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Campana V, Inizan C, Pommier JD, Menudier LY, Vincent M, Lecuit M, Lamballerie XD, Dupont-Rouzeyrol M, Murgue B, Cabié A. Liver involvement in dengue: A systematic review. Rev Med Virol 2024; 34:e2564. [PMID: 38923215 DOI: 10.1002/rmv.2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Liver involvement is an unusual yet frequently overlooked dengue complication. Pivotal for an efficient clinical management, the early diagnosis of dengue-associated liver involvement relies on an accurate description of its clinical and biological characteristics, its prognosis factors, its association with severe dengue and its clinical management. We conducted a systematic review by searching PubMed and Web of Science databases for original case reports, cohort and cross-sectional studies reporting the clinical and/or biological features of dengue-associated liver involvement. The study was registered in PROSPERO (CRD42021262657). Of the 2552 articles identified, 167 were included. Dengue-associated liver involvement was characterised by clinical features including abdominal pain, hepatomegaly, jaundice, nausea/vomiting, and an echogenic liver exhibiting hepatocellular necrosis and minimal inflammation. Elevated Aspartate Aminotransferase and Alanine Aminotransferase but also elevated bilirubin, Alkaline Phosphatase, gamma-glutamyl transferase, increased International Normalised Ratio, creatinine and creatine kinase, lower albumin and prolonged prothrombin and activated partial thromboplastin time were prevalent in dengue-associated liver involvement. Cardiovascular and haematological systems were frequently affected, translating in a strong association with severe dengue. Liver involvement was more common in males and older adults. It was associated with dengue virus serotype-2 and secondary infections. Early paracetamol intake increased the risk of liver involvement, which clinical management was mostly conservative. In conclusion, this systematic review demonstrates that early monitoring of transaminases, clinical assessment, and ultrasound examination allow an efficient diagnosis of dengue-associated liver involvement, enabling the early identification and management of severe dengue.
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Affiliation(s)
- Valentine Campana
- CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France
- PCCEI, Université de Montpellier, INSERM, Etablissement Français du Sang, Université des Antilles, Montpellier, France
| | - Catherine Inizan
- Unité Dengue et Arboviroses, Institut Pasteur de Nouvelle-Calédonie, Pasteur Network, 110, Boulevard Joseph Wamytan, Dumbéa-sur-Mer, Noumea, New Caledonia
| | - Jean-David Pommier
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles - Guyane University, Chemin de Chauvel, Les Abymes, France
| | | | | | - Marc Lecuit
- Institut Pasteur, Université Paris Cité, Inserm U1117, Biology of Infection Unit, Paris, France
- Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, APHP, Paris, France
| | - Xavier De Lamballerie
- Unité des Virus Emergents (UVE: Aix-Marseille Université - IRD 190 - Inserm 1207), Marseille, France
| | - Myrielle Dupont-Rouzeyrol
- Unité Dengue et Arboviroses, Institut Pasteur de Nouvelle-Calédonie, Pasteur Network, 110, Boulevard Joseph Wamytan, Dumbéa-sur-Mer, Noumea, New Caledonia
| | - Bernadette Murgue
- Unité des Virus Emergents (UVE: Aix-Marseille Université - IRD 190 - Inserm 1207), Marseille, France
| | - André Cabié
- CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France
- PCCEI, Université de Montpellier, INSERM, Etablissement Français du Sang, Université des Antilles, Montpellier, France
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Paraná VC, Feitosa CA, da Silva GCS, Gois LL, Santos LA. Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:173-191. [PMID: 38263345 DOI: 10.1111/tmi.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. METHODS PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. RESULTS Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. CONCLUSION These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.
