Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract

Introduction:The dengue classifi cation proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classifi cation proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classifi cation to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classifi cation to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. Methods: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confi rmed to have dengue based on the fi ndings of laboratory examinations. Results: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classifi cation, 9.1% (11/121) of the cases were classifi ed as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classifi ed as dengue with complications. According to the 2009 classifi cation, 100% (121/121) of the cases were classifi ed as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm 3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. Conclusions: The WHO 2009 classifi cation is more sensitive than the WHO 1997 classifi cation for identifying dengue deaths among autopsied individuals suspected of having dengue.

Atypical complication in an adult patient with dengue and autoimmune hemolytic anemia: a case report

“…Severe bleeding can lead to systemic shock via disseminated intravascular coagulopathy. The mortality rate of those with severe dengue infection is 22.6% with severe bleeding, and 19.8% for those with severe plasma leakage [ 5 ]. Multiple blood transfusions used as replacement therapy for patients with severe bleeding may ultimately lead to volume overload [ 3 ].…”

Molecular and clinical epidemiological surveillance of dengue virus in Paraíba, Northeast Brazil

“…However, data on comorbidities are not included in the SINAN, and can only be obtained through investigation of fatal dengue cases [33][34][35][36] .…”

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil

“…6 Au to p s i e s p e r fo rm e d by t h e D ea t h Verif ication Service (Serviço de Verif icação de Óbito -SVO) of the Ceará State Health Department contributed to greater detection of deaths due to dengue, being one of the largest sources of notification of suspected deaths due to dengue in 2011-2012 and chikungunya in 2016-2017 in its territory. [7][8][9][10] However, refusal to authorize autopsies is considerable, due to lack of information, prejudice or pressure from burial services. 11,12 Therefore, there is greater need to use safer and less invasive techniques to obtain organ samples for post-mortem analysis, potentially more acceptable to relatives or guardians of those who died.…”