Unique Immune Blood Markers Between Severe Dengue and Sepsis in Children

Abstract

Background: Pediatric dengue and sepsis share clinical and pathophysiologic aspects. Multiple inflammatory and regulatory cytokines, decoy receptors and vascular permeability factors have been implicated in the pathogenesis of both diseases. The differential pattern and dynamic of these soluble factors, and the relationship with clinical severity between pediatric dengue and sepsis could offer new diagnosis and therapeutic strategies. Methods: We evaluated the concentration levels of 11 soluble factors with proinflammatory, regulatory and vascular permeability involvement, in plasma from children with dengue or sepsis, both clinically ranging from mild to severe, in the early, late and convalescence phases of the disease. Results: During early acute infection, children with sepsis exhibited specific higher concentration levels of IL-6, vascular endothelial growth factor (VEGF), and its soluble decoy receptor II (sVEGFR2) and lower concentration levels of IL-10 and the soluble tumor necrosis factor receptor 2 (sTNFR2), in comparison with children with severe dengue. In addition, the circulating amounts of soluble ST2, and VEGF/sVEGFR2 were widely associated with clinical and laboratory indicators of dengue severity, whereas secondary dengue virus infections were characterized by an enhanced cytokine response, relative to primary infections. In severe forms of dengue, or sepsis, the kinetics and the cytokines response during the late and convalescence phases of the disease also differentiate. Conclusions: Dengue virus infection and septic processes in children are characterized by cytokine responses of a specific magnitude, pattern and kinetics, which are implicated in the pathophysiology and clinical outcome of these diseases.

Frequency, Markers and Costs of Secondary Bacterial Infection in Pediatric Dengue

“…These data are in line with our recent study, where we observed upregulation of IL-6 in children with dengue plus bacterial sepsis, relative to individuals with sepsis alone. 51 In the clinical setting, IL-6 measurement (in addition to other clinical and laboratory parameters) could help to better guide the early diagnosis of these concomitant entities.…”

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay

“…A modo de conclusión, es posible indicar que la combinación 11 del estudio comprendía una proteína C reactiva negativa y plaquetopenia fue lo más relevante en el estudio, y presentó mayor validez como posible herramienta para el diagnóstico (20)(21)(22)(23)(24) . Por ello se considera una opción atractiva para el diagnóstico presuntivo de dengue en la sala de urgencias en la que el paciente fue recibido.…”