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Affiliation(s)
- Victoria Cruz Paraná
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | | | | | - Luana Leandro Gois
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Department of Biointeraction Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciane Amorim Santos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Graduate Program in Health Sciences, College of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
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Preeprem N, Phumeetham S. Paediatric dengue shock syndrome and acute respiratory failure: a single-centre retrospective study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001578. [PMID: 36645744 PMCID: PMC9668030 DOI: 10.1136/bmjpo-2022-001578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Dengue shock syndrome (DSS) is a serious health condition leading to paediatric intensive care unit (PICU) admissions and deaths in tropical countries. Acute respiratory failure (ARF) is associated with DSS and is a major cause of dengue deaths. We aimed to identify risk factors associated with ARF in children with DSS. METHODS We retrospectively reviewed children with DSS admitted to a PICU from 2010 to 2020 at a tertiary level hospital in Bangkok, Thailand. Patient characteristics, clinical parameters and laboratory data were collected. Multivariable logistic regression analysis was used to identify factors associated with ARF. RESULTS Twenty-six (43.3%) of 60 children with DSS developed ARF and 6 did not survive to day 28. The median (IQR) age was 8.1 years (IQR 4.0-11.0). Fluid accumulation during the first 72 hours of PICU admission was greater in the ARF group compared with the non-ARF group (12.2% (IQR 7.6-21.7) vs 8.3% (IQR 4.4-13.3), p=0.009). In a multivariate analysis at 72 hours post PICU admission, the presence of ˃15% fluid accumulation was independently associated with ARF (adjusted OR 5.67, 95% CI 1.24 to 25.89, p=0.025). CONCLUSION ARF is an important complication in children with DSS. A close assessment of patient fluid status is essential to identify patients at risk of ARF. Once the patient is haemodynamically stable and leakage slows, judicious fluid management is required to prevent ARF.
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Affiliation(s)
- Nutnicha Preeprem
- Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwannee Phumeetham
- Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Laoprasopwattana K, Khantee P, Saelim K, Geater A. Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue. Pediatr Infect Dis J 2022; 41:211-216. [PMID: 34840312 DOI: 10.1097/inf.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the mortality rate of severe dengue (SD) before and after implementation of a revised SD guideline. METHODS Medical records of SD patients <15 years of age hospitalized during 1998-2020 were reviewed. The revised SD guidelines were implemented in 2016, including intensive monitoring of vital signs and intra-abdominal pressure, the release of intra-abdominal pressure in cases of abdominal compartment syndrome (ACS) and the use of N-acetyl cysteine in cases of acute liver failure. RESULTS On initial admission, organ failure including severe bleeding, acute respiratory failure, acute kidney injury and acute liver failure was not significantly different between 78 and 23 patients treated in the pre- and postrevised guideline periods, respectively. After hospitalization, the proportions of patients who developed profound shock (68.8% vs. 41.2%), multiorgan failures (60.4% vs. 73.3%), ACS (37.2% vs. 26.1%) and fatal outcome (33.3% vs. 13.0%) were also not significantly different between the pre- and postrevised guideline periods, respectively. In subgroup analysis, the mortality rates in patients with multiorgan failure (44.1% vs. 15.8%), acute respiratory failure and active bleeding (78.1% vs. 37.5%) and ACS (82.8% vs. 33.3%), respectively, were significantly higher in the pre- than the postrevised guideline periods. The durations of time before the liver function tests returned to normal levels, and the mortality rates in acute liver failure patients treated with and without N-acetyl cysteine were not significantly different. CONCLUSIONS Although following the revised guidelines could not prevent organ failure, the mortality rates in patients with multiorgan failure and/or ACS decreased significantly when following the revised guidelines.
