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Leng X, Yang H, Hong W, He J, Wang J, He X, Zhao L, Liao B, Chen X, Xie D, Peng J, Wang C, Feng J, Liao L, Jin K, Li L, Tang X, Qin C, Zhang F. Severe Organ Impairment Was Common in Elderly Individuals with Dengue in Guangdong, China. Am J Trop Med Hyg 2024; 111:610-616. [PMID: 38981501 PMCID: PMC11376186 DOI: 10.4269/ajtmh.24-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/03/2024] [Indexed: 07/11/2024] Open
Abstract
Guangdong, China, has experienced several dengue epidemics involving thousands of confirmed cases in recent decades, and elderly individuals suffered severe dengue (SD) most seriously. However, the clinical characteristics and risk factors for SD among elderly patients in Guangdong have not been investigated. Patients older than 65 years were recruited and divided into a dengue fever (DF) group and an SD group according to the 2009 Dengue Guidelines of the WHO. We analyzed the clinical manifestations of the elderly patients with dengue and then assessed the risk factors for SD. Of a total of 1,027 patients, 868 patients were diagnosed as having DF and 159 as having SD. Of the 159 elderly patients with SD, 129 (81%) had comorbidities, with hypertension being the most common. Severe organ impairment (SOI) (115, 54%) was the most common presentation in SD patients, followed by severe plasma leakage (52, 24.4%) and severe hemorrhage (46, 21.6%). The most common symptom of SOI was kidney injury, followed by heart injury and central nervous system injury. Furthermore, multivariate regression revealed that the presence of chronic obstructive pulmonary disease (COPD), a lower red blood cell (RBC) count (≤3.5 × 1012/L; odds ratio [OR], 0.35; 95% CI, 0.17-0.55; P <0.001), lower serum albumin (ALB) (≤35 U/L; OR, 0.18; 95% CI, 0.09-0.32; P <0.001), and hyperpyrexia (body temperature ≥39°C; OR, 1.8; 95% CI, 1.2-2.6, P <0.001) were risk factors for SD. Severe organ impairment was the predominant manifestation in elderly individuals with SD characterized by kidney injury. The potential risk factors of SD such as presence of COPD and hyperpyrexia and lower RBC and ALB levels might help clinicians identify patients with SD early.
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Affiliation(s)
- Xingyu Leng
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Huiqin Yang
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wenxin Hong
- Department of Infectious Diseases, Guangzhou Red Cross Hospital, Guangzhou, People's Republic of China
| | - Jianfeng He
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Jian Wang
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xi He
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lingzhai Zhao
- Department of Clinical Laboratory, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Baolin Liao
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xuefu Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Dongying Xie
- Department of Infectious Disease, the Third Affiliated Hospital, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Jie Peng
- Department of Infectious Disease, Nanfang Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Changtai Wang
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
- Department of Infectious Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jiamin Feng
- Institution of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lu Liao
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Kanghong Jin
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Linghua Li
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaoping Tang
- Institution of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Chengfeng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Fuchun Zhang
- Guangzhou Medical Research Institute of Infectious Diseases, Department of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
- Institution of Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
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Day ME, Puello YC, Mejía Sang ME, Diaz Brockmans EJ, Díaz Soto MF, Rivera Defilló SM, Taveras Cruz KM, Santiago Pérez JO, Meña R, Mota C, Hostetter MK, Muglia LJ, del Rey JG, Schlaudecker EP, Martin LJ, Simpson BN, Prada CE. Complete Blood Count Values Over Time in Young Children During the Dengue Virus Epidemic in the Dominican Republic From 2018 to 2020. BIOMED RESEARCH INTERNATIONAL 2024; 2024:3716786. [PMID: 39130533 PMCID: PMC11316910 DOI: 10.1155/2024/3716786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 08/13/2024]
Abstract
Background: Dengue fever (DF) is a mosquito-borne illness with substantial economic and societal impact. Understanding laboratory trends of hospitalized Dominican Republic (DR) pediatric patients could help develop screening procedures in low-resourced settings. We sought to describe laboratory findings over time in DR children with DF and DF severity from 2018 to 2020. Methods: Clinical information was obtained prospectively from recruited children with DF. Complete blood count (CBC) laboratory measures were assessed across Days 1-10 of fever. Participants were classified as DF-negative and DF-positive and grouped by severity. We assessed associations of DF severity with demographics, clinical characteristics, and peripheral blood studies. Using linear mixed-models, we assessed if hematologic values/trajectories differed by DF status/severity. Results: A total of 597 of 1101 with a DF clinical diagnosis were serologically evaluated, and 574 (471 DF-positive) met inclusion criteria. In DF, platelet count and hemoglobin were higher on earlier days of fever (p < = 0.0017). Eighty had severe DF. Severe DF risk was associated with thrombocytopenia, intraillness anemia, and leukocytosis, differing by fever day (p < = 0.001). Conclusions: In a pediatric hospitalized DR cohort, we found marked anemia in late stages of severe DF, unlike the typically seen hemoconcentration. These findings, paired with clinical symptom changes over time, may help guide risk-stratified screenings for resource-limited settings.
