In a prospective study, the relationship between the clinical severity of dengue haemorrhagic fever (DHF) and the sonographic findings was examined. The study comprised 73 cases classified as mild (grades I-II) and 75 as severe (grades III-IV). Ultrasonography in the mild group revealed pleural effusions in 30%, ascites in 34%, gallbladder wall thickening in 32%, hepatomegaly in 49%, splenomegaly in 16%, and pancreatic enlargement in 14%. In the severe group, pleural effusions, ascites and gallbladder wall thickening were found in 95%, pararenal and perirenal fluid collections in 77%, hepatic and splenic subcapsular fluid collections in 9%, pericardial effusion in 8%, hepatomegaly in 56%, splenomegaly in 16%, and pancreatic gland enlargement in 44%. Ultrasound may be useful for early prediction of the severity of DHF in children.

A two-year study using a cluster investigation method was conducted in West Jakarta, Indonesia to demonstrate the detection of dengue cases prior to onset of clinical illness. The clusters consisted of family members and neighbors of 53 hospitalized dengue index cases. Among 785 adult and child volunteers enrolled, 17 (2.2%) post-enrollment dengue (PED) infections were identified. Eight PED cases were asymptomatic and nine were symptomatic. Symptomatic cases included eight with dengue fever and one with dengue hemorrhagic fever (DHF) (grade II). Among the eight asymptomatic PED cases, viremia was detected in two. Eleven volunteers had acute dengue infections at the time of enrollment. Four of the 11 developed DHF, resulting in a total of five DHF cases detected during the investigation. This study design can serve as a benchmark for future investigations that seek to define early immunologic events following dengue infections that contribute to the development of DHF.

This study attempts to investigate whether gallbladder wall thickening (GBWT) measured by ultrasonography can be used in children as a reliable criterion to predict the onset of severe dengue hemorrhage fever (DHF). In this prospective study, we performed ultrasound examinations focusing on the gallbladder wall and the presence of intraperitoneal free fluid in 48 mild DHF cases (grades I-II) and 48 severe cases (grades III-IV). GBWT varied between 1 mm and 8 mm with a mean of 3.77 mm +/- 2.04 mm. The mean value of DHF grades I and II (2.39 mm +/- 1.48 mm) is significantly lower than that of grades III and IV (5.14 mm +/- 1.54 mm), p < 0.001. GBWT exceeded 3 mm in only 16 of 48 (33.3%) grade I-II patients and in 45 of 48 (93.8%) grade III-IV patients. A significant positive correlation was apparent between GBWT and the severity of illness, p < 0.001. Patients with ascites have significantly thicker gallbladder walls than those without, p < 0.01. In clinically confirmed DHF cases, the sonographic finding of GBWT > 3 mm to 5 mm, with 93.8% sensitivity, can be used as a criterion indicating the need for admission and monitoring. A GBWT of > or = 5 mm, with 91.7% specificity, is useful as a criterion for identifying DHF patients at high risk of developing hypovolemic shock.

Purpose This study reports the sonographic features of the pancreas in children who have dengue hemorrhagic fever (DHF) with epigastric pain, evaluates pancreatic abnormalities as the source of this pain, and relates sonographic findings, DHF status, and serum levels of amylase and lipase. Methods Over 3.5 years, real‐time sonographic examination of the pancreas was prospectively performed in 148 children (age range, 5 months–14 years) who had DHF with epigastric pain. The DHF diagnosis was confirmed by serologic examination and viral isolation. Results Of the 142 children included in this study, 72 had mild DHF (grade I or II) and 70 had severe DHF (grade III or IV). An enlarged pancreas was found in 41 patients (29%), 10 (14%) of whom had mild DHF and 31 (44%) of whom had severe DHF. The pancreas was hyperechoic relative to the liver in 36 patients (25%), isoechoic in 98 (69%), and hypoechoic in 8 (6%). Conclusions The majority of patients with DHF and epigastric pain do not have an enlarged pancreas, different echogenicity of the pancreas compared with the liver, or a dilated pancreatic duct. Thus, pathologic changes of the pancreas cannot be the only cause of epigastric pain in DHF patients. Increased serum levels of amylase and lipase are commonly seen in patients with severe DHF and an enlarged pancreas. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:257–259, 1998.

Starting from September 1987, a one year prospective study on lgM and lgG in dengue hemorrhagic fever, was carried out at the Department of Pediatrics, Sumber War as Hospital West Jakarta. This report describes the preliminary finding of the study from September 1987 through June 1988. Virus isolation and serologic analysis (HI, lgG and lgM capture ELISA) for DHF were done by NAMRU 2 in Jakarta. The subjects were 151 virologically confirmed DHF patients consisting of 82 boys and 69 girls of 6 months - 15 years old. Serum samples were collected: (I) on the day of admission; (II) on the day of discharge and (Ill) 2 weeks after the first samples. Serum samples I, II, and Ill were collected from respectively 151, 131 and 64 subjects on respectively 3.5 ± 1.7; 8.8 ± 2.7 and 16.8 ± 2.1 days of illness. Positive lgM titer from acute sera was observed in 20% of subjects. A positive correlation between HI -lgM and HI -lgG was also observed. The percentage of positive lgM titers rose with the increase of HI titer, the percentage of positive lgG titer was lower than that of /gM but a sudden increase exceeding that of lgM was observed at the HI liter of 320 and more. This study revealed that HI titer of640 and 1280 were indicators for the primary and secondary dengue infection respectively and lgM capture ELISA can be used as a reliable predictor for DHF even more in fatal cases where only single serum is available.