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Affiliation(s)
| | | | | | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Abhinayaa J, James S, Jebaraj R, Vinoth PN. Incidence of Cardiac Manifestations in Children with Dengue Fever: A Cross-sectional Study. Rambam Maimonides Med J 2021; 12:RMMJ.10436. [PMID: 33938801 PMCID: PMC8092955 DOI: 10.5041/rmmj.10436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of our study was to explore the incidence of cardiac involvement in children with dengue infection admitted in a tertiary care hospital and to evaluate the features of cardiac involvement with the severity of dengue fever. METHODS This was a cross-sectional study conducted from September 2014 to August 2016. A total of 130 patients with confirmed dengue NS1 antigen or IgM antibody positivity between the ages of 1 month and 18 years were evaluated. On the third day of admission, blood samples for cardiac markers were collected, and electrocardiograms (ECG) and echocardiograms were performed for each patient. RESULTS Of the 130 dengue patients in the study, 60 (46.2%) were males and 70 (53.8%) were females (male to female ratio, 1:1.16). Cardiac involvement was present in 60 (46.2%) children and was more prominent in children with severe dengue (72.7%), followed by dengue with warning symptoms (53.8%) and dengue fever (28.6%). There was no significant correlation between cardiac involvement and primary/secondary dengue. Both ECG and echocardiography changes were significantly correlated with dengue severity, as opposed to cardiac markers. CONCLUSIONS Cardiac involvement was present in children with dengue. Evaluation with ECG, echocardiography, and cardiac markers such as creatine phosphokinase-myocardial band (CPK-MB) are required for the management of cardiac complications in children with dengue. Our study showed an association between cardiac involvement and the severity of dengue. Further studies should be framed, and follow-up of dengue patients with cardiac involvement is necessary for therapeutic management.
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Affiliation(s)
- Janakiraman Abhinayaa
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Saji James
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Rathinasamy Jebaraj
- Department of Cardiology, Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India
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Hilmy AI, Dey RK, Imad HA, Yoosuf AA, Nazeem A, Latheef AA. Coronavirus disease 2019 and dengue: two case reports. J Med Case Rep 2021; 15:171. [PMID: 33771221 PMCID: PMC7995386 DOI: 10.1186/s13256-021-02707-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background The pandemic of this century has overwhelmed the healthcare systems of affected countries, and all resources have been diverted to coronavirus disease 2019. At the onset, coronavirus disease 2019 can present as any other acute febrile undifferentiated illness. In tropical regions, clinicians are increasingly challenged to differentiate these febrile illnesses without the use of diagnostics. With this pandemic, many of these tropical diseases are neglected and go underreported. Dengue is holoendemic in the Maldives, and dengue viruses circulate throughout the year. Reports about coinfections with dengue virus and severe acute respiratory syndrome coronavirus 2 are scarce, and the outcome and the dynamics of the disease may be altered in the presence of coinfection. We have described the clinical manifestation and serial laboratory profile, and highlighted the atypical findings uncommon in dengue infection. Case presentation Case 1 was a 39-year old Asian male, presented on day 6 of dengue infection with warning signs. Reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 that was done as per hospital protocol was found to be positive. Case 2 was a 38-year old Asian male, was admitted on day 5 of illness with symptoms of acute respiratory infection with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2. Evaluation of progressive leukopenia and thrombocytopenia showed positive dengue serology. Conclusion Clinicians must be conscientious when working on the differential diagnosis of possible tropical diseases in cases of coronavirus disease 2019, specifically, when patients develop hemoconcentration, thrombocytopenia, and transaminitis with elevated expression of aspartate higher than alanine transaminase, which is frequently observed in dengue infection. Caution must be taken during the administration of intravenous fluids when treating patients with coronavirus disease 2019 and dengue coinfection, as coronavirus disease 2019 patients are more prone to develop pulmonary edema. Timely diagnosis and appropriate management are essential to avoid the devastating complications of severe forms of dengue infection. It is important to repeat and reconfirm the dengue serology in coronavirus disease 2019 patients to avoid false positivity. Diligence and care must be taken not to neglect other endemic tropical diseases in the region during the present pandemic.
