1
|
Bukhari MH, Annan E, Haque U, Arango P, Falconar AKI, Romero-Vivas CM. Pre-or co-SARS-CoV-2 Infections Significantly Increase Severe Dengue Virus Disease Criteria: Implications for Clinicians. Pathogens 2024; 13:573. [PMID: 39057800 PMCID: PMC11279652 DOI: 10.3390/pathogens13070573] [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: 03/29/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 07/28/2024] Open
Abstract
Few studies have investigated whether SARS-CoV-2 infections increase the incidence of dengue haemorrhagic fever/shock syndrome (DHF/DSS) and/or severe dengue (SD) in dengue virus (DENV)-infected patients. This study was performed on a site with high incidences of classical dengue, but relatively few DHF/DSS or SD cases as defined by the WHO 1997 or 2009 criteria, respectively. Clinical, haematological/biochemical, and viral diagnostic data were collected from febrile patients before, during, and after the COVID-19 epidemic to assess whether (a) DENV-infected patients with prior SARS-CoV-2 infections or (b) DENV-SARS-CoV-2-co-infected patients had increased incidences of SD/DHF/DSS using logistic regression and machine learning models. Higher numbers of DHF/DSS/SD occurred during the COVID-19 epidemic, particularly in males and 18-40-year-olds. Significantly increased symptoms in the DENV-SARS-CoV-2-co-infected cases were (a) haemoconcentration (p < 0.0009) and hypotension (p < 0.0005) (DHF/DSS and SD criteria), (b) thrombocytopenia and mucosal bleeding (DHF/DSS-criteria), (c) abdominal pain, persistent vomiting, mucosal bleeding, and thrombocytopenia (SD warning signs) and (d) dyspnoea, but without fluid accumulation. DENV-infected patients with prior SARS-CoV-2 infections had significantly increased incidences of thrombocytopenia (DHF/DSS-criteria) and/or abdominal pain and persistent vomiting and also thrombocytopenia (SD warning signs), but without significant haemoconcentration or hypotension. DENV-SARS-CoV-2 co-infections significantly increased the incidence of DHF/DSS/SD, while DENV-infected patients with prior SARS-CoV-2 infections displayed significantly increased incidences of thrombocytopenia (DHF/DSS-criteria) and three important SD warning signs, which are therefore very important for health workers/clinicians in assessing patients' DHF/DSS/SD risk factors and planning their optimal therapies.
Collapse
Affiliation(s)
- Moeen Hamid Bukhari
- Department of Statistics, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Esther Annan
- Centre for Health and Wellbeing, School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA
| | - Ubydul Haque
- Rutgers Global Health Institute, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ 08901, USA
| | - Pedro Arango
- District Department of Health of Barranquilla, Barranquilla 080003, Colombia
| | - Andrew K. I. Falconar
- Laboratory of Tropical Diseases, Department of Medicine, Health Division, Universidad del Norte, Barranquilla 080003, Colombia (C.M.R.-V.)
| | - Claudia M. Romero-Vivas
- Laboratory of Tropical Diseases, Department of Medicine, Health Division, Universidad del Norte, Barranquilla 080003, Colombia (C.M.R.-V.)
| |
Collapse
|
2
|
Chowdhury R, Faria S, Chowdhury V, Islam MS, Akther S, Akter S. Bamboo stumps that are artificially in use put pressure on dengue and chikungunya vector control in Dhaka city, Bangladesh. J Vector Borne Dis 2024; 61:227-235. [PMID: 38922657 DOI: 10.4103/jvbd.jvbd_152_23] [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: 09/09/2023] [Accepted: 11/17/2023] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND OBJECTIVES Aedes aegypti and Ae. albopictus mosquitoes breed in natural and artificial containers, and they transmit dengue and chikungunya. A study was conducted to identify the contribution of bamboo stumps to these disease vectors that were used in the flower garden as pillars to hold the bamboo flex fence. METHODS Two sizes of whole bamboo were used to hold fences around gardens at Dhaka University, Bangladesh, and were painted red and green. Mosquito larvae and pupae were collected from bamboo stumps between July and August, and vectors were identified up to the species level. The data were analyzed using the STATA/MP 14.2 version. RESULTS 83.5% and 0.2% were Ae. albopictus and Ae. aegypti, respectively, and the remaining were Culex and Ar-migeres species. Ae. albopictus, Ae. aegypti, and both species-positive bamboo stumps were 46.9, 0.7, and 47.1%, respectively. 54.5% of the bamboo stumps had at least one mosquito species. The average stump depth for Aedes positive stumps (mean=11.7 cm, SE = 0.5) was significantly (p <0.001) higher than the Aedes negative stumps (mean = 9.5 cm, SE = 0.4). 53.8% and 38.0% stumps were found Aedes positive on the ground and upper sides of fences, respectively, and found significant (p<0.01) differences between both sides. A zero-inflated negative binomial count model is significant at a 5% level of significance, χ2(4) = 11.8, p = 0.019 (<0.05) for Ae. albopictus. Stump depth is found to have a significant positive effect on the number of Aedes-positive stumps. INTERPRETATION CONCLUSION Artificially used natural containers are adding pressure to current mosquito control activities as mosquitoes are breeding on them, which needs additional attention.
Collapse
Affiliation(s)
- Rajib Chowdhury
- Department of Public Health, Independent University Bangladesh (IUB), Dhaka, Bangladesh
| | - Shyla Faria
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | | | - Md Sahidul Islam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Shireen Akther
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
| | - Sakila Akter
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
| |
Collapse
|
3
|
Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:16-33. [PMID: 38263966 PMCID: PMC10800775 DOI: 10.1016/j.jointm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 01/25/2024]
Abstract
Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
Collapse
Affiliation(s)
- Alexandre Mestre Tejo
- Intensive Care Unit, Department of Intensive Medicine of the Cancer Institute of the State of São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Transfusion Medicine and Cell Therapy Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Letícia Mattos Menezes
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Mahmud MAF, Abdul Mutalip MH, Lodz NA, Muhammad EN, Yoep N, Hasim MH, Abdul Rahim FA, Aik J, Rajarethinam J, Muhamad NA. The application of environmental management methods in combating dengue: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1148-1167. [PMID: 35642722 DOI: 10.1080/09603123.2022.2076815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
Among several vector control methods commonly used, environmental management is one of the control measures to mitigate dengue in such vulnerable communities. Since there is no curative treatment for dengue yet, targeted environmental and ecosystem management is increasingly relevant. Hence, this review was conducted to identify the effectiveness of environmental management intervention strategy to reduce dengue cases. We searched PUBMED, CENTRAL, SCOPUS, Web of Science, CIJE, WHO ICTRP, and ClinicalTrials.gov up to January 2021. A total of 521 articles were screened. Only 16 studies were included in this review. There were 6 studies that applied all three types of environmental management interventions (manipulation, modification and behavior), 8 studies applied two types of interventions (manipulation and behavior) and 2 studies applied one type of intervention (manipulation or behavior). All included studies reported reduction of Aedes entomological indices. The studies showed reduction in dengue cases and density of Aedes population through environmental interventions. It is recommended for the health authority to incorporate environmental management intervention in dengue control activities and enhanced the community involvement to ensure sustainability with high impact on dengue reduction.
Collapse
Affiliation(s)
| | | | - Noor Aliza Lodz
- Institute for Public Health, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | | | - Norzawati Yoep
- Institute for Public Health, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Mohd Hazrin Hasim
- Institute for Public Health, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | | | - Joel Aik
- Environmental Health Institute (WHO Collaboration Center for Reference and Research of Arbovirus and their Associated Vectors), National Environment Agency, Singapore, Singapore
| | - Jayanthi Rajarethinam
- Environmental Health Institute (WHO Collaboration Center for Reference and Research of Arbovirus and their Associated Vectors), National Environment Agency, Singapore, Singapore
| | - Nor Asiah Muhamad
- Sector for Evidence-Based Healthcare, National Institutes of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
5
|
Haridas S, M GP, Bhaskaran R. A predictive score for severity in patients with confirmed dengue fever in a tertiary care hospital in Kerala, India. Trans R Soc Trop Med Hyg 2023; 117:741-750. [PMID: 37625166 DOI: 10.1093/trstmh/trad058] [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] [Received: 10/23/2022] [Revised: 05/24/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The study aimed to identify predictors of severe dengue during the 2017 epidemic and to develop and validate a simple predictive score for severity. METHODS A retrospective analytical study was conducted using clinical and laboratory data from adult dengue patients with a confirmed microbiological diagnosis. The study included patients who presented to a tertiary care centre in Kerala, India, during the febrile phase (≤4 d) between June 2017 and February 2019. Using appropriate statistical tests, we derived predictors of severe disease and computed a risk score model. RESULTS Of the 153 patients (mean age 50±17 y; 64% males), 31 (20%) had severe dengue and 4 (3%) died. Petechial lesions, hypoalbuminemia (<3.5 g/dl), elevated alanine aminotransferase (>40 IU/l) and urea >40 IU/l were significant predictors. Our scoring system (cut-off: 2) showed excellent performance, with an area under the receiver operating characteristics curve of 0.9741, sensitivity of 100%, specificity of 96% and accuracy of 98%. The risk score was secondarily validated on 48 patients hospitalized from March 2019 to June 2019. CONCLUSION Our scoring system is easy to implement and will help primary healthcare practitioners in promptly identifying severe dengue cases upon hospital presentation.
Collapse
Affiliation(s)
- Sruthi Haridas
- Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, AIMS Ponekkara P. O, Kochi, Ernakulam 682041, Kerala, India
| | - Gopalakrishna Pillai M
- Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, AIMS Ponekkara P. O, Kochi, Ernakulam 682041, Kerala, India
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, AIMS Ponekkara P. O, Kochi, Ernakulam 682041, Kerala, India
| |
Collapse
|
6
|
de Andrade Vieira Alves F, Nunes PCG, Arruda LV, Salomão NG, Rabelo K. The Innate Immune Response in DENV- and CHIKV-Infected Placentas and the Consequences for the Fetuses: A Minireview. Viruses 2023; 15:1885. [PMID: 37766291 PMCID: PMC10535478 DOI: 10.3390/v15091885] [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] [Received: 06/28/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Dengue virus (DENV) and chikungunya (CHIKV) are arthropod-borne viruses belonging to the Flaviviridae and Togaviridae families, respectively. Infection by both viruses can lead to a mild indistinct fever or even lead to more severe forms of the diseases, which are characterized by a generalized inflammatory state and multiorgan involvement. Infected mothers are considered a high-risk group due to their immunosuppressed state and the possibility of vertical transmission. Thereby, infection by arboviruses during pregnancy portrays a major public health concern, especially in countries where epidemics of both diseases are regular and public health policies are left aside. Placental involvement during both infections has been already described and the presence of either DENV or CHIKV has been observed in constituent cells of the placenta. In spite of that, there is little knowledge regarding the intrinsic earlier immunological mechanisms that are developed by placental cells in response to infection by both arboviruses. Here, we approach some of the current information available in the literature about the exacerbated presence of cells involved in the innate immune defense of the placenta during DENV and CHIKV infections.
Collapse
Affiliation(s)
- Felipe de Andrade Vieira Alves
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro/UERJ, Rio de Janeiro 20550170, RJ, Brazil; (F.d.A.V.A.); (L.V.A.)
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil
| | - Priscila Conrado Guerra Nunes
- Laboratório de Imunologia Viral, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil;
| | - Laíza Vianna Arruda
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro/UERJ, Rio de Janeiro 20550170, RJ, Brazil; (F.d.A.V.A.); (L.V.A.)
