Management and outcomes of severe dengue patients presenting with sepsis in a tropical country

Abstract

BackgroundDengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.MethodsFrom June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays.ResultsA total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4), and 5 of them (4%) died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%), and recorded dengue infection as the final diagnosis in 96 patients (76%). Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality.ConclusionsA number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.

Epidemiology and Immune Pathogenesis of Viral Sepsis

“…One study in Thailand found that ~14% of patients diagnosed with sepsis (Sepsis-2 definition) tested positive for dengue viruses upon re-analysis of banked serum samples by PCR ( 71 ). Of the patients who were diagnosed with dengue by PCR from banked serum samples five had died, of which four had been diagnosed with sepsis but not dengue infection.…”

“…Of the patients who were diagnosed with dengue by PCR from banked serum samples five had died, of which four had been diagnosed with sepsis but not dengue infection. It was suggested that it may prove beneficial to increase testing for dengue viruses in patients presenting with sepsis to ensure the patient receives appropriate treatment ( 71 ).…”

Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries

“…We conducted a secondary analysis of 9 data sets: 8 cohort studies (5 prospective and 3 retrospective) and 1 randomized clinical trial. [8][9][10][11][12][13][14][15] Of the countries represented in this study (Bangladesh, Haiti, India, Indonesia, Myanmar, Rwanda, Sierra Leone, Sri Lanka, Thailand, and Vietnam), 3 are classified as low income, 6 as lower middle income, and 1 as upper middle income by the World Bank. 16 Patients were recruited to the cohorts from a range of hospital settings, including small community hospitals, military hospitals, rural regional hospitals, national referral hospitals, and specialty infectious disease hospitals.…”

Performance of Two Commercial Dengue NS1 Rapid Tests for the Diagnosis of Adult Patients with Dengue Infection

“…In addition, recent report from Thailand indicated that a number of adult patients who died of dengue virus are misdiagnosed as severe sepsis and septic shock. 13 Thus diagnosis of dengue based on clinical features alone is difficult. Rapid NS1 antigen detection, using ICT method, is the most widely used method for the diagnosis of dengue in endemic areas.…”