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Affiliation(s)
- Abdullah Isneen Hilmy
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male' 20002, Maldives.
| | - Rajib Kumar Dey
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male' 20002, Maldives
| | - Hisham Ahmed Imad
- Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.,Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Abdul Azeez Yoosuf
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male' 20002, Maldives
| | - Ali Nazeem
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male' 20002, Maldives
| | - Ali Abdulla Latheef
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male' 20002, Maldives.,Technical Advisory Group, Health Emergency Operation Center, Male' 20002, Maldives
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Kenmoe S, Tchatchouang S, Ebogo-Belobo JT, Ka'e AC, Mahamat G, Guiamdjo Simo RE, Bowo-Ngandji A, Demeni Emoh CP, Che E, Tchami Ngongang D, Amougou-Atsama M, Nzukui ND, Mbongue Mikangue CA, Mbaga DS, Kenfack S, Kingue Bebey SR, Amvongo Adjia N, Efietngab AN, Tazokong HR, Modiyinji AF, Kengne-Nde C, Sadeuh-Mba SA, Njouom R. Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa. PLoS Negl Trop Dis 2020; 14:e0008589. [PMID: 32845889 PMCID: PMC7478710 DOI: 10.1371/journal.pntd.0008589] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/08/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
Accurate data on the Lassa virus (LASV) human case fatality rate (CFR) and the prevalence of LASV in humans, rodents and other mammals are needed for better planning of actions that will ultimately reduce the burden of LASV infection in sub-Saharan Africa. In this systematic review with meta-analysis, we searched PubMed, Scopus, Africa Journal Online, and African Index Medicus from 1969 to 2020 to obtain studies that reported enough data to calculate LASV infection CFR or prevalence. Study selection, data extraction, and risk of bias assessment were conducted independently. We extracted all measures of current, recent, and past infections with LASV. Prevalence and CFR estimates were pooled using a random-effect meta-analysis. Factors associated with CFR, prevalence, and sources of between-study heterogeneity were determined using subgroup and metaregression analyses. This review was registered with PROSPERO, CRD42020166465. We initially identified 1,399 records and finally retained 109 reports that contributed to 291 prevalence records from 25 countries. The overall CFR was 29.7% (22.3-37.5) in humans. Pooled prevalence of LASV infection was 8.7% (95% confidence interval: 6.8-10.8) in humans, 3.2% (1.9-4.6) in rodents, and 0.7% (0.0-2.3) in other mammals. Subgroup and metaregression analyses revealed a substantial statistical heterogeneity explained by higher prevalence in tissue organs, in case-control, in hospital outbreak, and surveys, in retrospective studies, in urban and hospital setting, in hospitalized patients, and in West African countries. This study suggests that LASV infections is an important cause of death in humans and that LASV are common in humans, rodents and other mammals in sub-Saharan Africa. These estimates highlight disparities between sub-regions, and population risk profiles. Western Africa, and specific key populations were identified as having higher LASV CFR and prevalence, hence, deserving more attention for cost-effective preventive interventions.
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Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Aude Christelle Ka'e
- Virology Department, Chantal Biya International Reference Centre, Yaoundé, Cameroon
| | - Gadji Mahamat
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Emmanuel Che
- Vaccinology and Biobank, Chantal Biya International Reference Centre, Yaounde, Cameroon
| | - Dimitri Tchami Ngongang
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Marie Amougou-Atsama
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Nathalie Diane Nzukui
- School of Health Sciences-Catholic University of Central Africa, Department of Medical Microbiology, Yaoundé, Cameroon
| | | | - Donatien Serge Mbaga
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Sorel Kenfack
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Nathalie Amvongo Adjia
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Atembeh Noura Efietngab
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Hervé Raoul Tazokong
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Science, The University of Yaoundé I, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Yaoundé, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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Abstract
BACKGROUND The study aimed to develop dengue severity score to assess severe manifestations among hospitalized patients with dengue infection. METHOD Children and adolescents with serologically confirmed dengue infection admitted at Ramathibodi Hospital from 2004 to 2018 and treated by an expert multidisciplinary team were recruited. Medical records were retrospectively reviewed and 14 items, related to clinical parameters and managements during hospitalization, were obtained daily as dengue severity score. RESULTS A total of 191 patients with a mean age of 10.7 years from 2004 to 2013 were recruited. They were classified as dengue fever (35), dengue hemorrhagic fever (DHF) I (53), II (50), III (37) and IV (16). The analysis of 593 daily records revealed the range of daily severity score among patients with DHF grades III (10-20) and IV (31-47) were significantly higher than those of other groups (dengue fever, 5-13; DHF I, 2-10; DHF II, 6-11) with P-values of 0.0001. Using a validity test, a total daily score of ≥12 was an assessment tool for dengue shock syndrome with sensitivity, 86% and specificity, 84%. An additional 51 hospitalized patients with DHF grades II, III and IV with similar ages from 2014 to 2018 were recruited. The number of patients with severe manifestations, having daily score of ≥12, was significantly higher than those without severe manifestations starting from Day -3 to Day +1 of illness. CONCLUSIONS Daily dengue severity score of ≥12 was an accurate assessment tool for severe manifestations.