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil
| | - Natália Gedeão Salomão
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil
- Laboratório de Imunologia Viral, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil;
| | - Kíssila Rabelo
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro/UERJ, Rio de Janeiro 20550170, RJ, Brazil; (F.d.A.V.A.); (L.V.A.)
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040900, RJ, Brazil
| |
Collapse
|
7
|
Yek C, Li Y, Pacheco AR, Lon C, Duong V, Dussart P, Young KI, Chea S, Lay S, Man S, Kimsan S, Huch C, Leang R, Huy R, Brook CE, Manning JE. National dengue surveillance, Cambodia 2002-2020. Bull World Health Organ 2023; 101:605-616. [PMID: 37638355 PMCID: PMC10452936 DOI: 10.2471/blt.23.289713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 08/29/2023] Open
Abstract
Global dengue incidence has increased dramatically over the past few decades from approximately 500 000 reported cases in 2000 to over 5 million in 2019. This trend has been attributed to population growth in endemic areas, rapid unplanned urbanization, increasing global connectivity, and climate change expanding the geographic range of the Aedes spp. mosquito, among other factors. Reporting dengue surveillance data is key to understanding the scale of the problem, identifying important changes in the landscape of disease, and developing policies for clinical management, vector control and vaccine rollout. However, surveillance practices are not standardized, and data may be difficult to interpret particularly in low- and middle-income countries with fragmented health-care systems. The latest national dengue surveillance data for Cambodia was published in 2010. Since its publication, the country experienced marked changes in health policies, population demographics, climate and urbanization. How these changes affected dengue control remains unknown. In this article, we summarize two decades of policy changes, published literature, country statistics, and dengue case data collected by the Cambodia National Dengue Control Programme to: (i) identify important changes in the disease landscape; and (ii) derive lessons to inform future surveillance and disease control strategies. We report that while dengue case morbidity and mortality rates in Cambodia fell between 2002 and 2020, dengue incidence doubled and age at infection increased. Future national surveillance, disease prevention and treatment, and vector control policies will have to account for these changes to optimize disease control.
Collapse
Affiliation(s)
- Christina Yek
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, 12735 Twinbrook Parkway, Rockville, MD20852, United States of America (USA)
| | - Yimei Li
- Department of Ecology and Evolution, University of Chicago, Chicago, USA
| | - Andrea R Pacheco
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Chanthap Lon
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Veasna Duong
- Biological Sciences Department, University of Texas at El Paso, El Paso, USA
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Katherine I Young
- Biological Sciences Department, University of Texas at El Paso, El Paso, USA
| | - Sophana Chea
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sreyngim Lay
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Somnang Man
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Souv Kimsan
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Chea Huch
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rithea Leang
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center of Parasitology, Entomology, and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Cara E Brook
- Department of Ecology and Evolution, University of Chicago, Chicago, USA
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, 12735 Twinbrook Parkway, Rockville, MD20852, United States of America (USA)
| |
Collapse
|
8
|
Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, Emetulu H, Epelboin L, Eperon G, Medebb L, Gobbi F, Grobusch MP, Itani O, Jordan S, Kelly P, Leder K, Díaz-Menéndez M, Okumura N, Rizwan A, Rothe C, Saio M, Waggoner J, Yoshimura Y, Libman M, Hamer DH, Schwartz E. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue : A GeoSentinel Analysis. Ann Intern Med 2023; 176:940-948. [PMID: 37335991 PMCID: PMC10760980 DOI: 10.7326/m23-0721] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. OBJECTIVE To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). DESIGN Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. SETTING 20 of 71 international GeoSentinel sites. PATIENTS Returning travelers with complicated dengue. MEASUREMENTS Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. RESULTS Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue. LIMITATIONS Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. CONCLUSION Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.
Collapse
Affiliation(s)
- Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy (R.H.)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (K.M.A.)
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (B.A.)
| | - Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada (S.B.)
| | - Elizabeth D Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (E.B.)
| | - Hannah Emetulu
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Loïc Epelboin
- Infectious and Tropical Diseases Unit and CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana (L.E.)
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland (G.E.)
| | - Line Medebb
- Aix Marseille University, AP-HM, IHU-Méditerranée Infection, Marseille, France (L.M.)
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (F.G.)
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands (M.P.G.)
| | - Oula Itani
- Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur, Paris, France (O.I.)
| | - Sabine Jordan
- Division of Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, and Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (S.J.)
| | - Paul Kelly
- BronxCare Hospital Center, Bronx, New York (P.K.)
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, and Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Victoria, Australia (K.L.)
| | - Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz-Carlos III, IdIPAz, and CIBERINFECT, Madrid, Spain (M.D.)
| | - Nobumasa Okumura
- Center Hospital of the National Center for Global Health and Medicine, Shinjuku City, Tokyo, Japan (N.O.)
| | - Aisha Rizwan
- International Society of Travel Medicine, Atlanta, Georgia (H.E., A.R.)
| | - Camilla Rothe
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany (C.R.)
| | - Mauro Saio
- Doctor's Plaza, Nairobi Hospital, Nairobi, Kenya (M.S.)
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia (J.W.)
| | | | - Michael Libman
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts (E.D.B., M.L.)
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Center for Emerging Infectious Disease Policy and Research, Boston University, and National Emerging Infectious Disease Laboratory, Boston, Massachusetts (D.H.H.)
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, and Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.S.)
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Dengue is the most important arthropod-borne viral disease of public health significance. Its geographic distribution includes 128 countries worldwide, affecting 390 million people every year causing significant morbidity and mortality in children and adults everywhere. RECENT FINDINGS In the past, severe dengue affected mostly adults in the Americas; this scenario has changed and now cases of dengue, severe dengue, and dengue deaths have increased in children under 15 years in Brazil and in Colombia. Dengue and COVID-19 co-infections have been reported in South America, with increased hospitalization. A dengue vaccine for 9-year-old children and older children and adults who have serological evidence of previous dengue has been licensed in many countries; a different dengue vaccine trial for 4-16-year-old children has demonstrated decrease in clinical dengue and decrease in dengue hospitalizations. SUMMARY There is no specific treatment of dengue, and a changing climate, insecticide resistance and urban expansion have permitted the vector's spread, making the vector control almost impossible. The hope for dengue control relies on vaccine development; there is important research on this area with one vaccine already licensed and another one showing promising results.
Collapse
Affiliation(s)
- Silvia Nunes Szente Fonseca
- Hospital Epidemiology and Infection Control, Hospital São Lucas
- Escola de Medicina Estácio-Idomed, Ribeirão Preto, São Paulo State, Brazil
| |
Collapse
|
10
|
Khan A, Ndenga B, Mutuku F, Bosire CM, Okuta V, Ronga CO, Mutai NK, Musaki SK, Chebii PK, Maina PW, Jembe Z, Amugongo JS, Malumbo SL, Ng'ang'a CM, LaBeaud D. Majority of pediatric dengue virus infections in Kenya do not meet 2009 WHO criteria for dengue diagnosis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000175. [PMID: 36962138 PMCID: PMC10021889 DOI: 10.1371/journal.pgph.0000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022]
Abstract
From 1975-2009, the WHO guidelines classified symptomatic dengue virus infections as dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. In 2009 the case definition was changed to a clinical classification after concern the original criteria was challenging to apply in resource-limited settings and not inclusive of a substantial proportion of severe dengue cases. Our goal was to examine how well the current WHO definition identified new dengue cases at our febrile surveillance sites in Kenya. Between 2014 and 2019 as part of a child cohort study of febrile illness in our four clinical study sites (Ukunda, Kisumu, Msambweni, Chulaimbo) we identified 369 dengue PCR positive symptomatic cases and characterized whether they met the 2009 revised WHO diagnostic criteria for dengue with and without warning signs and severe dengue. We found 62% of our PCR-confirmed dengue cases did not meet criteria per the guidelines. Our findings also correlate with our experience that dengue disease in children in Kenya is less severe as reported in other parts of the world. Although the 2009 clinical classification has recently been criticized for being overly inclusive and non-specific, our findings suggest the 2009 WHO dengue case definition may miss more than 50% of symptomatic infections in Kenya and may require further modification to include the African experience.
Collapse
Affiliation(s)
- Aslam Khan
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Bryson Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Francis Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Carren M Bosire
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Victoria Okuta
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles O Ronga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Noah K Mutai
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sandra K Musaki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Philip K Chebii
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Priscilla W Maina
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Zainab Jembe
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Jael S Amugongo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Said L Malumbo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Charles M Ng'ang'a
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| |
Collapse
|
11
|
van Leur SW, Heunis T, Munnur D, Sanyal S. Pathogenesis and virulence of flavivirus infections. Virulence 2021; 12:2814-2838. [PMID: 34696709 PMCID: PMC8632085 DOI: 10.1080/21505594.2021.1996059] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/15/2021] [Indexed: 11/01/2022] Open
Abstract
The Flavivirus genus consists of >70 members including several that are considered significant human pathogens. Flaviviruses display a broad spectrum of diseases that can be roughly categorised into two phenotypes - systemic disease involving haemorrhage exemplified by dengue and yellow Fever virus, and neurological complications associated with the likes of West Nile and Zika viruses. Attempts to develop vaccines have been variably successful against some. Besides, mosquito-borne flaviviruses can be vertically transmitted in the arthropods, enabling long term persistence and the possibility of re-emergence. Therefore, developing strategies to combat disease is imperative even if vaccines become available. The cellular interactions of flaviviruses with their human hosts are key to establishing the viral lifecycle on the one hand, and activation of host immunity on the other. The latter should ideally eradicate infection, but often leads to immunopathological and neurological consequences. In this review, we use Dengue and Zika viruses to discuss what we have learned about the cellular and molecular determinants of the viral lifecycle and the accompanying immunopathology, while highlighting current knowledge gaps which need to be addressed in future studies.
Collapse
Affiliation(s)
| | - Tiaan Heunis
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, OxfordOX1 3RE, UK
| | - Deeksha Munnur
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, OxfordOX1 3RE, UK
| | - Sumana Sanyal
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, OxfordOX1 3RE, UK
| |
Collapse
|
12
|
Giang HTN, Sayed AM, Dang T, Iqtadar S, Tuan NM, Khiem NT, Viet DC, Van TTK, Phuoc NT, Dung TTK, Elhalwagy EA, Vien LHL, Triet NM, Tong NT, Son DH, Hung LC, Tam DTH, Hirayama K, Huy NT. Survey of knowledge, attitude and practice of healthcare professionals on dengue transmission, diagnosis and clinical classification. BMC Infect Dis 2021; 21:1130. [PMID: 34727869 PMCID: PMC8564985 DOI: 10.1186/s12879-021-06816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the knowledge, attitudes, and practices of the healthcare professionals (HCPs) including physicians and nurses regarding dengue transmission, diagnosis and clinical classification using the warning signs of World Health Organization (WHO) 2009 classification. RESULTS Out of 471 respondents from three countries, 80.9% of physicians and 74% of nurses did not receive previous training regarding the dengue infection. The majority of respondents could identify the primary dengue vector (86%), while only a third of HCPs knew the biting time of dengue mosquitoes. Only half of our respondents knew about immunity induced by serotypes; Moreover, half of our participants could determine the diagnostic tests. On the other hand, about 90% of the respondents took responsibility for talking to the patients about preventive measures. Our respondents also showed wide variations in definition of warning signs listed in the WHO 2009 classification. Multivariate analysis linked the impact of different cofactors including prior training on dengue infection, type of profession, frequency of taking care of dengue patients and country on how HCPs defined these warning signs. CONCLUSIONS This study could declare the variation in employing the warning signs listed in the WHO 2009 classification. We have figured that most of the HCPs did not take prior training on the dengue viral infection; Also, we found gaps in the knowledge regarding various topics in dengue fever. This paper recommends the gathering of efforts to establish the proper knowledge of dengue infection and the warning signs listed by the WHO.
