Background Clinical and biochemical impacts on liver

Background Clinical and biochemical impacts on liverdysfunction, as manifested by an increase in serum transaminaselevels, are common in dengue infection. Howevei; an association ofelevated serum transaminase and dengue shock syndrome (DSS)has n ot been well-established.Objective To assess for an association between serum transaminaselevels and the presence of DSS in children.Methods A nested, case control study was conducted on childrenaged l month to 12 years admitted to Sanglah Hospital whowere diagnosed with dengue infection. Baseline characteristicsand serum transaminase levels were recorded. Patients who wereincluded in the study were observed for the presence of DSS.Those who had DSS were selected as cases, and those who did notdevelop DSS were selected as controls. Data was analyzed usingbivariate and multivariate methods with 95% confidence intervalsand P value <0.05 was considered as statistically significant.Results Ninety-four children were involeved, 4 7 children in thecase group and the other 4 7 were in the control group. Baselinecharacteristics of the subjects were similar between the case andcontrol groups. Serum aspart ate transaminase (AST) level of2:: 128 U/L and alanine transaminase (ALT) of 2: 40 U/L wereassociated with DSS (OR 10; 95%CI 2.3 to 44.4; P=0.002) and(OR 7 .3; 95%CI 1.6 to 32.9; P= 0.009), respectively.Conclusion Elevated AST and ALT levels were associatedwith an increased risk of DSS in children with dengue infection.

Background The determination of primary or secondary dengueinfection using hemagglutination inhibition (HI) test is time-con-suming. The IgG to IgM ratio which can be obtained earlier wasused by several studies to differentiate secondary from primaryinfection, but they still reported various cut-off points.Objective To find the diagnostic value and best cut off point ofIgG to IgM ratio for predicting secondary dengue infection.Methods This was a prospective study carried out between July2003 and June 2004. Children with suspected dengue hemor-rhagic fever (DHF) were tested for HI during acute and convales-cent phase. The IgG and IgM titer were examined during the acutephase using ELISA method.Results Sixty-two children were recruited, 48 with secondary in-fection and 14 with primary infection. The prevalence of second-ary infection was 77%. The best cut off point of the IgG to IgM ratioto predict secondary infection was >1.1 with sensitivity of 87.5%,specificity 92.9%, likelihood ratio 12.3, and post test probability97.7%.Conclusion The IgG to IgM ratio of >1.1 is a good predictor forsecondary infection

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