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Rocha BAM, Guilarde AO, Argolo AFLT, Tassara MP, da Silveira LA, Junqueira IC, Turchi MD, Féres VCR, Martelli CMT. Dengue-specific serotype related to clinical severity during the 2012/2013 epidemic in centre of Brazil. Infect Dis Poverty 2017; 6:116. [PMID: 28764747 PMCID: PMC5540539 DOI: 10.1186/s40249-017-0328-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 06/18/2017] [Indexed: 11/19/2022] Open
Abstract
Multilingual abstracts Please see Additional file 1 for translations of the abstract into the five official working languages of the United Nations. Background Currently, in Brazil, there is a co-circulation of the four dengue (DENV-1 to DENV-4) serotypes. This study aimed to assess whether different serotypes and antibody response patterns were associated with the severity of the disease during a dengue outbreak, which occurred in 2012/2013 in centre of Brazil. Methods We conducted a prospective study with 452 patients with laboratory confirmed dengue in central Brazil, from January 2012 to July 2013. The clinical outcome was the severity of cases: dengue, dengue with warning signs, and severe dengue. The patients were evaluated at three different moments. Blood sampling for laboratory testing and confirmatory tests for dengue infection were performed. We performed a multinomial analysis considering the three categories of the dependent variable, as outlined above. The odds ratios (ORs) were calculated. A multinomial logistic regression model was applied for variables with a P-value <0.20. Statistical analysis was performed with STATA 12.0 software. Results Four hundred fifty-two patients (452/632, 71.5%) were diagnosed with dengue. The dengue virus (DENV) serotypes were identified in 243 cases. DENV-4 was detected in 135 patients (55.6%), DENV-1 in 91 (37.4%), DENV-3 in 13 (5.3%), and DENV-2 in 4 (1.6%). Patients with the DENV-1 serotype were more prone to present with several clinical and laboratory features as compared with DENV-4 patients, including spontaneous bleeding (P = 0.03), intense abdominal pain (P = 0.004), neurological symptoms (P = 0.09), and thrombocytopenia (P = 0.01). Secondary infection was more predominant among DENV-4 cases (80.0%) compared with DENV-1 cases (62.3%) (P = 0.03). The univariate analysis showed that females (OR = 2.12; 95% CI: 1.44–3.13; P < 0.01) had a higher risk of having dengue with warning signs. The multinomial analysis showed that severe dengue cases with secondary infection had an adjusted OR of 2.80 (95% CI: 0.78–10.00; P = 0.113) as compared with dengue fever with primary infection when adjusted for age and sex. Conclusion The current data show that 5.8% of patients recruited for treatment in healthcare centres and hospitals during the study period had severe dengue. DENV-4 was the predominant serotype, followed by DENV-1, in a large outbreak of dengue in central Brazil. Our findings contribute to the understanding of clinical differences and immune status related to the serotypes DENV-1 and DENV-4 in central of Brazil. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0328-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benigno A M Rocha
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil. .,School of Nursing, State University of Goiás, Ceres, Brazil.