Collapse
Affiliation(s)
- Hoang Thi Nam Giang
- School of Medicine and Pharmacy, The University of Danang, Danang, 550000, Vietnam.
| | - Ahmed M Sayed
- Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Thao Dang
- Department of Internal Medicine, Texas Tech University Health Science Center at the Permian Basin, Odessa, TX, USA
| | - Somia Iqtadar
- Dengue Expert Advisory Group Punjab, King Edward Medical University, Lahore, Pakistan
| | | | | | | | | | | | | | | | - Le Huu Linh Vien
- School of Medicine and Pharmacy, The University of Danang, Danang, 550000, Vietnam
| | | | | | - Do Hong Son
- The Tay Ninh General Hospital, Tay Ninh, Vietnam
| | | | - Dong Thi Hoai Tam
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
| |
Collapse
|
13
|
Sharp TM, Anderson KB, Katzelnick LC, Clapham H, Johansson MA, Morrison AC, Harris E, Paz-Bailey G, Waterman SH. Knowledge gaps in the epidemiology of severe dengue impede vaccine evaluation. THE LANCET. INFECTIOUS DISEASES 2021; 22:e42-e51. [PMID: 34265259 DOI: 10.1016/s1473-3099(20)30871-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 10/20/2022]
Abstract
The most severe consequences of dengue virus infection include shock, haemorrhage, and major organ failure; however, the frequency of these manifestations varies, and the relative contribution of pre-existing anti-dengue virus antibodies, virus characteristics, and host factors (including age and comorbidities) are not well understood. Reliable characterisation of the epidemiology of severe dengue first depends on the use of consistent definitions of disease severity. As vaccine trials have shown, severe dengue is a crucial interventional endpoint, yet the infrequency of its occurrence necessitates the inclusion of thousands of study participants to appropriately compare its frequency among participants who have and have not been vaccinated. Hospital admission is frequently used as a proxy for severe dengue; however, lack of specificity and variability in clinical practices limit the reliability of this approach. Although previous infection with a dengue virus is the best characterised risk factor for developing severe dengue, the influence of the timing between dengue virus infections and the sequence of dengue virus infections on disease severity is only beginning to be elucidated. To improve our understanding of the diverse factors that shape the clinical spectrum of disease resulting from dengue virus infection, prospective, community-based and clinic-based immunological, virological, genetic, and clinical studies across a range of ages and geographical regions are needed.
Collapse
Affiliation(s)
- Tyler M Sharp
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA; United States Public Health Service, Silver Springs, MD, USA.
| | - Kathryn B Anderson
- Institute for Global Health and Translational Sciences and Department of Medicine, and Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Virology, Armed Forces Research Institute for Medical Sciences, Bangkok, Thailand
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Biology, University of Florida, Gainesville, FL, USA
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael A Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Amy C Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Stephen H Waterman
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA; United States Public Health Service, Silver Springs, MD, USA
| |
Collapse
|
14
|
Htun TP, Xiong Z, Pang J. Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis. Emerg Microbes Infect 2021; 10:1116-1128. [PMID: 34036893 PMCID: PMC8205005 DOI: 10.1080/22221751.2021.1935327] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The World Health Organization (WHO) introduced the new dengue classification in 2009. We aimed to assess the association of clinical signs and symptoms with WHO severe dengue classification in clinical practice. A systematic literature search was performed using the databases of PubMed, Embase, and Scopus between 2009 and 2018 according to PRISMA guideline. Meta-analysis was performed with the RevMan software. A random or fixed-effect model was applied to pool odds ratios and 95% confidence intervals of important signs and symptoms across studies. Thirty nine articles from 1790 records were included in this review. In our meta-analysis, signs and symptoms associated with higher risk of severe dengue were comorbidity, vomiting, persistent vomiting, abdominal pain or tenderness, pleural effusion, ascites, epistaxis, gum bleeding, GI bleeding, skin bleeding, lethargy or restlessness, hepatomegaly (>2 cm), increased HCT with decreased platelets, shock, dyspnea, impaired consciousness, thrombocytopenia, elevated AST and ALT, gall bladder wall thickening and secondary infection. This review shows new factors comorbidity, epistaxis, GI and skin bleeding, dyspnea, gall bladder wall thickening and secondary infection may be useful to refine the 2009 classification to triage severe dengue patients.
Collapse
Affiliation(s)
- Tha Pyai Htun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Zhonghui Xiong
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| |
Collapse
|
15
|
Sahu AK, Aggarwal P, Ekka M, Nayer J, Bhoi S, Kumar A, Luthra K. Assessing the serum chymase level as an early predictor of dengue severity. J Med Virol 2021; 93:3330-3337. [PMID: 32857465 DOI: 10.1002/jmv.26468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
We conducted a prospective, observational study to assess the serum chymase level, a mast cell derived protease, as a predictor of dengue severity. NS1-positive non-severe dengue patients of age ≥14 years with duration of fever ≤4 days were included in the study. At the time of admission, the serum sample was taken for chymase estimation. Patients were followed up to four days after they became afebrile to find out the final diagnosis. Total of 338 non-severe dengue patients were recruited (mean age: 29.15 years; male: 66%). On follow-up, 26 patients (7.8%) developed severe dengue. Only chymase level (adjusted odds ratio [aOR]: 1.787; 95% confidence interval [CI]: 1.309-2.440) and platelet count at admission (aOR: 0.981; 95% CI: 0.968-0.993) were able to predict the severity after adjustment for all variables. But, for prediction of severe dengue, the area under receiver's operating curve of chymase was 0.835 (95% CI: 0.765-0.905), which was significantly higher than that of the platelet count at admission (0.760, 95% CI: 0.650-0.870) (p < .001). Patients who developed severe dengue in due course of illness had significantly higher serum chymase level at admission as compared with the rest of the patients. Similar findings were noted across all age-groups. At an optimum cut-off value of 1.35 ng/ml, chymase had a positive likelihood ratio (LR) of 3.5 and a negative LR of 0.15, for predicting severe dengue. This study demonstrated the potential ability of serum chymase levels at admission, as a biomarker for prediction of severe dengue in due course of illness.
Collapse
Affiliation(s)
- Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Suwanbamrung C, Le CN, Maneerattanasak S, Satian P, Talunkphet C, Nuprasert Y, Siwarin A, Kotchawat S, Srimoung P, Ponprasert C, Nontapet O. Developing and using a dengue patient care guideline for patients admitted from households to primary care units and the district hospital: A community participatory approach in Southern Thailand. One Health 2020; 10:100168. [PMID: 33117880 PMCID: PMC7582214 DOI: 10.1016/j.onehlt.2020.100168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care. METHODS 26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions. RESULTS The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data. CONCLUSION The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.
Collapse
Key Words
- CBC, Complete blood count
- CPAR, Community participatory action
- CVI, Content validity index
- DALY, Disability adjusted life year
- DAR, Dextrose acetate ringer
- DEN, Dengue virus
- DF, Dengue fever
- DHF, Dengue haemorrhagic fever
- DLR, Dextrose lactate ringer
- DPCG, Dengue patient care guideline
- DSS, Dengue shock syndrome
- Dengue patient care guideline
- EC for DRAS, Excellent Centre for Dengue Research and Academic Service
- ER, Emergency room
- ER1, Guideline of DPCG at emergency room for hospital discharge for observing at home
- ER2, Guideline of DPCG at emergency room for admission to in patient department
- ER3, Guideline of DPCG at emergency room for serious dengue to province hospital
- HCT, Hematocrit
- HGT/DTX, Haemogluco test/Dextrostix
- Hospital
- Household
- IPD, Inpatient department
- IPD1, DPCG at inpatient department for dengue patient grade I and II
- IPD2, DPCG at inpatient department for severe dengue and send to province hospital Iowa model: The Model was developed at the University of Iowa Hospitals and Clinics in 1990s to serve as a guide for nurses to use research findings to help improve patient care.
- KAP
- Lansaka model, the larval indices surveillance system for a sustainable solution to the dengue problem in southern Thailand
- NSAIDs, Non-steroidal anti-inflammatory drugs
- NSS, Normal saline solution
- OPD, Outpatient department
- OPD1, DPCG at outpatient department for continuous observation at home
- OPD2, DPCG at outpatient department for admission to inpatient department, district hospital
- OPD3, DPCG at outpatient department for serious dengue case and send to province hospital
- PCU1, DPCG at primary care unit for dengue case with fever>48 h and send to district hospital
- PCU2, DPCG at primary care unit for dengue case with fever<48 h for observation at home/community
- PCUs, Primary care units (PCUs)
- Primary care unit
- SRRT, Surveillance and Rapid Response Team
- Secondary hospital, the district hospital that mean secondary care level of health care system in Thailand
- Tertiary hospital, the province hospital that mean tertiary care level of health care system in Thailand
- Vital signs, BT (Body temperature), PR (Pulse), RR (Respiratory rate), and BP (Blood pressure)
- WA, Warning signs
- WBC, White blood count (Dengue infection WBC ≤ 5000 cells/mm3.)
- WHO 1997, Guideline for classification dengue DF/DHF/DSS by WHO regional publication, SEARO No. 29
- WHO 2009, Guideline for classification dengue, dengue with or without signs (WS) and severe dengue (D, D ± WS, SD)
- WHO, World health organization
Collapse
Affiliation(s)
- Charuai Suwanbamrung
- School of Public Health, Walailak University, Nakhon Si Thammarat Province, Thailand
- Excellent Center for Dengue Research and Academic Service (EC for DRAS), Walailak University, Thailand
| | - Cua Ngoc Le
- School of Public Health, Walailak University, Nakhon Si Thammarat Province, Thailand
- Excellent Center for Dengue Research and Academic Service (EC for DRAS), Walailak University, Thailand
| | - Sarunya Maneerattanasak
- School of Public Health, Walailak University, Nakhon Si Thammarat Province, Thailand
- Excellent Center for Dengue Research and Academic Service (EC for DRAS), Walailak University, Thailand
| | | | | | | | - Anuson Siwarin
- Lansaka Hospital, Nakhon Si Thammarat Province, Thailand
| | - Somsri Kotchawat
- Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat Province, Thailand
| | - Poungpen Srimoung
- Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat Province, Thailand
| | - Chumpron Ponprasert
- Public Health Official of Lansaka District, Nakhon Si Thammarat Province, Thailand
- Excellent Center for Dengue Research and Academic Service (EC for DRAS), Walailak University, Thailand
| | - Orratai Nontapet
- School of Nursing, Walailak University, Nakhon Si Thammarat Province, Thailand
- Excellent Center for Dengue Research and Academic Service (EC for DRAS), Walailak University, Thailand
| |
Collapse
|
17
|
Gupta S, Mall P, Alam A. Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue. Trans R Soc Trop Med Hyg 2020; 114:838-846. [PMID: 32964929 DOI: 10.1093/trstmh/traa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/07/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Taking into consideration, the variable performance of WHO's dengue case definition and the magnitude of epidemics in India, a score based on clinical and laboratory parameters is required for the early identification of severe dengue. METHODS A retrospective observational study of children (aged ≤12 y) presenting with dengue, defined as per the WHO 2009 classification and NS1 antigen/IgM ELISA positivity, was conducted at a tertiary care hospital from 2013 to 2015. Clinical laboratory parameters were compared between severe/non-severe dengue using univariate and multivariate analysis. Areas under receiver operating characteristic curves (AUROCs), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for independent and composite markers. RESULTS Of 135 dengue patients, 46 (34.1%) had non-severe dengue and 89 (65.9%) had severe dengue. Logistic regression determined prolonged capillary refill time (CRT), lactate ≥2.9 mmol/L and serum aspartate transaminase (AST) ≥135 IU/L as predictive for severe dengue. AUROCs of lactate, AST and combined score incorporating AST, lactate and prolonged CRT for identifying severity were 7.55, 7.23 and 8.5, respectively. The combined score cut-off ≥1 had 87.6% sensitivity, 65.2% specificity, 83% PPV and 73.2% NPV. The combined score cut-off ≥3 had 100% specificity and 100% PPV. However, AST >135 IU/L and lactate >2.9 mmol/L together had 97.8% specificity and 97.1% PPV for identifying severity. CONCLUSIONS The presence of either 'prolonged capillary refill time with one deranged biochemical parameter' or 'both deranged biochemical parameters' is nearly 100% specific for severity of dengue.
