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The World Health Organization (WHO) proposed a revised dengue classification in 2009 to facilitate a more effective identification of severe dengue cases. We compared the two systems of dengue severity classification, 1997 and 200...
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The World Health Organization (WHO) proposed a revised dengue classification in 2009 to facilitate a more effective identification of severe dengue cases. We compared the two systems of dengue severity classification, 1997 and 2009 WHO guidelines, at a Thai tertiary-care teaching hospital. A total of 765 patients with dengue infection were studied: 510 (66.7%) were adults, and 496 (64.8%) were from the outpatient department. According to the WHO 2009 guidelines, 61.7%, 33.5%, and 4.8% were classified as having dengue without warning signs, dengue with warning signs, and severe dengue, respectively. When the WHO 1997 classification was applied, 87.2%, 11.4%, and 1.4% were classified as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), respectively. Seven cases (1 %) of DF patients were categorized as severe dengue by severe bleeding. Of DHF patients, 10.3% had severe bleeding, and 10.3% had severe organ impairment. Overall, we observed that the 2009 WHO classification stratifies a much larger proportion of patients into a category requiring a higher level of medical and nursing care (dengue with warning signs or severe dengue) than the 1997 classification (DHF or DSS). However, DHF patients had a significantly higher frequency of in-patient treatment than dengue with warning signs patients (92% vs 53.1%; p < 0.001). The 1997 classification appeared to identify truly severe cases while the 2009 guidelines were more useful in detecting a broad range of severe clinical manifestations such as severe bleeding. Further studies are needed to assess the utility of the WHO dengue severity classification guidelines and to identify areas that require modification.
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Pregnant women living in an endemic area or travel to tropical countries have a risk of dengue infection. When compared to non-pregnant women, pregnant women are at increased risk of dengue hemorrhagic fever (DHF), dengue shock sy...
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Pregnant women living in an endemic area or travel to tropical countries have a risk of dengue infection. When compared to non-pregnant women, pregnant women are at increased risk of dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and death. Dengue diseases during pregnancy are found to be associated with a higher risk of cesarean delivery, preeclampsia, preterm birth, and low birthweight infant. Vertical transmission of the virus causing symptomatic diseases in the newborn has been reported. Physiologic changes during pregnancy and some obstetric complications may mask or resemble clinical or laboratory features of dengue leading to misdiagnosis and delayed treatment. Early recognition of dengue during pregnancy and its consequences as well as prompt management would result in a better outcome. In endemic countries, dengue infection should be considered in pregnant women presenting with febrile illness. Hospitalization, close clinical and laboratory monitoring and fluid therapy are recommended in the management of dengue in pregnancy. Vaccination among women in reproductive age in endemic countries prior to pregnancy may be an effective method to prevent dengue disease during pregnancy.
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Background: We evaluated the validity of clinical diagnosis compared with Laboratory diagnosis of dengue in a retrospective sample of patients in Sao Jose do Rio Preto, Brazil.
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Dengue Fever (DF) is the commonest mosquito-bome viral infection that results in hospitalisation amongst patients in Malaysia. The cornerstone of managing dengue virus infection is the prediction hence prevention of severe DF from...
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Dengue Fever (DF) is the commonest mosquito-bome viral infection that results in hospitalisation amongst patients in Malaysia. The cornerstone of managing dengue virus infection is the prediction hence prevention of severe DF from developing. Warning signs proposed by WHO as clinical predictors of severe DF are insensitive. Procalcitonin (PCT) has been shown to increase in bacterial infections and is useful in predicting disease severity and mortality. Objective: To determine the level of PCT and other clinical and biochemical parameters associated with severe DF. This is a cross-sectional study conducted over 6 months from September 2017 to February 2018. Patients aged 18 years and above who were hospitalised in Hospital Selayang for a serologically-confirmed DF were recruited. PCT level was taken within 24 h of hospital admission and patients were followed up throughout admission until discharge or death. Out of 133 recruits, 117 (88%) had uncomplicated DF and 16 (12%) had severe DF either with shock (44%) or organ failure (56%). There were 2 (13%) deaths from the severe group. Median PCT levels were higher in severe [0.35 ng/mL (0.15-4.4)] versus non-severe [0.28 ng/mL (0.17-0.54)] DF, however there was no significant difference between both groups (p = 0.518). Other significant clinical and biochemical factors associated with severe DF were defervescence phase (p = 0.043), lethargy (p = 0.000) and albumin <35g/L (p = 0.015). On multivariate analysis, parameters significantly associated with severe DF include lethargy (p = 0.001) and albumin <35g/L (p = 0.009). These two parameters plus PCT of >0.3 ng/mL predict severe DF with a sensitivity of 73% and specificity of 85%. PCT [median 3.6 ng/mL (3.2-4.0)] is also significantly associated with death (p = 0.021). PCT at a cut-off of >0.3 ng/mL predicts severe DF when combined with lethargy and albumin <35g/L. Furthermore, PCT is significantly associated with death.
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The Letter to the Editor send by Drs. Ayra and Nirmala [ 1 ] rightly points out that the absence of IgM might increase the chances of a secondary or a dengue vaccine-linked disease transmission through the mosquito bite. We would ...