| | - Adriana O Guilarde
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Angela F L T Argolo
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Marianna Peres Tassara
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Lucimeire A da Silveira
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Isabela C Junqueira
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Marília D Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | - Celina M T Martelli
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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10
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Laoprasopwattana K, Binsaai J, Pruekprasert P, Geater A. Prothrombin Time Prolongation was the Most Important Indicator of Severe Bleeding in Children with Severe Dengue Viral Infection. J Trop Pediatr 2017; 63:314-320. [PMID: 28177091 DOI: 10.1093/tropej/fmw097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
To determine the indicators of severe bleeding in children with severe dengue viral infection (DVI), the medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Severe-bleeding DVI was defined as needing blood products transfusion owing to DVI-caused bleeding. Of the 238 children with severe DVI according to the World Health Organization 2009 criteria, 44 (18.5%) had severe bleeding, of whom 28 (63.6%) died. The international normalized ratio (INR) had high correlations with both transaminase enzymes (Spearman correlation, rs = 0.67-0.69, p <0.01). Multivariate analysis found that patients who had dengue haemorrhagic fever (DHF) grade IV, platelets <20 000/mm3 and INR ≥ 1.5 had increased risk of severe bleeding with odds ratios (95% confidence intervals) of 3.4 (1.4, 8.6), 2.6 (1.1, 6.2) and 10.6 (4.0, 28.4), respectively. Blood products should be at hand in severe DHF children with high risk of severe bleeding.
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Affiliation(s)
- Kamolwish Laoprasopwattana
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jehrabeeyah Binsaai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pornpimol Pruekprasert
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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11
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Yacoub S, Trung TH, Lam PK, Thien VHN, Hai DHT, Phan TQ, Nguyet OPK, Quyen NTH, Simmons CP, Broyd C, Screaton GR, Wills B. Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress. PLoS Negl Trop Dis 2017; 11:e0005740. [PMID: 28692675 PMCID: PMC5519203 DOI: 10.1371/journal.pntd.0005740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/20/2017] [Accepted: 06/23/2017] [Indexed: 01/18/2023] Open
Abstract
Background Dengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue. Methods/Principle findings We performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded. 102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3–5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01–1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001). Conclusions/Significance Echo-derived intravascular volume assessment and venous lactate levels can help identify dengue patients at high risk of recurrent shock and respiratory distress in ICU. These findings may serve to, not only assist in the management of DSS patients, but also these haemodynamic endpoints could be used in future dengue fluid intervention trials. Dengue is a viral illness that can lead to severe and potentially fatal complications. The most common complication is fluid leakage from blood vessels, which can cause low blood pressure or dengue shock syndrome (DSS). The majority of patients recover with simple intravenous fluid replacement, however in approximately 30% of DSS cases, recurrent episodes of shock occur, and these patients have a higher risk of fluid overload, respiratory distress and death. We investigated whether using portable echocardiograms (Echo) in the intensive care unit (ICU) to assess cardiac function and intravascular volume parameters as well as blood lactate levels, can help identify these patients. We found patients who developed recurrent shock had higher heart rates and lower Stroke Volume Index (SVI), and higher lactate levels at enrolment than those with 1 episode or no shock. Higher SVI and worse cardiac function after 3 days in ICU was associated with respiratory distress. Admission lactate levels predicted patients who subsequently developed recurrent shock and correlated positively with the total IV fluid volume received. These results demonstrate that Echo-derived intravascular volume assessment and venous lactate levels can help identify dengue patients at high risk of poor outcomes in the ICU, and could assist in the management of severe dengue.