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Affiliation(s)
- Melissa E. Day
- Division of Infectious DiseasesCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yonairy Collado Puello
- School of MedicineInstituto Tecnológico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Miguel E. Mejía Sang
- School of MedicineInstituto Tecnológico de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - María F. Díaz Soto
- School of MedicineInstituto Tecnológico de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Karla M. Taveras Cruz
- School of MedicineInstituto Tecnológico de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Rafael Meña
- Department of PediatricsCentro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Cesár Mota
- Pediatric Emergency Medicine DepartmentHospital Infantil Dr. Robert Reid, Santo Domingo, Dominican Republic
| | - Margaret K. Hostetter
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Louis J. Muglia
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Human GeneticsCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Javier Gonzalez del Rey
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Emergency MedicineCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elizabeth P. Schlaudecker
- Division of Infectious DiseasesCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa J. Martin
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Human GeneticsCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brittany N. Simpson
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Human GeneticsCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- St. Jude Children's Research HospitalDepartment of PediatricsUniversity of Tennessee Health Science CenterLe Bonheur Children's Hospital, Memphis, Tennesse, USA
| | - Carlos E. Prada
- Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Human GeneticsCincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of GeneticsBirth Defects & MetabolismAnn & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of PediatricsFeinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
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Alam A, Andriyani FM, Peryoga SU. Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study. Int J Emerg Med 2024; 17:85. [PMID: 38992604 PMCID: PMC11242006 DOI: 10.1186/s12245-024-00658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management. METHODS Medical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital's PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses. RESULTS Seventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients. CONCLUSION Age, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.
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Affiliation(s)
- Anggraini Alam
- Infection & Tropical Diseases Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Fina Meilyana Andriyani
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Stanza Uga Peryoga
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
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Salazar Flórez JE, Marín Velasquez K, Segura Cardona ÁM, Restrepo Jaramillo BN, Ortega Díaz YE, Giraldo Cardona LS, Arboleda Naranjo M. Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia. Am J Trop Med Hyg 2024; 110:971-978. [PMID: 38507814 PMCID: PMC11066339 DOI: 10.4269/ajtmh.23-0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/30/2023] [Indexed: 03/22/2024] Open
Abstract
Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.
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Affiliation(s)
- Jorge Emilio Salazar Flórez
- Epidemiology and Biostatistics Group, CES University, Medellín, Colombia
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Sabaneta, Colombia
| | | | | | | | | | - Luz Stella Giraldo Cardona
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Sabaneta, Colombia
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Paraná VC, Feitosa CA, da Silva GCS, Gois LL, Santos LA. Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:173-191. [PMID: 38263345 DOI: 10.1111/tmi.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. METHODS PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. RESULTS Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. CONCLUSION These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.
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Affiliation(s)
- Victoria Cruz Paraná
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | | | | | - Luana Leandro Gois
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Department of Biointeraction Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciane Amorim Santos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Graduate Program in Health Sciences, College of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
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Padhi BK, Khatib MN, Gaidhane S, Zahiruddin QS, Satapathy P, Rabaan AA, Alrasheed HA, Al-Subaie MF, Alfaresi M, Zaidan TI. Association of cardiovascular disease with severe dengue: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102346. [PMID: 38103821 DOI: 10.1016/j.cpcardiol.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) and dengue are both significant global health concerns, and their intersection presents a growing clinical challenge. Emerging evidence suggests that individuals with pre-existing CVD may face an elevated risk of severe dengue outcomes. The present study aims to perform a systematic review to assess the relationship between CVD and the severity of dengue. METHODS We conducted a literature search across multiple databases from inception to November 25, 2023. Primary studies reporting the number of dengue patients with CVD in severe dengue and non-severe dengue groups were included. Quality assessment was performed using the Newcastle-Ottawa Scale, and a meta-analysis was conducted using R software version 4.2 to determine the pooled Relative Risk (RR). The study protocol has been registered in PROSPERO. RESULTS Based on data from 5 studies involving 274,576 dengue patients, our meta-analysis revealed a significant association between CVD and an increased risk of severe dengue, with a calculated RR of 2.71 (95 % CI: 1.03 to 7.10). However, substantial heterogeneity was observed among the included studies (I2 = 79 %). CONCLUSION The current evidence suggests an association between CVD and severe dengue, emphasizing the importance of closely monitoring individuals with pre-existing cardiovascular disease and providing them with targeted interventions upon dengue diagnosis to mitigate the risk of severe outcomes.