Collapse
Affiliation(s)
- Sarika Gupta
- Department of Paediatrics, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, India
| | - Pranaya Mall
- Department of neonatology, PGIMER, Dr RML Hospital, Presidents's Estate, New Delhi, India
| | - Areesha Alam
- Department of Paediatrics, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi road, Lucknow, Uttar Pradesh, India
| |
Collapse
|
18
|
|
19
|
Dussart P, Duong V, Bleakley K, Fortas C, Lorn Try P, Kim KS, Choeung R, In S, Andries AC, Cantaert T, Flamand M, Buchy P, Sakuntabhai A. Comparison of dengue case classification schemes and evaluation of biological changes in different dengue clinical patterns in a longitudinal follow-up of hospitalized children in Cambodia. PLoS Negl Trop Dis 2020; 14:e0008603. [PMID: 32925941 PMCID: PMC7515206 DOI: 10.1371/journal.pntd.0008603] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/24/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. METHODOLOGY/PRINCIPAL FINDINGS We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were designated SD using an adapted WHO 2009 classification for SD case definition. Systematic use of ultrasound at patient admission was crucial for detecting plasma leakage. No difference was observed in the concentration of secreted NS1 protein between different dengue severity groups. Lipid profiles were different between DWWS and SD at admission, characterized by a decrease in total cholesterol, HDL cholesterol, and LDL cholesterol, in SD. CONCLUSIONS/SIGNIFICANCE Our results show discrepancies between the two classifications, including misclassification of severe dengue cases as mild cases by the WHO 1997 classification. Using an adapted WHO 2009 classification, SD more precisely defines the group of patients requiring careful clinical care at a given time during hospitalization.
Collapse
Affiliation(s)
- Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Kevin Bleakley
- Laboratoire de mathématiques d'Orsay, Université Paris-Saclay, CNRS, Inria, Orsay, France
| | - Camille Fortas
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Patrich Lorn Try
- Pediatric Department, Kampong Cham Provincial hospital, Kampong Cham, Cambodia
| | - Kim Srorn Kim
- Pediatric Department, Kampong Cham Provincial hospital, Kampong Cham, Cambodia
| | - Rithy Choeung
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Saraden In
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Anne-Claire Andries
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Tineke Cantaert
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Marie Flamand
- Structural Virology Unit, Department of Virology, Institut Pasteur, CNRS UMR 3569, Paris, France
| | | | - Anavaj Sakuntabhai
- Functional Genetics of Infectious Diseases Unit, Department of Genomes and Genetics, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, Génomique évolutive, modélisation et santé, UMR 2000, Paris, France
| |
Collapse
|
20
|
de Jong W, Asmarawati TP, Verbeek I, Rusli M, Hadi U, van Gorp E, Goeijenbier M. Point-of-care thrombocyte function testing using multiple-electrode aggregometry in dengue patients: an explorative study. BMC Infect Dis 2020; 20:580. [PMID: 32762658 PMCID: PMC7409667 DOI: 10.1186/s12879-020-05248-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Dengue virus (DENV) causes the hospitalisation of an estimated 500,000 people every year. Outbreaks can severely stress healthcare systems, especially in rural settings. It is difficult to discriminate patients who need to be hospitalized from those that do not. Earlier work identified thrombocyte count and subsequent function as a promising prognostic marker of DENV severity. Herein, we investigated the potential of quantitative thrombocyte function tests in those admitted in the very early phase of acute DENV infections, using Multiplate™ multiple-electrode aggregometry to explore its potential in triage. Methods In this prospective cohort study all patients aged ≥13 admitted to Universitas Airlangga Hospital in Surabaya, Indonesia with a fever (≥38 °C) between 25 January and 1 August 2018 and with a clinical suspicion of DENV, were eligible for inclusion. Exclusion criteria were a thrombocyte count below 100 × 109/L and the use of any medication with a known anticoagulant effect, nonsteroidal anti-inflammatory drugs and acetyl salicylic acid. Clinical data was collected and blood was taken on admission, day 1 and day 7. Samples were tested for acute DENV, using Panbio NS1 ELISA. Platelet aggregation using ADP-, TRAP- and COL-test were presented as Area Under the aggregation Curve (AUC). Significance was tested between DENV+, probably DENV, fever of another origin, and healthy controls (HC). Results A total of 59 patients (DENV+ n = 10, DENV probable n = 25, fever other origin n = 24) and 20 HC were included. We found a significantly lower thrombocyte aggregation in the DENV+ group, compared with both HCs and the fever of another origin group (p < .001). Low ADP AUC values on baseline correlated to a longer hospital stay in DENV+ and probable DENV cases. Conclusion Thrombocyte aggregation induced by Adenosine diphosphate, Collagen and Thrombin receptor activating peptide-6 is impaired in human DENV cases, compared with healthy controls and other causes of fever. This explorative study provides insights to thrombocyte function in DENV patients and could potentially serve as a future marker in DENV disease.
Collapse
Affiliation(s)
- Wesley de Jong
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.
| | - Tri Pudy Asmarawati
- Department of Internal Medicine, Universitas Airlangga Hospital, Airlangga University, Surabaya, Indonesia
| | - Inge Verbeek
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands
| | - Musofa Rusli
- Department of infectious diseases, Rumah Sakit Umum Daerah Dr Soetomo, Airlangga University, Surabaya, Indonesia
| | - Usman Hadi
- Department of infectious diseases, Rumah Sakit Umum Daerah Dr Soetomo, Airlangga University, Surabaya, Indonesia
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.,Department of internal medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands. .,Department of internal medicine, Erasmus MC, Rotterdam, the Netherlands.
| |
Collapse
|
21
|
Das R, Emon MPZ, Shanu SA, Akter D, Islam MR. A Haemophilic Dengue Patient with Pleural Effusion and Earache. Cureus 2020; 12:e9572. [PMID: 32913689 PMCID: PMC7474559 DOI: 10.7759/cureus.9572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
About 2.5 billion people are living at a higher risk of dengue fever in hundreds of tropical and sub-tropical countries. Treatment of dengue fever is quite complicated and challenging because of the lack of effective treatment approaches. We herein report a rare case of a 25-year-old female with a past medical history of haemophilia A, suffering from dengue fever, pleural effusion, earache, myalgia, headache, and vomiting. Dengue was confirmed by the non-structural protein 1 (NS1) antigen and immunoglobulin M (IgM) antibody test. She had low blood pressure (80/60 mmHg), frequent vomiting, and low platelet count during hospitalization. Moreover, a genetic disorder like haemophilia with plasma leakage and earache made the patient's condition worse. However, by repeated platelet infusion, the platelet counts elevated and the patient was discharged from the hospital after nine days. Complete recovery was achieved after 27 days. This is a rare case of dengue; physicians should be aware of the severity of the disease and its management tactics. More discussion and research need to be carried out to develop an effective and optimized treatment and management options to reduce the mortality and morbidity due to dengue fever with a co-morbid disease.
Collapse
Affiliation(s)
- Rajesh Das
- Pharmacy, University of Asia Pacific, Dhaka, BGD
| | | | | | - Dilruba Akter
- Medicine, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, BGD
| | | |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
Rosenberger KD, Alexander N, Martinez E, Lum LCS, Dempfle CE, Junghanss T, Wills B, Jaenisch T. Severe dengue categories as research endpoints-Results from a prospective observational study in hospitalised dengue patients. PLoS Negl Trop Dis 2020; 14:e0008076. [PMID: 32130212 PMCID: PMC7055818 DOI: 10.1371/journal.pntd.0008076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/19/2020] [Indexed: 01/12/2023] Open
Abstract
Severe dengue was perceived as one clinical disease entity until the WHO 2009 classification stratified it into severe vascular leakage, severe bleeding, and severe organ dysfunction. The objectives of this study were to investigate the potential use of severe dengue categories as endpoints for intervention research. 271 patients with severe dengue among 1734 confirmed dengue patients were followed prospectively in this hospital-based observational study in Latin America and Asia. We compared the distribution of severe dengue categories according to gender and age (below/above 15y), and determined the relative frequency and the overlap of severe dengue categories in the same patients. In a next step, we extended the analysis to candidate moderate severity categories, based on recently suggested definitions which were adapted for our purposes. Severe vascular leakage occurred in 244 (90%), severe bleeding in 39 (14%), and severe organ dysfunction in 28 (10%) of 271 severe dengue patients. A higher frequency of severe leakage was seen in children or adolescents (<15y) compared to adults. More than 80% of the severe leakage cases, and 30-50% of the cases with severe bleeding or severe organ dysfunction, were defined as severe on the basis of that feature alone. In 136 out of 213 patients with severe leakage alone, neither moderate bleeding manifestation nor hepatic involvement was recorded. On the other hand, moderate leakage manifestations were detected in 4 out of 12 cases that were classified as severe based on bleeding alone. A major proportion of severe dengue patients exhibited clinical manifestations of severe vascular leakage only, which may constitute a useful endpoint for intervention research or pathophysiology studies. Severe bleeding and severe organ manifestation were recorded less frequently and exhibited a higher degree of overlap with severe leakage. Severe bleeding without leakage may be associated with individual predisposition or the presence of comorbidities. More detailed assessments are needed to explore this hypothesis. Candidate moderate disease endpoints were investigated and need to be further validated.
Collapse
Affiliation(s)
- Kerstin D. Rosenberger
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Eric Martinez
- Pedro Kouri Institute for Tropical Medicine, Havana, Cuba
| | - Lucy C. S. Lum
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Thomas Junghanss
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Thomas Jaenisch
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | |
Collapse
|
24
|
Kaur G, Kumar V, Puri S, Tyagi R, Singh A, Kaur H. Predictors of dengue-related mortality in young adults in a tertiary care centre in North India. J Family Med Prim Care 2020; 9:694-697. [PMID: 32318404 PMCID: PMC7114013 DOI: 10.4103/jfmpc.jfmpc_605_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background Outbreaks of dengue fever cause widespread mortality. There is a paucity of studies on predictors of morbidity and mortality in dengue. This observational study was performed to study the factors predicting adverse outcomes caused due to dengue fever thereby optimally manage the patient's to reduce mortality. Methods The study included a 1-year retrospective and 1-year prospective period were clinical, laboratory and outcome data of patients between 18-30 years of age, having serology proven (NS1/dengue IgM) dengue fever were recorded and analysed. Results Out of 418 patients, 404 (96.64%) recovered and 14 (3.35%) expired, resulting in a 3.35% mortality rate. Platelet count did not determine the outcome in dengue patients. The shock factor was present in 45 (11.1%) patients who recovered and 10 out of 14 patients who expired (71.4%), P value was statistically significant. Mean value of SGOT and SGPT in dengue patients who expired were 2865.43 and 1510.07 IU/L, respectively, which were significantly higher than the mean values of SGOT and SGPT in those who survived. Bleeding was present in 39 (9.7%) patients who recovered. Out of the 14 expired patients, bleeding was present in 5 (35.7%) which is statistically significant. Hence, on multivariate logistics analysis, bleeding, a higher SGOT and SGPT value and shock were found to be significant risk factors for mortality in dengue fever patients. Conclusion Bleeding, shock and raised SGOT and SGPT levels were identified as predictors of adverse outcomes and mortality in dengue fever. Timely identification of these risk factors and active management is important to reduce dengue-related mortality.