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Affiliation(s)
- Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Department of Medicine, Imperial College London, London, United Kingdom
- * E-mail:
| | - Trieu Huynh Trung
- Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phung Khanh Lam
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | | | - Duong Ha Thi Hai
- Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tu Qui Phan
- Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Than Ha Quyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Cameron Paul Simmons
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Christopher Broyd
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Bridget Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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12
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Burdmann EA, Jha V. Acute kidney injury due to tropical infectious diseases and animal venoms: a tale of 2 continents. Kidney Int 2017; 91:1033-1046. [PMID: 28088326 DOI: 10.1016/j.kint.2016.09.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/10/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022]
Abstract
South and Southeast Asia and Latin American together comprise 46 countries and are home to approximately 40% of the world population. The sociopolitical and economic heterogeneity, tropical climate, and malady transitions characteristic of the region strongly influence disease behavior and health care delivery. Acute kidney injury epidemiology mirrors these inequalities. In addition to hospital-acquired acute kidney injury in tertiary care centers, these countries face a large preventable burden of community-acquired acute kidney injury secondary to tropical infectious diseases or animal venoms, affecting previously healthy young individuals. This article reviews the epidemiology, clinical picture, prevention, risk factors, and pathophysiology of acute kidney injury associated with tropical diseases (malaria, dengue, leptospirosis, scrub typhus, and yellow fever) and animal venom (snakes, bees, caterpillars, spiders, and scorpions) in tropical regions of Asia and Latin America, and discusses the potential future challenges due to emerging issues.
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Affiliation(s)
- Emmanuel A Burdmann
- LIM 12, Division of Nephrology, University of São Paulo Medical School, São Paulo, Brazil.
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India, and University of Oxford, Oxford, UK
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13
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Hsieh CC, Cia CT, Lee JC, Sung JM, Lee NY, Chen PL, Kuo TH, Chao JY, Ko WC. A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis. PLoS Negl Trop Dis 2017; 11:e0005270. [PMID: 28060934 PMCID: PMC5245902 DOI: 10.1371/journal.pntd.0005270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 01/19/2017] [Accepted: 12/19/2016] [Indexed: 01/09/2023] Open
Abstract
Background There was a large dengue outbreak in Taiwan in 2015, in which the ages of the affected individuals were higher than those in other countries. The aim of this study was to explore the characteristics and prognostic factors for adults with severe dengue in intensive care units (ICUs). Methods All adults admitted to ICUs with dengue virus infection (DENV) at a medical center from July 1, 2015 to December 31, 2015 were enrolled. DENV was diagnosed by the presence of serum NS1 antigen, IgM antibodies to dengue virus, or dengue virus RNA by real-time reverse transcriptase polymerase chain reaction. Demographic data, clinical features, and lab data were collected, and a multivariate Cox model was used to identify the predictive factors for in-hospital mortality. Results Seventy-five patients admitted to ICUs with laboratory-confirmed DENV were enrolled (mean age 72.3±9.3 years). The most common comorbidities included hypertension (72.0%), diabetes (43.7%), and chronic kidney disease (22.7%). The in-hospital case fatality rate (CFR) was 41.3%. The patients who died were predominantly female, had higher disease severity at ICU admission, shorter ICU/hospital stay, longer initial activated partial thromboplastin time (APTT), and higher initial serum aspartate transaminase levels. Cardiac arrest before ICU admission (hazard ratio [HR]: 6.26 [1.91–20.54]), prolonged APTT (>48 seconds; HR: 3.91 [1.69–9.07]), and the presence of acute kidney injury on admission (HR: 2.48 [1.07–5.74]), were independently associated with in-hospital fatality in the Cox multivariate analysis. Conclusion During the 2015 dengue outbreak in Taiwan, the patients with severe dengue in ICUs were characterized by old age, multiple comorbidities, and a high CFR. Organ failure (including cardiac failure, and renal failure) and coagulation disturbance (prolongation of initial APTT) were independent predictive factors for in-hospital fatality. Severe forms of dengue fever (DF) are usually considered as a pediatric disease in southern Asia and are graded from dengue hemorrhagic fever (DHF) to dengue with shock syndrome (DSS). However, the age of affected individuals is increasing in Singapore, Thailand, Mainland China, Taiwan and many other countries. Limited data are available on the elderly with DF in intensive care units (ICUs). DF in the elderly is an emerging infectious disease and poses a new clinical challenge to physicians. We enrolled the patients with laboratory-confirmed dengue in our ICU during the 2015 dengue outbreak in Taiwan. These patients were characterized by old age, multiple comorbidities, and a high case fatality rate (CFR). All of the patients were classified as severe dengue, and the in-hospital CFR was 41.3%. Renal failure and cardiac arrest were associated with fatality. In addition to organ failure, initial prolonged activated partial thromboplastin time (APTT) in our study was consistent with an independent predictive factor for in-hospital fatality. Previous studies have also reported that prolongation of APTT is a clinical predictor of dengue virus infection (DENV) or DHF. Our results highlight that APTT prolongation may be a prognostic factor in critically ill adults with severe dengue.
