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Dussart P, Duong V, Bleakley K, Fortas C, Lorn Try P, Kim KS, Choeung R, In S, Andries AC, Cantaert T, Flamand M, Buchy P, Sakuntabhai A. Comparison of dengue case classification schemes and evaluation of biological changes in different dengue clinical patterns in a longitudinal follow-up of hospitalized children in Cambodia. PLoS Negl Trop Dis 2020; 14:e0008603. [PMID: 32925941 PMCID: PMC7515206 DOI: 10.1371/journal.pntd.0008603] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/24/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. METHODOLOGY/PRINCIPAL FINDINGS We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were designated SD using an adapted WHO 2009 classification for SD case definition. Systematic use of ultrasound at patient admission was crucial for detecting plasma leakage. No difference was observed in the concentration of secreted NS1 protein between different dengue severity groups. Lipid profiles were different between DWWS and SD at admission, characterized by a decrease in total cholesterol, HDL cholesterol, and LDL cholesterol, in SD. CONCLUSIONS/SIGNIFICANCE Our results show discrepancies between the two classifications, including misclassification of severe dengue cases as mild cases by the WHO 1997 classification. Using an adapted WHO 2009 classification, SD more precisely defines the group of patients requiring careful clinical care at a given time during hospitalization.
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Affiliation(s)
- Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Kevin Bleakley
- Laboratoire de mathématiques d'Orsay, Université Paris-Saclay, CNRS, Inria, Orsay, France
| | - Camille Fortas
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Patrich Lorn Try
- Pediatric Department, Kampong Cham Provincial hospital, Kampong Cham, Cambodia
| | - Kim Srorn Kim
- Pediatric Department, Kampong Cham Provincial hospital, Kampong Cham, Cambodia
| | - Rithy Choeung
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Saraden In
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Anne-Claire Andries
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Tineke Cantaert
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Marie Flamand
- Structural Virology Unit, Department of Virology, Institut Pasteur, CNRS UMR 3569, Paris, France
| | | | - Anavaj Sakuntabhai
- Functional Genetics of Infectious Diseases Unit, Department of Genomes and Genetics, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, Génomique évolutive, modélisation et santé, UMR 2000, Paris, France
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Ferreira BDC, Correia D. Ultrasound Assessment of Hepatobiliary and Splenic Changes in Patients With Dengue and Warning Signs During the Acute and Recovery Phases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2015-2024. [PMID: 30549307 DOI: 10.1002/jum.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/04/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate whether abdominal ultrasound (US) with a gallbladder (GB) contractility study or motor function test can be used as a diagnostic tool in patients with dengue and warning signs in acute and recovery phases. METHODS Fifty-one individuals in the acute phase of dengue presenting with warning signs (dengue group) and 49 healthy individuals without a history of dengue or hepatobiliary disease (control group) were studied with abdominal US and a GB contractility study. RESULTS Statistical differences in US measurements of the liver (right lobe, P = .012; left lobe, P = .001) and spleen (P = .008) dimensions, GB wall thickness (P < .001), and the GB emptying fraction (P < .001) were observed in dengue during the acute phase compared with the control group. After 60 days, abdominal US of the dengue group showed a statistical difference in liver (right lobe, P < .001; left lobe, P = .078) and spleen (P < .001) dimensions, GB wall thickness, and the GB emptying fraction (P < .001) compared with the results obtained during the acute phase. Furthermore, a statistical difference in the spleen volume and GB emptying fraction (P < .001) was observed when comparing dengue after clinical recovery and the control group. Abdominal pain in patients with dengue was positively associated with hepatomegaly (P = .031), splenomegaly (P = .008), increased GB wall thickness (P = .016), and a reduced GB emptying fraction (P = .038) during the acute phase and with splenomegaly (P = .001) and a reduced GB emptying fraction (P = .003) after clinical recovery. CONCLUSIONS Abdominal US with a GB motor function test can be used as a diagnostic tool in patients with dengue during acute and recovery phases.
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Affiliation(s)
| | - Dalmo Correia
- Infectious Diseases, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Pothapregada S, Kullu P, Kamalakannan B, Thulasingam M. Is Ultrasound a Useful Tool to Predict Severe Dengue Infection? Indian J Pediatr 2016; 83:500-4. [PMID: 26846603 DOI: 10.1007/s12098-015-2013-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/23/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. METHODS This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. RESULTS Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4 %) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. CONCLUSIONS Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.
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Affiliation(s)
- Sriram Pothapregada
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, 605009, India.