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The Letter to the Editor send by Drs. Ayra and Nirmala [ 1 ] rightly points out that the absence of IgM might increase the chances of a secondary or a dengue vaccine-linked disease transmission through the mosquito bite. We would like to provide additional observations concerning IgM seropositivity and clinical outcome. In our previous report, we found a correlation between high seropositivity rate to IgM and low viral load levels. Thus, we have concluded that IgM seropositivity may interfere with viral detection and may be related with a better infection control by the host [2]. Therefore, we analyzed if there is a correlation between IgM seropositivity and dengue disease clinical outcome using a panel of 380 sera from dengue patients collected within the first 5 days after fever onset. Most of the infections (83.1%) corresponded to primary cases.
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Background Clinical symptoms of Dengue vary from mild febrile illness to severe infection. A potent pro-inflammatory cytokine, IL-17, secreted by mainly Th17 cells mediate inflammation and autoimmune dis...
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Background Clinical symptoms of Dengue vary from mild febrile illness to severe infection. A potent pro-inflammatory cytokine, IL-17, secreted by mainly Th17 cells mediate inflammation and autoimmune diseases. Role of IL-17 in pathogenesis of dengue virus (DV) infection is not clear.
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Background: Revised case definitions of dengue into dengue with/without warning signs (DWS/D) and severe dengue (SD) was proposed by the World Health Organization (WHO)/Tropical Disease Research (TDR) in 2009. To date, there has b...
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Background: Revised case definitions of dengue into dengue with/without warning signs (DWS/D) and severe dengue (SD) was proposed by the World Health Organization (WHO)/Tropical Disease Research (TDR) in 2009. To date, there has been no Indian study that has applied this classification. Aims and objectives: To assess the accuracy and applicability of the revised WHO classification (2009) of dengue in children seen at a tertiary healthcare facility in India. Materials and methods: Over a period of 1 year children from the pediatric ward and Out Patient Department (OPD) of the King George Medical University Hospital, Lucknow were enrolled in the study according to predefined criteria and tested for dengue. Each dengue-positive patient was classified according to both the older system [dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS)] and the new system (D, DWS, and SD). The severity of dengue was compared to the level of treatment received. Results: A total of 56 patients tested positive for dengue - 51 from the pediatric ward and five from the OPD. According to the older WHO classification, 42 (75 %) patients were classified as DF and 13 (23.2 %) as DHF/DSS; one patient was unclassifiable. Five patients (8.9 %) received level 1 treatment, ten (17.8 %) received level 2 treatment, and 41 (73.2 %) received level 3 treatment. According to the new WHO/TDR classification, 46 (82.1 %) patients were classified as SD, nine (16 %) as DWS, and only one (1.7 %) as D. Many of the severe manifestations (encephalopathy, shock, mucosal bleed, platelet count <20,000, respiratory distress, liver enzymes >1,000 U/L) were seen in patients who were classified as DF according to old classification, whereas these patients were mostly classified as SD by the new classification. Sensitivity of the older and new classifications was 24.8 and 98 %, respectively. Conclusions: The revised WHO/TDR (2009) classification has very high sensitivity for identifying severe dengue and is easy to apply.
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Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Ger...
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Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. Methods: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. Results: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). Conclusions: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.
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We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue fo...
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We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014-14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53-79) and specificity of 95% (95% CI, 82-99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68-100) and specificity of 38% (95% CI, 9-76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts.
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To evaluate risk factors for the development of dengue into severe dengue in Guangdong. A retrospective analysis of clinical data from 212 dengue patients between June and October 2014. A total of 174 (82.1%) patients in our study...
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To evaluate risk factors for the development of dengue into severe dengue in Guangdong. A retrospective analysis of clinical data from 212 dengue patients between June and October 2014. A total of 174 (82.1%) patients in our study had classic dengue, of which 38 (17.9%) had severe diseases. The frequencies of jaundice, pleural effusion, ascites, and vaginal bleeding were significantly different between the two groups ( P? <?0.05). The routine laboratory test results for alanine aminotransferase, aspertate aminotransferase, albumin, leukocyte count, platelet count, activated partial prothrombin time, prothrombin time, and aspartate aminotransferase/platelet count ratio index showed a significant association with severe dengue ( P ?<?0.01). The areas under the receiver operating characteristic curves (AUC) were 0.727 (95% CI 0.662–0.78), 0.699 (95%CI 0.632–0.760), 0.634 (95%CI 0.565–0.698), 0.757 (95%CI 0.694–0.813), 0.775 (95%CI 0.713–0.829), 0.713 (95%CI 0.647–0.773), 0.719 (95%CI 0.730–0.843), and 0.785 (95%CI 0.724–0.893), respectively. The logistic regression analysis identified three factors, including high WBC (OR 1.52), prolonged PT (OR 1.745). and high APRI (OR 1.05) may be associated with the discrimination criteria to identify patients with and without severe diseases. The combination of the three factors (WBC, PT, and APRI) showed better AUC (0.877) and OR (1.52) scores. Our study indicates that laboratory tests such as WBC, PT, and APRI, helped identify patients at risk of developing severe dengue. The APRI was identified as a valuable predictor of patients with severe dengue. Combining the WBC, PT, and APRI scores allowed a better prediction of severe dengue.
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