Collapse
Affiliation(s)
- Gursheen Kaur
- Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vipin Kumar
- Department of General Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Puri
- Department of General Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashwajit Singh
- Department of General Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
25
|
Ahmed AM, Mohammed AT, Vu TT, Khattab M, Doheim MF, Ashraf Mohamed A, Abdelhamed MM, Shamandy BE, Dawod MT, Alesaei WA, Kassem MA, Mattar OM, Smith C, Hirayama K, Huy NT. Prevalence and burden of dengue infection in Europe: A systematic review and meta‐analysis. Rev Med Virol 2019; 30:e2093. [DOI: 10.1002/rmv.2093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Thao T. Vu
- School of Health and Biomedical SciencesRMIT University Melbourne Victoria Australia
| | | | | | | | | | | | | | - Wafaa Ali Alesaei
- Faculty of MedicineMisr University for Science and Technology Giza Egypt
| | - Mahmoud Attia Kassem
- Medical Oncology DepartmentThe Ohio State University Wexner Medical Center Columbus Ohio USA
| | | | - Chris Smith
- School of Tropical Medicine and Global HealthNagasaki University Nagasaki Japan
- Department of Clinical ResearchLondon School of Hygiene and Tropical Medicine London UK
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global HealthNagasaki University Nagasaki Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research GroupTon Duc Thang University Ho Chi Minh City Vietnam
- Faculty of Applied SciencesTon Duc Thang University Ho Chi Minh City Vietnam
| |
Collapse
|
26
|
Health facility use by dengue patients in the Klang Valley, Malaysia: a secondary analysis of dengue surveillance data. Western Pac Surveill Response J 2019; 10:39-45. [PMID: 31720053 PMCID: PMC6831957 DOI: 10.5365/wpsar.2019.10.1.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Dengue patients in Malaysia have the choice to seek care from either public or private sector providers. This study aims to analyse the pattern of health facility use among dengue patients to provide input for the ongoing policy discussion regarding public-private integration. The focus of this study is in the Klang Valley, which has a high dengue burden as well as a high number of private facilities. Methods This is a cross-sectional study using an available secondary data source - the Malaysian national dengue passive surveillance system, e-Dengue registry. A total of 61 455 serologically confirmed dengue cases from the Klang Valley, registered in year 2014, were included. We retrospectively examined the relationship between demographic factors and the choice of health-care sector by logistic regression. Results The median age of the cohort was 26 (interquartile range: 17 to 37) years. More private facilities (54.4%) were used for inpatient care; more public facilities (68.2%) were used for outpatient care. The Chinese and urban populations showed significantly higher use of the private health-care sector with an adjusted odds ratio of 4.8 [95% confidence interval (CI): 4.6-5.1] and 2.3 (95% CI: 2.2-2.4), respectively. Conclusion Both public and private health facilities bear significant responsibilities in delivering health-care services to dengue patients. The workload of both sectors should be included in future health policy planning by public agencies.
Collapse
|
27
|
Estofolete CF, de Oliveira Mota MT, Bernardes Terzian AC, de Aguiar Milhim BHG, Ribeiro MR, Nunes DV, Mourão MP, Rossi SL, Nogueira ML, Vasilakis N. Unusual clinical manifestations of dengue disease - Real or imagined? Acta Trop 2019; 199:105134. [PMID: 31415737 DOI: 10.1016/j.actatropica.2019.105134] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/10/2023]
Abstract
The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.
Collapse
Affiliation(s)
| | | | | | | | - Milene Rocha Ribeiro
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Delzi Vinha Nunes
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Maria Paula Mourão
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), Manaus, Amazonas, Brazil
| | - Shannan L Rossi
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | | | - Nikos Vasilakis
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA.
| |
Collapse
|
28
|
Rothan HA, Zhong Y, Sanborn MA, Teoh TC, Ruan J, Yusof R, Hang J, Henderson MJ, Fang S. Small molecule grp94 inhibitors block dengue and Zika virus replication. Antiviral Res 2019; 171:104590. [PMID: 31421166 DOI: 10.1016/j.antiviral.2019.104590] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/06/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022]
Abstract
Two major flaviviruses, dengue virus (DENV) and Zika virus (ZIKV), cause severe health and economic burdens worldwide. Recently, genome-wide screenings have uncovered the importance of regulators of the Hrd1 ubiquitin ligase-mediated endoplasmic reticulum (ER)-associated degradation (ERAD) pathway for flavivirus replication in host cells. Here we report the identification of the compound Bardoxolone methyl (CDDO-me) as a potent inhibitor of the Hrd1 ubiquitin ligase-mediated ERAD, which possesses a broad-spectrum activity against both DENV and ZIKV. Cellular thermal shift assay (CETSA) suggested that CDDO-me binds to grp94, a key component of the Hrd1 pathway, at a low nanomolar concentration, whereas interaction was not detected with its paralog Hsp90. CDDO-me and the grp94 inhibitor PU-WS13 substantially suppressed DENV2 replication and the cytopathic effects caused by DENV and ZIKV infection. The antiviral activities of both compounds were demonstrated for all four DENV serotypes and four ZIKV strains in multiple human cell lines. This study defines grp94 as a crucial host factor for flavivirus replication and identified CDDO-me as a potent small molecule inhibitor of flavivirus infection. Inhibition of grp94 may contribute to the antiviral activity of CDDO-me. Further investigation of grp94 inhibitors may lead to a new class of broad-spectrum anti-flaviviral medications.
Collapse
Affiliation(s)
- Hussin A Rothan
- Center for Biomedical Engineering and Technology, Department of Physiology, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Yongwang Zhong
- Center for Biomedical Engineering and Technology, Department of Physiology, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mark A Sanborn
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Teow Chong Teoh
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Jingjing Ruan
- Center for Biomedical Engineering and Technology, Department of Physiology, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rohana Yusof
- Department of Molecular Medicine, Faculty of Science, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Jun Hang
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Mark J Henderson
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, 20850, USA
| | - Shengyun Fang
- Center for Biomedical Engineering and Technology, Department of Physiology, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| |
Collapse
|
29
|
Nunes PCG, Daumas RP, Sánchez-Arcila JC, Nogueira RMR, Horta MAP, Dos Santos FB. 30 years of fatal dengue cases in Brazil: a review. BMC Public Health 2019; 19:329. [PMID: 30898104 PMCID: PMC6429821 DOI: 10.1186/s12889-019-6641-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Over the last 30 years, extensive dengue epidemics have occurred in Brazil, characterized by emergences and re-emergences of different serotypes, a change in the epidemiological profile and an increase in the number of severe and fatal cases. Here, we present a review on the dengue fatal cases that occurred in Brazil in 30 years (1986-2015). METHODS We performed an ecological study by using secondary data on dengue fatal cases obtained in the National System of Reported Diseases (Sistema de Informação de Agravos de Notificação -SINAN) and in the Mortality Information System (SIM), both maintained by the Brazilian Ministry of Health. Cases were analyzed by region, demographic variables, clinical classification and complications based on the data available. RESULTS In 30 years (1986-2015), the Southeast region reported 43% (n = 2225) of all dengue deaths in the country. The Midwest region was responsible for 18% of the fatal cases. After 2000, deaths occurred in almost all states, with the exception of Santa Catarina and Rio Grande do Sul, South region. From 2006 to 2010, the number of deaths increased, with higher rates of mortality, especially in Goiás and Mato Grosso. From 2011 to 2015, Goiás became the state with the highest mortality rate in the country, and Rio Grande do Sul reported its first dengue deaths. In 30 years, a total of 2682 dengue deaths occurred in males and 2455 in females, and an equal distribution between the sexes was observed. From 1986 to 2006, dengue deaths occurred predominantly in individuals over 15 years old, but this scenario changed in 2007-2008. After 2009, fatal cases on individuals above 15 years old became more frequent, with peaks in the years of 2010, 2013 and 2015. CONCLUSIONS The Brazil is experiencing a hyperendemic scenario, which has resulted in the co-circulation of the four DENV serotypes and with the increasing occurrence of severe and fatal cases. The disease surveillance and studies characterizing what has been reported overtime, are still important tools to better understand the factors involved in the disease outcome.
Collapse
Affiliation(s)
- Priscila Conrado Guerra Nunes
- Viral Immunology Laboratory, Oswaldo Cruz Institute, IOC, Oswaldo Cruz Foundation, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Regina Paiva Daumas
- Clinical Epidemiology Laboratory, Evandro Chagas Clinical Research Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Juan Camilo Sánchez-Arcila
- Viral Immunology Laboratory, Oswaldo Cruz Institute, IOC, Oswaldo Cruz Foundation, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Rita Maria Ribeiro Nogueira
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute - FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Marco Aurélio Pereira Horta
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute - FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Flávia Barreto Dos Santos
- Viral Immunology Laboratory, Oswaldo Cruz Institute, IOC, Oswaldo Cruz Foundation, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil.
| |
Collapse
|
30
|
Wiemer D, Frickmann H, Krüger A. [Dengue fever : Symptoms, epidemiology, entomology, pathogen diagnosis and prevention]. Hautarzt 2019; 68:1011-1020. [PMID: 29147722 PMCID: PMC7096031 DOI: 10.1007/s00105-017-4073-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dengueinfektionen gehören zu den häufigsten Ursachen fieberhafter Erkrankungen im tropischen Umfeld. Die Infektion wird durch ein Flavivirus verursacht, das durch Aedes-Moskitos übertragen wird. Hauptüberträger für Dengueviren sind die weltweit in den Tropen verbreiteten Aedes-aegypti-Stechmücken. Da diese einerseits tagaktiv und andererseits sog. „container breeder“ sind, bedarf es besonderer Vorbeugungs- und Bekämpfungsmaßnahmen. Die Schwere der Symptomatik variiert und kann vom milden grippeähnlichen klinischen Bild bis hin zu schweren Hämorrhagien und Schock reichen. Zu den häufigsten Symptomen bei Reisenden gehören Fieber, Muskelschmerzen, Kopfschmerzen und Hautausschlag. Zur Diagnostik kommen, in Abhängigkeit vom Stadium der Infektion, patientennah einsetzbare Schnellteste oder – in der virämischen Phase – molekulare Erregerdirektnachweise infrage. Die serologische Diagnostik ist aufgrund von serologischen Kreuzreaktionen mit anderen Flaviviren hinsichtlich ihrer Interpretation anspruchsvoll.
Collapse
Affiliation(s)
- D Wiemer
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland
| | - H Frickmann
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland.
| | - A Krüger
- Fachbereich Tropenmedizin am Bernhard-Nocht Institut, Bundeswehrkrankenhaus Hamburg, Bernhard-Nocht Str. 74, 20359, Hamburg, Deutschland
| |
Collapse
|
31
|
Sabeena S, Chandrabharani K, Ravishankar N, Arunkumar G. Classification of dengue cases in Southwest India based on the WHO systems-a retrospective analysis. Trans R Soc Trop Med Hyg 2018; 112:479-485. [PMID: 30107616 DOI: 10.1093/trstmh/try080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background The WHO dengue classification 1997 was revised in 2009 and the revised classification system has now been in use for the past decade. This study was carried out to compare the 1997 and revised classifications in assessing the severity of dengue infection among all age groups during a dengue outbreak in southwest India. Methodology This retrospective cross-sectional study was carried out including serologically confirmed dengue cases. A total of 1033 dengue cases were classified on the basis of the 1997 WHO classification and 2009 revised classification. The statistical analysis was carried out using SPSS 15.0 for Windows (SPSSTM Inc, Chicago, IL, USA). Results Both the 1997 and revised WHO classifications were applied to 1033 confirmed dengue cases, including 692 males (67%) and 341 females (33%). The median age of the study participants was 23 years (IQR 10-33), including 112 (10.8%) children at and below the age of 5 years. The level of agreement between the two systems of classification was poor (kappa=0.143, 0.055-0.198, p-value <0.001). Conclusion A greater sensitivity and specificity of the revised classification was observed in comparison with the 1997 WHO classification. In the context of changing dengue epidemiology and geographical expansion, the revised classification is helpful in the identification of severe cases, facilitating timely management.
