Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children

Lovera, Dolores; Cuéllar, Celia Martínez de; Araya, Soraya; Amarilla, Sara; Gónzalez, Nicolás; Aguiar, Carlos; Acuña, Julia; Arbo, Antonio

doi:10.1097/inf.0000000000001308

Cited by 25 publications

(40 citation statements)

References 39 publications

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“…Several previous studies noted different cut-off platelet counts to predict the development of shock. 12,13 We found a significant correlation with development of severe dengue using a platelet count cut-off of ≤ 125,000/μL. This cut-off was not as low as in previous studies, 3,17 and, moreover, did not fulfill the minimum WHO diagnostic criteria (i.e., < 100,000/μL), but it could be considered as a sensitive predictor for severe dengue.…”

Section: Discussioncontrasting

confidence: 44%

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Yolanda

Alfan

2017

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Background. In dengue infection, it is difficult to differentiate mild and severe dengue prior to its critical phase. Ability to identify risk factors for severe dengue form patients’ initial presentation would help decrease the need of hospitalization, increase physicians’ awareness, and improve outcome.Objective. To predict pediatric dengue infection severity based on initial patient characteristics, routine clinical and laboratory profiles. Methods. This was a cross-sectional study based on medical records of children with dengue infection in Atma Jaya Hospital, Jakarta. Inclusion criteria were children aged 1 – 18 years old with proven dengue infection, hospitalized in Atma Jaya Hospital during January – December 2016. Clinical profiles and laboratory parameters at the time of patient presentation were extracted and analyzed in relationship with dengue severity. Result. Data collected was 110 patients with mean age 9.5 years old. Initial clinical profiles that significantly related to severe dengue were: age ≤5 years old (OR = 0.113, p = 0.001), hepatomegaly (OR = 2.643, p = 0.035), pleural effusion (OR = 9.545, p = 0.000), platelet ≤125,000/uL (OR = 0.201, p = 0.025), hyponatremia (OR = 10.139, p = 0.000) and AST >135 u/L (OR = 5.112, p = 0.014). Gender, duration of fever, additional symptoms, spontaneous bleeding, blood pressure, pulse pressure, hematocrit, leucocyte, random blood glucose, calcium, and ALT were not related significantly to dengue severity.Conclusion. Physician should be cautious in pediatric dengue patients presented in age younger than 5 years old, with hepatomegaly and/or pleural effusion, platelet below 125,000/uL, hyponatremia, and AST more than three times upper normal limit. These patients have higher risk of severe dengue than patients without those findings.

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Section: Discussioncontrasting

confidence: 44%

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Yolanda

Alfan

2017

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“…The nonsevere dengue group was divided into patients with and without warning signs. Cases of dengue with warning signs included the following symptoms and/or signs: abdominal pain, persistent vomiting, oral intolerance, clinical accumulation of fluid, bleeding of mucous membranes, lethargy/restlessness, precordial pain, hepatomegaly or laboratory data, such as thrombocytopenia (platelets less than 100,000/mm 3 ), and hemoconcentration, documented by the hematocrit increased up to 20% or more [18]. Only cases of dengue with warning signs or severe criteria were hospitalized.…”

Section: Definitionsmentioning

confidence: 99%

Clinical manifestations of primary and secondary dengue in Paraguay and its relation to virus serotype

Lovera

Martínez-Cuellar

et al. 2019

J Infect Dev Ctries

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Introduction: Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity. Methodology: We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1). Results: Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05). Conclusions: The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.

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“…Las investigaciones realizadas tanto en el país como a nivel internacional han sido principalmente enfoca- (7,8) das en pacientes hospitalizados . De ahí el objetivo del presente estudio fue describir las características clínicas y laboratoriales de los pacientes con dengue que no han requerido hospitalización.…”

Section: Introductionunclassified

Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue

Perrota

Araya

Lovera

et al. 2020

Pediatr (Asunción).

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Introducción: La fiebre dengue (FD) ha representado en nuestro país una de las causas más frecuentes de consulta en la última década. Objetivos: Describir las características clínicas y de laboratorio de los pacientes con dengue observados en la unidad de atención ambulatoria de un centro de referencia. Materiales y Métodos: Se incluyeron todos los casos de dengue en pacientes menores de 20 años asistidos en la unidad de consulta ambulatoria del Instituto de Medicina Tropical, en el período entre noviembre de 2015 y marzo 2016. En función a una base estructurada de colección de datos, se analizaron las características demográficas, clínicas y de laboratorio. Resultados: Se incluyeron 1491 casos de dengue. La edad media fue de 12±5 años, correspondiendo 58 casos (4%) al grupo etario <2 años, 438 (29%) al grupo >2-9 años y 995 (67%) al grupo >9 años (p<0.01). La distribución de sexo fue similar (fem/masc 1.04:1). Presentaron fiebre los 1491 pacientes (100%). La cefalea, mialgias y artralgias se observaron mas frecuentemente en los pacientes >9 años, constatándose en el 79%, 60% y 55% de los casos (p<0,01 comprado con otros grupos etarios). En cambio, el exantema fue más frecuente en los menores de 2 años (36%) (p<0,01 al comparar con los niños mayores de 2 años). Laboratorialmente la frecuencia de leucopenia fue mayor en los mayores de 2 años (72% en el grupo de 2-9 años y 81% en los >9 años) al compáralos con los menores de 2 años (p<0,01). La detección del antígeno no estructural NS1 del dengue se observó en la mayoría de los casos (84%). Conclusiones: El grupo etario predominante que consulta por dengue es el de los niños >9 años. Se identificaron variables clínicas (exantema más frecuente en lactantes y algias en niños >9 años) y laboratoriales (citopenias poco frecuentes en lactantes) que dependen del grupo etario. La sensibilidad de la antigenemia ha sido excelente y similar en los grupos etarios. Conflicto de interés: Los autores declaran no poseer conflicto de interés Recibido: 22/11/2019 Aceptado: 5/02/2020

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Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children

Abstract: This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.

Cited by 25 publications

References 39 publications

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Initial clinical and laboratory profiles to predict pediatric dengue infection severity

Clinical manifestations of primary and secondary dengue in Paraguay and its relation to virus serotype

Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue

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