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Affiliation(s)
- Chih-Cheng Hsieh
- Division of Critical Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cong-Tat Cia
- Division of Critical Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jen-Chieh Lee
- Division of Critical Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Junne-Ming Sung
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Te-Hui Kuo
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Yen Chao
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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14
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Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study. Sci Rep 2017; 7:39872. [PMID: 28045096 PMCID: PMC5206669 DOI: 10.1038/srep39872] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/29/2016] [Indexed: 12/22/2022] Open
Abstract
Progression to severe organ involvement due to dengue infection has been associated with severe dengue disease, intensive care treatment, and mortality. However, there is a lack of understanding of the impact of pre-existing comorbidities and other risk factors of severe organ involvement among dengue adults. The aim of this retrospective case-control study is to characterize and identify risk factors that predispose dengue adults at risk of progression with severe organ involvement. This study involved 174 dengue patients who had progressed with severe organ involvement and 865 dengue patients without severe organ involvement, matched by the year of presentation of the cases, who were admitted to Tan Tock Seng Hospital between year 2005 and 2008. Age group of 60 years or older, diabetes, cardiac disorders, asthma, and having two or more pre-existing comorbidities were independent risk factors of severe organ involvement. Abdominal pain, clinical fluid accumulation, and hematocrit rise and rapid platelet count drop at presentation were significantly associated with severe organ involvement. These risk factors, when validated in a larger study, will be useful for triage by clinicians for prompt monitoring and clinical management at first presentation, to minimize the risk of severe organ involvement and hence, disease severity.
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15
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Chen CM, Chan KS, Yu WL, Cheng KC, Chao HC, Yeh CY, Lai CC. The outcomes of patients with severe dengue admitted to intensive care units. Medicine (Baltimore) 2016; 95:e4376. [PMID: 27495047 PMCID: PMC4979801 DOI: 10.1097/md.0000000000004376] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue.This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality.During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures.The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections.
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Affiliation(s)
- Chin-Ming Chen
- Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Khee-Siang Chan
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Wen-Liang Yu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
- Department of Medicine, Taipei Medical University, Taipei
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi-Mei Medical Center
- Department of Safety Health and Environment, Chung Hwa University of Medical Technology
| | - Hui-Chun Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Chiu-Yin Yeh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Correspondence: Chih-Cheng Lai, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan (e-mail: )
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16
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Laoprasopwattana K, Jundee P, Pruekprasert P, Geater A. Outcome of Severe Dengue Viral Infection-caused Acute Liver Failure in Thai Children. J Trop Pediatr 2016; 62:200-5. [PMID: 26851434 DOI: 10.1093/tropej/fmv099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To determine clinical course and outcomes of liver functions in children with dengue viral infection-caused acute liver failure (ALF), the records of patients aged <15 years attending our institution during 1989-2011 were reviewed. Of the 41 ALF patients, 2, 6 and 33 patients had dengue hemorrhagic fever grade II, III and IV, respectively. Multiorgan failure including respiratory failure, massive bleeding and acute kidney injury occurred in 80.0%, 96.0% and 84.0% of the ALF cases, respectively, with an overall fatality rate of 68.3%. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were highest on the day that the patient developed ALF. Lactate dehydrogenase levels had positive correlations with AST (r = 0.95) and ALT (r = 0.87) (all p < 0.01). The median (interquartile range) days before the AST and ALT levels returned to lower than 200 U/L after the ALF were 10.5 (8.8, 12.8) and 10.5 (7.8, 14.0) days, respectively.
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Affiliation(s)
- Kamolwish Laoprasopwattana
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Puthachat Jundee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornpimol Pruekprasert
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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