Collapse
Affiliation(s)
- Sasidharanpillai Sabeena
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Kiran Chandrabharani
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Nagaraja Ravishankar
- Department of Statistics, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Govindakarnavar Arunkumar
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
| |
Collapse
|
32
|
da Silva NS, Undurraga EA, Verro AT, Nogueira ML. Comparison between the traditional (1997) and revised (2009) WHO classifications of dengue disease: a retrospective study of 30 670 patients. Trop Med Int Health 2018; 23:1282-1293. [DOI: 10.1111/tmi.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Natal Santos da Silva
- União das Faculdades dos Grandes Lagos; São José do Rio Preto, São Paulo Brazil
- Laboratório de Modelagens Matemática e Estatística em Medicina; União das Faculdades dos Grandes Lagos; São José do Rio Preto, São Paulo Brazil
- Laboratório de Pesquisas em Virologia; Faculdade de Medicina de São José do Rio Preto; São Paulo Brazil
| | - Eduardo A. Undurraga
- Escuela de Gobierno; Pontificia Universidad Católica de Chile; Santiago Región Metropolitana Chile
| | - Alice Tobal Verro
- União das Faculdades dos Grandes Lagos; São José do Rio Preto, São Paulo Brazil
- Laboratório de Modelagens Matemática e Estatística em Medicina; União das Faculdades dos Grandes Lagos; São José do Rio Preto, São Paulo Brazil
| | - Maurício Lacerda Nogueira
- Laboratório de Pesquisas em Virologia; Faculdade de Medicina de São José do Rio Preto; São Paulo Brazil
| |
Collapse
|
33
|
Wakimoto MD, Camacho LAB, Gonin ML, Brasil P. Clinical and Laboratory Factors Associated with Severe Dengue: A Case-Control Study of Hospitalized Children. J Trop Pediatr 2018; 64:373-381. [PMID: 29059411 DOI: 10.1093/tropej/fmx078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND More than half of the hospitalizations because of dengue in Brazil occurred in children <15 years of age in 2007 and 2008, an unexpected change in the epidemiological pattern. We sought to determine clinical and laboratory parameters associated with severity. METHODS A case-control study was conducted in three pediatric hospitals in Rio de Janeiro, Brazil; 233 laboratory-confirmed dengue patients were included: 69 cases and 164 controls. Specific clinical and laboratory factors were assessed using univariate and multivariate logistic regression models. RESULTS Lethargy [adjusted odds ratio (ORa): 9.15, 95% confidence interval (CI): 3.08-27.12], dyspnea (ORa: 8.24, 95% CI: 3.27-20.72) and abdominal pain (ORa: 6.78, 95% CI: 1.44-31.84) were independently associated with severe dengue in children. Lethargy and dyspnea presented as early as 72 and 48 h, respectively, before shock. CONCLUSIONS Abdominal pain and lethargy confirmed their role as warning signs, which along with dyspnea might be helpful in identifying cases progressing to severe dengue.
Collapse
Affiliation(s)
- Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, Manguinhos, Rio de Janeiro CEP, Brasil
| | - Luiz Antonio Bastos Camacho
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Manguinhos, Rio de Janeiro CEP, Brasil
| | - Michelle Luiza Gonin
- Hospital Municipal Jesus, Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro, Rua Oito de Dezembro Vila Isabel, Rio de Janeiro CEP, Brasil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, Manguinhos, Rio de Janeiro CEP, Brasil
| |
Collapse
|
34
|
Low GKK, Gan SC, Zainal N, Naidu KD, Amin-Nordin S, Khoo CS, Ridzuan MI, Said RM, Mansor MM, Zailani MH, Chee HY, Lim SJ, Suppiah J, Appu S, Ismail I, Zin T, Te KK, Hatta NM. The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in severe dengue. Pathog Glob Health 2018; 112:334-341. [PMID: 30246621 DOI: 10.1080/20477724.2018.1516417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
This study aimed to evaluate vascular endothelial growth factor (VEGF) and pentraxin 3 (PTX-3) as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The study was conducted in Ampang Health Clinic, Ampang Hospital and Serdang Hospital. The plasma levels of VEGF and PTX-3 were compared between severe dengue and non-severe dengue by ELISA from the day of presentation until discharged. Multiple logistic regression was used to develop predictive and diagnostic models by incorporating other clinical parameters. The receiver operating characteristics (ROC) analysis was used to assess the accuracy of the biomarkers and the developed models. Eighty-two patients were recruited, 29 with severe dengue and four died. The Area Under the Curve (AUC) was statistically significant in VEGF as diagnostic marker at Day 2 and 3 of illness with sensitivity of 80.00%-100.00% and specificity of 76.47%-80.00%. The predictive model with AUC of 0.84 (p < 0.01) has a sensitivity of 100.00% and specificity of 79.25% for predicting severe dengue. The diagnostic model with AUC of 0.71 (p < 0.01) has a sensitivity of 76.19% and specificity of 73.58% for diagnosing severe dengue. The AUC for PTX-3 was not statistically significant. VEGF may be used in combination with other clinical parameters to predict the severity of the disease. As a single biomarker, it may be used as an adjunct investigation to support the diagnosis of severe dengue. PTX-3 was not able to differentiate severe dengue from non-severe dengue.
Collapse
Affiliation(s)
- Gary Kim Kuan Low
- a Department of Public Health , Torrens University Australia - Sydney Campus Pyrmont , Sydney , Australia.,b Department of Population Medicine , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| | - Seng-Chiew Gan
- c Department of Pre-Clinical Sciences , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| | - Norsafina Zainal
- d Department of Pathology, Haematology Unit , Selangor , Malaysia
| | - Komala Devi Naidu
- e Department of Anaesthesiology , Ampang Hospital , Selangor , Malaysia
| | - Syafinaz Amin-Nordin
- f Department of Medical Microbiology & Parasitology , Faculty of Medicine & Health Sciences, Universiti Putra Malaysia , Selangor , Malaysia
| | - Ching-Soong Khoo
- g Department of Medicine , Pusat Perubatan Universiti Kebangsaan Malaysia , Selangor , Malaysia
| | | | | | | | | | - Hui-Yee Chee
- f Department of Medical Microbiology & Parasitology , Faculty of Medicine & Health Sciences, Universiti Putra Malaysia , Selangor , Malaysia
| | - Sheng Jye Lim
- c Department of Pre-Clinical Sciences , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| | - Jeyanthi Suppiah
- j Virology Unit, Infectious Disease Research Centre , Institute Medical Research , Kuala Lumpur , Malaysia
| | - Santhi Appu
- d Department of Pathology, Haematology Unit , Selangor , Malaysia
| | - Izani Ismail
- d Department of Pathology, Haematology Unit , Selangor , Malaysia
| | - Thaw Zin
- c Department of Pre-Clinical Sciences , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| | - Kian Keong Te
- c Department of Pre-Clinical Sciences , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| | - Nadia Mohd Hatta
- c Department of Pre-Clinical Sciences , Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman , Selangor , Malaysia
| |
Collapse
|
35
|
Development of a Prognostic Prediction Model to Determine Severe Dengue in Children. Indian J Pediatr 2018; 85:433-439. [PMID: 29344875 DOI: 10.1007/s12098-017-2591-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop a prognostic prediction model using the seven warning signs highlighted by WHO revised Dengue fever classification 2009 to determine severe dengue in children. METHODS In this prospective analytical study conducted in a tertiary care centre, consecutive sampling of all children aged 1mo to 12y admitted with serologically confirmed Dengue was done from May 2015 through August 2016. After excluding 27 patients with co-infections and co-morbidities, 359 patients were followed up daily to assess clinical and laboratory progression till discharge/ death. Independent predictors were abdominal pain or tenderness, persistent vomiting, lethargy, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm and rising hematocrit concurrent with platelet count <100 × 109/L. Outcome measure was severe dengue defined as per WHO guidelines 2009. RESULTS Among 359 children, 93 progressed to severe dengue. In univariate analysis, significant predictors were clinical fluid accumulation (OR 4.773, p = 0.000, 95%CI 2.511-9.075), persistent vomiting (OR 1.944, p = 0.010, 95%CI 1.170-3.225), mucosal bleed (OR 2.045, p = 0.019, 95%CI 1.127-3.711) and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (OR 2.985, p = 0.000, 95%CI 1.783-4.997). The final multivariable model included clinical fluid accumulation (aOR 3.717, p = 0.000, 95%CI 1.901-7.269), hematocrit ≥0.40 concurrent with platelet count <100 × 109/L (aOR 2.252, p = 0.004, 95%CI 1.302-3.894) and persistent vomiting (p = 0.056) as predictors of severe dengue. CONCLUSIONS Among seven WHO warning signs, predictors of severe dengue as suggested by the present multivariable prediction model include clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L.
Collapse
|
36
|
Severe Dengue: Developing a Universally Applicable Simple Prediction Model. Indian J Pediatr 2018; 85:413-414. [PMID: 29637462 DOI: 10.1007/s12098-018-2668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
|
37
|
Tosepu R, Tantrakarnapa K, Nakhapakorn K, Worakhunpiset S. Climate variability and dengue hemorrhagic fever in Southeast Sulawesi Province, Indonesia. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:14944-14952. [PMID: 29549613 DOI: 10.1007/s11356-018-1528-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
To determine the association of climatic factors and dengue hemorrhagic fever and to develop the prediction approach of future dengue transmission. The study used totally monthly dengue hemorrhagic fever cases at Health Office Kendari, Southeast Sulawesi, Indonesia. Monthly meteorological data, consisting of temperature, rainfall, and humidity, was obtained from the Meteorology, Climatology and Geophysics Agency in Kendari district. All data analysis, including Spearman and Poisson distribution, was carried out in R Studio (version 3.3.2) utilizing the R statistical language version 2.15. The highest rate of dengue hemorrhagic fever cases was found in January, February, and March. Temperature averages at lag 2 (p = 0.53, p < 0.0001), lag 3 (p = 0.59, p < 0.0001), and lag 4 (p = 0.41, p < 0.01)) correlated with the incident rate of DHF. The average temperature at lag 2 was found to have a positive impact on the incidence of DHF by Poisson function. This study provides preliminary evidence of the influence of climatic factors on dengue transmission.
