour AH, Dhayhi NS, Eisa ZM. Dengue meningoencephalitis in a child presenting with focal seizures. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2020; 7:153-154. [PMID: 33094145 PMCID: PMC7568077 DOI: 10.1016/j.ijpam.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/01/2022] Open
Abstract
We report a 9-year-old female child who presented with fever and focal seizures. The Cerebrospinal Fluid (CSF) analysis was compatible with viral meningoencephalitis and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) on same sample was positive for dengue virus RNA, serotype 2. The dengue IgM in blood sample was positive on the 8th day of the illness. This case demonstrates the emerging neurological manifestations of dengue infection and the first confirmed pediatric meningoencephalitis reported from Saudi Arabia. In areas where it does exist, dengue should be included in the differential diagnosis of cases of viral meningitis or meningoencephalitis.
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Clinical Profiles of Selected Biomarkers Identifying Infection and Cancer Patients: A Gorzów Hospital Example. DISEASE MARKERS 2019; 2019:6826127. [PMID: 31565102 PMCID: PMC6745159 DOI: 10.1155/2019/6826127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Abstract
Introduction Many pathobiological processes that manifest in a patient's organs could be associated with biomarker levels that are detectable in different human systems. However, biomarkers that promote early disease diagnosis should not be tested only in personalized medicine but also in large-scale diagnostic evaluations of patients, such as for medical management. Objective We aimed to create an easy algorithmic risk assessment tool that is based on obtainable "everyday" biomarkers, identifying infection and cancer patients. Patients We obtained the study data from the electronic medical records of 517 patients (186 infection and 331 cancer episodes) hospitalized at Gorzów Hospital, Poland, over a one and a half-year period from the 1st of January 2017 to the 30th of June 2018. Methods and Results A set of consecutive statistical methods (cluster analysis, ANOVA, and ROC analysis) was used to predict infection and cancer. For in-hospital diagnosis, our approach showed independent clusters of patients by age, sex, MPV, and disease fractions. From the set of available "everyday" biomarkers, we established the most likely bioindicators for infection and cancer together with their classification cutoffs. Conclusions Despite infection and cancer being very different diseases in their clinical characteristics, it seems possible to discriminate them using "everyday" biomarkers and popular statistical methods. The estimated cutoffs for the specified biomarkers can be used to allocate patients to appropriate risk groups for stratification purposes (medical management or epidemiological administration).
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