| | - Poonam Kullu
- Department of Radiodiagnosis, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Banupriya Kamalakannan
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, 605009, India
| | - Mahalakshmy Thulasingam
- Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India
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Oliveira RVBD, Rios LTM, Branco MDRFC, Braga Júnior LL, Nascimento JMS, Silva GF, Bandeira KP. Valor da ultrassonografia em crianças com suspeita de febre hemorrágica do dengue: revisão da literatura. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
O dengue é doença endêmica em regiões tropicais e subtropicais. Quando sintomática, classifica-se em febre do dengue e febre hemorrágica do dengue, com tendência a síndrome do choque do dengue. A febre hemorrágica do dengue é marcada por manifestações hemorrágicas, trombocitopenia e aumento da permeabilidade capilar. A síndrome do choque do dengue apresenta os achados de febre hemorrágica do dengue com hipotensão. Muitos achados ultrassonográficos têm sido descritos, incluindo derrame pleural, ascite, espessamento da parede da vesícula biliar e derrame pericárdico. O objetivo desta revisão da literatura é descrever os achados ultrassonográficos e demonstrar o papel da ultrassonografia em crianças com suspeita de febre hemorrágica do dengue
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Affiliation(s)
| | | | | | | | | | | | - Kemuel Pinto Bandeira
- Universidade Federal do Maranhão, Brasil; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, Brasil
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Clinico-epidemiological profile of children hospitalized with dengue. Indian J Pediatr 2010; 77:1103-7. [PMID: 20890686 DOI: 10.1007/s12098-010-0202-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 06/16/2010] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the clinico-epidemiological profile of children hospitalized with dengue illness. METHODS Prospective study of children hospitalized with the diagnosis of dengue illness during from September through November 2006 at a tertiary care centre in Jaipur. RESULTS A total of 948 children including 671 (70.8%) boys and 277 (29.2%) girls were diagnosed to have dengue illness during the outbreak. Two third of children were from urban areas while 6-12 years was the most commonly affected age group (45.8%). 58.3% cases had dengue fever (DF) while 41.7% had DHF (dengue hemorrhagic fever). Dengue fever with bleed (DFB) accounted for 32% of cases. Common constitutional symptoms were vomiting (35.2%), pain abdomen (22.1%) and myalgia (10.1%). Bleeding manifestations were observed in 44.5% of cases.. Positive tourniquet test was the most common manifestation which was seen in 300 cases (31.6%) while in 9.2% cases bleeding was the only manifestation. Epistaxis (25%) was the most common spontaneous bleeding manifestation. Thrombocytopenia was documented in 84% of total cases and bleeding occurred more often in patients with severe thrombocytopenia. Ten children expired with a case fatality rate of 1.1%. CONCLUSIONS Children between 6 and 12 yrs were most affected by dengue with larger number of cases from urban areas. DFB cases accounted for almost one third cases of dengue. Epistaxis was the most common spontaneous bleeding manifestation. Bleeding occurs more often in patients with severe thrombocytopenia.
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Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 2008; 13:1328-40. [PMID: 18803612 DOI: 10.1111/j.1365-3156.2008.02151.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Clinicians in resource-poor countries need to identify patients with dengue using readily-available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue-endemic populations. METHOD Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. RESULTS Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case-control studies. Seven studies assessed all ages, four assessed children only, and four assessed adults only. Patients with dengue had significantly lower platelet, white blood cell (WBC) and neutrophil counts, and a higher frequency of petechiae than OFI patients. Higher frequencies of myalgia, rash, haemorrhagic signs, lethargy/prostration, and arthralgia/joint pain and higher haematocrits were reported in adult patients with dengue but not in children. Most multivariable models included platelet count, WBC, rash, and signs of liver damage; however, none had high statistical validity and none considered changes in clinical features over the course of illness. CONCLUSIONS Several individual clinical and laboratory variables distinguish dengue from OFI; however, some variables may be dependent on age. No published multivariable model has been validated. Study design, populations, diagnostic criteria, and data collection methods differed widely across studies, and the majority of studies did not identify specific aetiologies of OFIs. More prospective studies are needed to construct a valid and generalizable algorithm to guide the differential diagnosis of dengue in endemic countries.
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Affiliation(s)
- James A Potts
- University of Massachusetts Medical School, Worcester, MA 01655, USA
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Colbert JA, Gordon A, Roxelin R, Silva S, Silva J, Rocha C, Harris E. Ultrasound measurement of gallbladder wall thickening as a diagnostic test and prognostic indicator for severe dengue in pediatric patients. Pediatr Infect Dis J 2007; 26:850-2. [PMID: 17721386 DOI: 10.1097/inf.0b013e3180619692] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gallbladder wall thickening measured by ultrasound was significantly associated with severe dengue, as well as with hallmark features of thrombocytopenia and elevated hematocrit/hemoconcentration, in children with suspected dengue in Nicaragua. We demonstrate that gallbladder wall thickening serves as a clinically relevant diagnostic test and prognostic indicator of severe dengue in pediatric populations.
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Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S, Nisalak A, Thomas SJ, Gibbons RV, Mammen MP, Libraty DH, Ennis FA, Rothman AL, Green S. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J 2007; 26:283-90; discussion 291-2. [PMID: 17414388 DOI: 10.1097/01.inf.0000258612.26743.10] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although plasma leakage is the major cause of mortality and morbidity in patients with dengue hemorrhagic fever (DHF), a detailed assessment of the natural course of this process is still lacking. We employed serial ultrasound examination to delineate the locations and the timing of plasma leakage and to evaluate the usefulness of ultrasound in detecting plasma leakage in DHF. METHOD Daily ultrasound examinations of the abdomen and right thorax were performed in 158 suspected dengue cases to detect ascites, thickened gall bladder wall and pleural effusions. Cases were classified into dengue fever (DF), DHF or other febrile illness (OFI) based on serology and evidence of plasma leakage including hemoconcentration and pleural effusion detected by chest radiograph. RESULTS Ultrasonographic evidence of plasma leakage was detected in DHF cases starting from 2 days before defervescence and was detected in some cases within 3 days after fever onset. Pleural effusion was the most common ultrasonographic sign of plasma leakage (62% of DHF cases one day after defervescence). Thickening of the gallbladder wall and ascites were detected less frequently (43% and 52% of DHF cases respectively) and resolved more rapidly than pleural effusions. The size of pleural effusions, ascites and gall bladder wall thickness in DHF grade I and II were smaller than those of grade III patients. Ultrasound detected plasma leakage in 12 of 17 DHF cases who did not meet the criteria for significant hemoconcentration. CONCLUSIONS Ultrasound examinations detected plasma leakage in multiple body compartments around the time of defervescence. Ultrasonographic signs of plasma leakage were detectable before changes in hematocrits. Ultrasound is a useful tool for detecting plasma leakage in dengue infection.
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Affiliation(s)
- Anon Srikiatkhachorn
- Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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