Collapse
Affiliation(s)
- Ramadhan Tosepu
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, Ratchathewi, 10400, Thailand
- Faculty of Public Health, University of Halu Oleo Kendari, Kendari, Indonesia
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, Ratchathewi, 10400, Thailand.
| | - Kanchana Nakhapakorn
- Faculty of Environment and Resource Studies, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand
| | - Suwalee Worakhunpiset
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, Ratchathewi, 10400, Thailand
| |
Collapse
|
38
|
Morra ME, Altibi AM, Iqtadar S, Minh LHN, Elawady SS, Hallab A, Elshafay A, Omer OA, Iraqi A, Adhikari P, Labib JH, Elhusseiny KM, Elgebaly A, Yacoub S, Huong LTM, Hirayama K, Huy NT. Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature. Rev Med Virol 2018; 28:e1979. [DOI: 10.1002/rmv.1979] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Somia Iqtadar
- Faculty of Medicine; King Edward Medical University; Lahore Pakistan
| | - Le Huu Nhat Minh
- University of Medicine and Pharmacy at Ho Chi Minh City; Ho Chi Minh City Vietnam
| | | | - Asma Hallab
- Sorbonne Universités; Université Pierre et Marie Curie (UPMC); Paris 06 France
| | | | | | | | | | | | | | | | - Sophie Yacoub
- Oxford University Clinical Research Unit; Ho Chi Minh City Vietnam
- Department of Medicine; Imperial College London; London UK
| | - Le Thi Minh Huong
- Department of Emergency Critical Care Medicine and Medical Toxicology; Tien Giang Hospital; My Tho Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, Graduate School of Biomedical Sciences; Nagasaki University; Nagasaki Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences; Ton Duc Thang University; Ho Chi Minh City Vietnam
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, Graduate School of Biomedical Sciences; Nagasaki University; Nagasaki Japan
| |
Collapse
|
39
|
Bodinayake CK, Tillekeratne LG, Nagahawatte A, Devasiri V, Kodikara Arachchi W, Strouse JJ, Sessions OM, Kurukulasooriya R, Uehara A, Howe S, Ong XM, Tan S, Chow A, Tummalapalli P, De Silva AD, Østbye T, Woods CW, Gubler DJ, Reller ME. Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic. PLoS Negl Trop Dis 2018; 12:e0006258. [PMID: 29425194 PMCID: PMC5823472 DOI: 10.1371/journal.pntd.0006258] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/22/2018] [Accepted: 01/22/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. METHODOLOGY/PRINCIPAL FINDINGS The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians' subjective clinical diagnosis (gestalt clinical impression) in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness. We confirmed acute dengue in 388 patients (305 adults ≥ 18 years and 83 children), including 103 primary and 245 secondary cases, of 976 patients prospectively enrolled with AFI. At presentation, both adults and children with acute dengue were more likely than those with other AFI to have leukopenia and thrombocytopenia. Additionally, adults were more likely than those with other AFI to have joint pain, higher temperatures, and absence of crackles on examination whereas children with dengue were more likely than others to have sore throat, fatigue, oliguria, and elevated hematocrit and transaminases. Similarly, presence of joint pain, thrombocytopenia, and absence of cough were independently associated with secondary vs primary dengue in adults whereas no variables were different in children. The 2009 WHO dengue classification was more sensitive than physicians' clinical diagnosis for identification of acute dengue (71.5% vs 67.1%), but was less specific. However, despite the absence of on-site diagnostic confirmation of dengue, clinical diagnosis was more sensitive on discharge (75.2%). The 2009 WHO criteria classified almost 75% as having warning signs, even though only 9 (2.3%) patients had evidence of plasma leakage and 16 (4.1%) had evidence of bleeding. CONCLUSIONS/SIGNIFICANCE In a large cohort with AFI, we identified features predictive of dengue vs other AFI and secondary vs primary dengue in adults versus children. The 2009 WHO dengue classification criteria had high sensitivity but low specificity compared to physicians' gestaldt diagnosis. Large cohort studies will be needed to validate the diagnostic yield of clinical impression and specific features for dengue relative to the 2009 WHO classification criteria.
Collapse
Affiliation(s)
| | - L. Gayani Tillekeratne
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Vasantha Devasiri
- Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | - John J. Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | | | - Ruvini Kurukulasooriya
- Duke Ruhuna Collaborative Research Center, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Anna Uehara
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Shiqin Howe
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Xin Mei Ong
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Sharon Tan
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Angelia Chow
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | | | | | - Truls Østbye
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Christopher W. Woods
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Hubert-Yeargan Center for Global Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Duane J. Gubler
- Duke Global Health Institute, Durham, NC, United States of America
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Megan E. Reller
- Hubert-Yeargan Center for Global Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| |
Collapse
|
40
|
Olliaro P, Fouque F, Kroeger A, Bowman L, Velayudhan R, Santelli AC, Garcia D, Skewes Ramm R, Sulaiman LH, Tejeda GS, Morales FC, Gozzer E, Garrido CB, Quang LC, Gutierrez G, Yadon ZE, Runge-Ranzinger S. Improved tools and strategies for the prevention and control of arboviral diseases: A research-to-policy forum. PLoS Negl Trop Dis 2018; 12:e0005967. [PMID: 29389959 PMCID: PMC5794069 DOI: 10.1371/journal.pntd.0005967] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research has been conducted on interventions to control dengue transmission and respond to outbreaks. A summary of the available evidence will help inform disease control policy decisions and research directions, both for dengue and, more broadly, for all Aedes-borne arboviral diseases. METHOD A research-to-policy forum was convened by TDR, the Special Programme for Research and Training in Tropical Diseases, with researchers and representatives from ministries of health, in order to review research findings and discuss their implications for policy and research. RESULTS The participants reviewed findings of research supported by TDR and others. Surveillance and early outbreak warning. Systematic reviews and country studies identify the critical characteristics that an alert system should have to document trends reliably and trigger timely responses (i.e., early enough to prevent the epidemic spread of the virus) to dengue outbreaks. A range of variables that, according to the literature, either indicate risk of forthcoming dengue transmission or predict dengue outbreaks were tested and some of them could be successfully applied in an Early Warning and Response System (EWARS). Entomological surveillance and vector management. A summary of the published literature shows that controlling Aedes vectors requires complex interventions and points to the need for more rigorous, standardised study designs, with disease reduction as the primary outcome to be measured. House screening and targeted vector interventions are promising vector management approaches. Sampling vector populations, both for surveillance purposes and evaluation of control activities, is usually conducted in an unsystematic way, limiting the potentials of entomological surveillance for outbreak prediction. Combining outbreak alert and improved approaches of vector management will help to overcome the present uncertainties about major risk groups or areas where outbreak response should be initiated and where resources for vector management should be allocated during the interepidemic period. CONCLUSIONS The Forum concluded that the evidence collected can inform policy decisions, but also that important research gaps have yet to be filled.
Collapse
Affiliation(s)
- Piero Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Florence Fouque
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Axel Kroeger
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
- Global Health Department, Centre for Medicine and Society/Anthropology, Freiburg University, Freiburg im Breisgau, Germany
| | - Leigh Bowman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases (WHO/NTD), World Health Organization, Geneva, Switzerland
| | | | - Diego Garcia
- Department of Communicable Diseases, Ministry of Health, Bogota, Colombia
| | - Ronald Skewes Ramm
- Program for the Prevention and Control of Dengue, Ministry of Health, Santo Domingo, Dominican Republic
| | | | - Gustavo Sanchez Tejeda
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE), Ministry of Health, Mexico City, Mexico
| | - Fabiàn Correa Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE), Ministry of Health, Mexico City, Mexico
| | | | | | - Luong Chan Quang
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Gamaliel Gutierrez
- PAHO/AMRO, World Health Organization, Washington, DC, United States of America
| | - Zaida E. Yadon
- PAHO/AMRO, World Health Organization, Rio de Janeiro, Brazil
| | | |
Collapse
|
41
|
Adrizain R, Setiabudi D, Chairulfatah A. Hospital-based Surveillance: Accuracy, Adequacy, and Timeliness of Dengue Case Report in Bandung, West Java, Indonesia of 2015. J Glob Infect Dis 2018; 10:201-205. [PMID: 30581261 PMCID: PMC6276323 DOI: 10.4103/jgid.jgid_108_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Context: Dengue fever (DF) altogether with its severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome, has become public health concerns. Indonesia belongs to category A of endemicity for DF/DHF. One of the several efforts to control dengue virus infection in Indonesia is a passive surveillance called “Dengue Case Surveillance.” Timeliness report defined as a report sent within 24 h after the clinical diagnosis is needed to have a proper surveillance. The study on the evaluation of dengue case report in terms of accuracy, adequacy, and timeliness in Indonesia is still limited. Aims: The aim of this study was to identify the accuracy, adequacy, and timeliness from the reports of dengue viral infection (DVI) cases admitted from January 1 to December 31, 2015 to 7 major hospitals in Bandung, West Java, Indonesia. Settings and Design: This was a retrospective analysis study. Materials and Methods: To evaluate the accuracy, all medical records of DVI patients were reviewed epidemiologically, clinically, and laboratory using a standardized questionnaire. To evaluate the adequacy, hospital data were compared with reported data in Bandung Municipality Health Authority. To evaluate the timeliness of report, interview to the person in charge for dengue reporting cases in each hospital and in Bandung Municipality Health Authority were performed. Statistical Analysis Used: Univariate analysis was used for statistical analysis. Results: A total of 4096 (72%) of 5712 hospitalized DVI cases lived in Bandung Municipality. The accuracy of the clinical diagnosis was 3397 out of 4096 cases (82.9%). The adequacy of the accurate cases was 1553 out of 3397 cases (45.7%). Conclusions: The timeliness of report was varied, ranging from days to month. The accuracy of dengue cases was good, but the adequacy and timely reporting should be strengthened.
Collapse
Affiliation(s)
- Riyadi Adrizain
- Department of Child Health, Hasan Sadikin General Hospital/Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Djatnika Setiabudi
- Department of Child Health, Hasan Sadikin General Hospital/Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Alex Chairulfatah
- Department of Child Health, Hasan Sadikin General Hospital/Universitas Padjadjaran, Bandung, West Java, Indonesia
| |
Collapse
|
42
|
Symptoms associated with adverse dengue fever prognoses at the time of reporting in the 2015 dengue outbreak in Taiwan. PLoS Negl Trop Dis 2017; 11:e0006091. [PMID: 29211743 PMCID: PMC5718413 DOI: 10.1371/journal.pntd.0006091] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/01/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tainan experienced the most severe dengue epidemic in Taiwan in 2015. This study investigates the association between the signs and symptoms at the time of reporting with the adverse dengue prognoses. METHODS A descriptive study was conducted using secondary data from the Dengue Disease Reporting System in Tainan, Taiwan, between January 1 and December 31, 2015. A multivariate stepwise logistic regression was used to identify the risk factors for the adverse prognoses: ICU admissions and mortality. RESULTS There were 22,777 laboratory-confirmed reported cases (mean age 45.6 ± 21.2 years), of which 3.7% were admitted to intensive care units (ICU), and 0.8% were fatal. The most common symptoms were fever (92.8%), myalgia (26.6%), and headache (22.4%). The prevalence of respiratory distress, altered consciousness, shock, bleeding, and thrombocytopenia increased with age. The multivariate analysis indicated that being in 65-89 years old age group [Adjusted Odds Ratio (aOR):4.95], or the 90 years old and above age group (aOR: 9.06), and presenting with shock (aOR: 8.90) and respiratory distress (aOR: 5.31) were significantly associated with the risk of ICU admission. While old age (aOR: 1.11), respiratory distress (aOR: 9.66), altered consciousness (aOR: 7.06), and thrombocytopenia (aOR: 2.55) were significantly associated with the risk of mortality. CONCLUSIONS Dengue patients older than 65 and those with severe and non-specific signs and symptoms at the time of reporting were at a higher risk of ICU admission and mortality. First-line healthcare providers need to be aware of the varied presentations between the different age groups to allow early diagnosis and in-time management, which would prevent ICU admissions and fatalities in dengue patients.
Collapse
|
43
|
Jain S, Mittal A, Sharma SK, Upadhyay AD, Pandey RM, Sinha S, Soneja M, Biswas A, Jadon RS, Kakade MB, Dayaraj C. Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India. Open Forum Infect Dis 2017; 4:ofx056. [PMID: 28491893 PMCID: PMC5419201 DOI: 10.1093/ofid/ofx056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/12/2017] [Indexed: 12/17/2022] Open
Abstract
Background There is lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak in India. Methods This prospective observational study included confirmed adult dengue patients hospitalized between August and November 2015 in a tertiary care centre in New Delhi, India. Appropriate statistical tests were used to compare clinicolaboratory characteristics, derive predictors of severe disease and mortality, and compute a predictive score for mortality. Serotyping was done. Results Data of 369 patients were analyzed (mean age, 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (grade 1 or 2), and 46 (12%) developed dengue shock syndrome (DSS). Twenty-two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnea at rest were identified as independent predictors of severe disease. Age ≥24 years, dyspnea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnea), which, if ≥22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were dengue virus DENV2 and DENV4. Conclusion Age ≥24 years, dyspnea at rest, and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine outcome in dengue patients. Timely referral/access to healthcare is important. The clinical risk score for mortality prediction that was developed in this study can be used in all healthcare settings, after validation in larger cohorts.
Collapse
|
44
|
Das S, Sarfraz A, Jaiswal N, Das P. Impediments of reporting dengue cases in India. J Infect Public Health 2017; 10:494-498. [PMID: 28262571 DOI: 10.1016/j.jiph.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 01/02/2017] [Accepted: 02/04/2017] [Indexed: 10/20/2022] Open
Abstract
Dengue has emerged as one of the most important mosquito-borne, fatal flaviviral disease, apparently expanding as a global health problem. An estimated 3.6 billion people are at risk for dengue, with 50 million infections per year occurring across 100 countries globally. The annual number of dengue fever cases in India is many times higher than it is officially reported. This under reporting would play a major role in the government's decision-making. Underestimating of the disease in India encumbers its people from taking preventive measures, discourages efforts to ensnare the sources of the disease and deliberates efforts for vaccine research. In this article, we highlight the probable impediments of under reporting leading to its impact on national and global public health and also offer key remedies to effectively address the issues across the clinics to the community level.
Collapse
Affiliation(s)
- Sushmita Das
- Department of Microbiology, All-India Institute of Medical Sciences (AIIMS), Patna, India.
| | - Asim Sarfraz
- Department of Microbiology, All-India Institute of Medical Sciences (AIIMS), Patna, India
| | - Nitesh Jaiswal
- Department of Microbiology, All-India Institute of Medical Sciences (AIIMS), Patna, India
| | - Pradeep Das
- Virology Unit, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| |
Collapse
|
45
|
Patterson J, Sammon M, Garg M. Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World. West J Emerg Med 2016; 17:671-679. [PMID: 27833670 PMCID: PMC5102589 DOI: 10.5811/westjem.2016.9.30904] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/19/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022] Open
Abstract
The arboviruses that cause dengue, chikungunya, and Zika illnesses have rapidly expanded across the globe in recent years, with large-scale outbreaks occurring in Western Hemisphere territories in close proximity to the United States (U.S.). In March 2016, the Centers for Disease Control and Protection (CDC) expanded its vector surveillance maps for A. aegypti and A. albopictus, the mosquito vectors for these arboviruses. They have now been shown to inhabit a larger portion of the U.S., including the heavily populated northeast corridor. Emergency physicians need to further familiarize themselves with these diseases, which have classically been considered only in returning travelers but may soon be encountered in the U.S. even in the absence of travel. In this paper, we discuss the presentation and treatment of dengue, Zika, and chikungunya, as well as special challenges presented to the emergency physician in evaluating a patient with a suspected arbovirus infection.
Collapse
Affiliation(s)
- Jessica Patterson
- Temple University Hospital and School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Maura Sammon
- Temple University Hospital and School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Manish Garg
- Temple University Hospital and School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
46
|
Abstract
INTRODUCTION Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.
Collapse
Affiliation(s)
- Tau Hong Lee
- a Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore
| | - Linda Kay Lee
- a Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore
| | - David Chien Lye
- a Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore.,b Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.,c Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore , Singapore
| | - Yee Sin Leo
- a Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore.,b Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.,c Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore , Singapore.,d Saw Swee Hock School of Public Health , National University of Singapore , Singapore , Singapore
| |
Collapse
|
47
|
Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014. PLoS Negl Trop Dis 2016; 10:e0005050. [PMID: 27780199 PMCID: PMC5079576 DOI: 10.1371/journal.pntd.0005050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022] Open
Abstract
In cases of Dengue fever, late hospital admission can lead to treatment delay and even death. In order to improve early disease notification and management, it is essential to investigate the factors affecting the time of admission of Dengue cases. This study determined the factors associated with the time of admission among notified Dengue cases. The study covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue classification, and period of admission (distinguishing between the 2010 Dengue epidemic and non-epidemic time). We analysed secondary data from the surveillance of notified Dengue cases. We calculated the association through chi-square test, ordinal logistic regression and linear regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted cases during this period. Late admission was more likely among adults than children (p<0.05). The severe type of the disease was more likely to be admitted late than the mild type (p<0.05). Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals and public hospitals when admitted late (p<0.05). Data suggests that early admission among child cases was common in Region VIII. This behavior is encouraging, and should be continued. However, further study is needed on the late admission among tertiary, public hospitals and non-epidemic period with reference to the quality of care, patient volume, out of pocket expense, and accessibility We recommend the consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria and time across hospitals. A variety of factors affect the time of admission of Dengue fever cases. These must be investigated, as delayed treatment of this disease can result in death. The authors of this study determined the factors associated with the time of admission among notified Dengue cases of Region VIII, Philippines, from 2008 to 2014. The factors assessed were age and sex of the patient, hospital sector, hospital level, disease severity and the presence of Dengue epidemic. A secondary surveillance data of Dengue was used. The associations were determined using chi-square test and regression. Late admission was more likely amongst adults, severe cases of the disease, public hospitals, tertiary level hospitals, and during the non-epidemic period. In comparison, early admission was more likely in cases concerning children, mild cases of the disease, private hospitals, non-tertiary hospitals and during an epidemic period. Case fatality was significantly associated to children, severe diseases, public hospitals and tertiary hospitals when admitted late. The routine early admission of children should be promoted, as severe cases of Dengue fever are more likely among children. Consistent admission criteria for Dengue should be implemented across all hospital sectors and levels.
Collapse
|
48
|
Sicuro Correa L, Hökerberg YHM, de Oliveira RDVC, Barros DMDS, Alexandria HAF, Daumas RP, de Andrade CAF, Passos SRL, Brasil P. Use of Warning Signs for Dengue by Pediatric Health Care Staff in Brazil. PLoS One 2016; 11:e0163946. [PMID: 27716812 PMCID: PMC5055364 DOI: 10.1371/journal.pone.0163946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. METHODS Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05). RESULTS The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care. DISCUSSION Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding.
Collapse
Affiliation(s)
- Luana Sicuro Correa
- Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
- School of Medicine, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Yara Hahr Marques Hökerberg
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- School of Medicine, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Regina Paiva Daumas
- Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brasil
| | - Carlos Augusto Ferreira de Andrade
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sonia Regina Lambert Passos
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
49
|
Runge-Ranzinger S, Kroeger A, Olliaro P, McCall PJ, Sánchez Tejeda G, Lloyd LS, Hakim L, Bowman LR, Horstick O, Coelho G. Dengue Contingency Planning: From Research to Policy and Practice. PLoS Negl Trop Dis 2016; 10:e0004916. [PMID: 27653786 PMCID: PMC5031449 DOI: 10.1371/journal.pntd.0004916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. METHODOLOGY/PRINCIPAL FINDINGS Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. CONCLUSIONS/SIGNIFICANCE Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan.
Collapse
Affiliation(s)
- Silvia Runge-Ranzinger
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Axel Kroeger
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Piero Olliaro
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Philip J. McCall
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Linda S. Lloyd
- Public Health Consultant, San Diego, California, United States of America
| | | | - Leigh R. Bowman
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Olaf Horstick
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
50
|
Thanachartwet V, Desakorn V, Sahassananda D, Jittmittraphap A, Oer-areemitr N, Osothsomboon S, Surabotsophon M, Wattanathum A. Serum Procalcitonin and Peripheral Venous Lactate for Predicting Dengue Shock and/or Organ Failure: A Prospective Observational Study. PLoS Negl Trop Dis 2016; 10:e0004961. [PMID: 27564863 PMCID: PMC5001649 DOI: 10.1371/journal.pntd.0004961] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/08/2016] [Indexed: 01/11/2023] Open
Abstract
Background Currently, there are no biomarkers that can predict the incidence of dengue shock and/or organ failure, although the early identification of risk factors is important in determining appropriate management to reduce mortality. Therefore, we sought to determine the factors associated with dengue shock and/or organ failure and to evaluate the prognostic value of serum procalcitonin (PCT) and peripheral venous lactate (PVL) levels as biomarkers of dengue shock and/or organ failure. Methodology/Principal Findings A prospective observational study was conducted among adults hospitalized for confirmed viral dengue infection at the Hospital for Tropical Diseases in Bangkok, Thailand between October 2013 and July 2015. Data, including baseline characteristics, clinical parameters, laboratory findings, serum PCT and PVL levels, management, and outcomes, were recorded on pre-defined case report forms. Of 160 patients with dengue, 128 (80.0%) patients had dengue without shock or organ failure, whereas 32 (20.0%) patients developed dengue with shock and/or organ failure. Using a stepwise multivariate logistic regression analysis, PCT ≥0.7 ng/mL (odds ratio [OR]: 4.80; 95% confidence interval [CI]: 1.60–14.45; p = 0.005) and PVL ≥2.5 mmol/L (OR: 27.99, 95% CI: 8.47–92.53; p <0.001) were independently associated with dengue shock and/or organ failure. A combination of PCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L provided good prognostic value for predicting dengue shock and/or organ failure, with an area under the receiver operating characteristics curve of 0.83 (95% CI: 0.74–0.92), a sensitivity of 81.2% (95% CI: 63.6–92.8%), and a specificity of 84.4% (95% CI: 76.9–90.2%). Dengue shock patients with non-clearance of PCT and PVL expired during hospitalization. Conclusions/Significance PCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L were independently associated with dengue shock and/or organ failure. The combination of PCT and PVL levels could be used as prognostic biomarkers for the prediction of dengue shock and/or organ failure. Dengue is a major global health concern, particularly in tropical countries, and affects all age groups. Mortality rates among patients who have been hospitalized with severe dengue are 1.6–10.9%, and death in adults is mainly due to the development of dengue shock and organ dysfunction. In states of poor tissue circulation or shock, lactate is produced. Additionally, procalcitonin is a highly specific biomarker of systemic inflammation. Therefore, we assessed whether procalcitonin and peripheral venous lactate could be used to predict the incidence of dengue shock and/or organ failure in patients with dengue. Our study showed that a combination of serum procalcitonin levels ≥0.7 ng/mL and peripheral venous lactate levels ≥2.5 mmol/L at admission could discriminate between patients who did and did not develop shock and/or organ failure, with high sensitivity and specificity. These parameters may therefore be useful as prognostic biomarkers. Our results suggest that serum procalcitonin is indicative of an extensive early inflammatory response, which may occur during the systemic phase of dengue. Peripheral venous lactate may be produced as a result of the poor tissue circulation that precedes dengue shock. Our findings may help clinicians to predict dengue shock and/or organ failure earlier to reduce in-hospital mortality.
Collapse
Affiliation(s)
- Vipa Thanachartwet
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Varunee Desakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Duangjai Sahassananda
- Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Akanitt Jittmittraphap
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nittha Oer-areemitr
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Sathaporn Osothsomboon
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Manoon Surabotsophon
- Pulmonary and Critical Care Division, Department of Medicine, Ramkhamhaeng Hospital, Bangkok, Thailand
| | - Anan Wattanathum
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
- * E-mail:
| |
Collapse
|