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Affiliation(s)
- Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher education and Research, Wardha, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; School of Pharmacy, Graphic Era Hill University, Dehradun 248001, India; School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Hayam A Alrasheed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Maha F Al-Subaie
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Research Center, Dr. Sulaiman Alhabib Medical Group, Riyadh 13328, Saudi Arabia; Department of Infectious Diseases, Dr. Sulaiman Alhabib Medical Group, 133, Riyadh, 13328Saudi Arabia
| | - Mubarak Alfaresi
- Department of Microbiology, National Reference Laboratory, Cleveland Clinic Abu Dhabi, Abu Dhabi 92323, United Arab Emirates; Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Tasneem I Zaidan
- Pediatric infectious diseases Unit, Pediatric department, King Abdulaziz Hospital, Jeddah 23831, Saudi Arabia
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Odio CD, Sánchez-González L, Delorey M, Adams LE, Jones ES, Lorenzi O, Munoz-Jordan J, Rivera-Amill V, Paz–Bailey G. The Effect of Age on Dengue Presentation and the Diagnostic Accuracy of the 2015 Pan American Health Organization Case Criteria in a Puerto Rican Cohort. Open Forum Infect Dis 2023; 10:ofad373. [PMID: 37663092 PMCID: PMC10468746 DOI: 10.1093/ofid/ofad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Background We evaluated dengue presentation by age, the performance of the 2015 Pan American Health Organization (PAHO) case criteria in identifying dengue cases, and variables to improve specificity. Methods Patients with fever ≤7 days (N = 10 408) were recruited from 2 emergency departments from May 2012 through December 2015. Serum samples were tested for dengue, chikungunya, and nasopharyngeal swabs for respiratory viruses. Smoothing splines assessed differences in the frequencies of signs/symptoms by age. Least absolute shrinkage and selection operator regressions identified the variables that best predicted dengue. Results Among 985 dengue cases, children aged <5 years were least likely to have leukopenia, but most likely to have rash and petechiae. Adults had the highest odds of aches/pains and headaches/retro-orbital pain. The 2015 PAHO criteria had sensitivity of 93% and specificity of 25%. Specificity could be improved by requiring at least 2 of the following criteria: vomiting/nausea, petechiae, rash, or leukopenia (specificity 68%, sensitivity 71%) or by using 2015 PAHO criteria plus either (1) aspartate aminotransferase >50 IU/L or platelet count <100 000 platelets/μL (specificity 81%, sensitivity 56%) or (2) itchy skin or absence of rhinorrhea or cough (specificity 51%, sensitivity 82%). Conclusions The 2015 PAHO dengue case criteria had excellent sensitivity but poor specificity. This can be improved by adding signs/symptoms associated with dengue diagnosis.
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Affiliation(s)
- Camila D Odio
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Liliana Sánchez-González
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Mark Delorey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Laura E Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Emma S Jones
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Olga Lorenzi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Jorge Munoz-Jordan
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | | | - Gabriela Paz–Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
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8
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Hossain MS, Noman AA, Mamun SMAA, Mosabbir AA. Twenty-two years of dengue outbreaks in Bangladesh: epidemiology, clinical spectrum, serotypes, and future disease risks. Trop Med Health 2023; 51:37. [PMID: 37434247 DOI: 10.1186/s41182-023-00528-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Dengue is the most rapidly spreading mosquito-borne disease and has become a major public health threat, particularly for tropical and subtropical countries including Bangladesh. This comprehensive review aims to summarize the overall scenario of dengue, including disease burden, clinical spectrum, seroprevalence, circulating serotypes/genotypes, and spatial distribution since the first recorded outbreak in Bangladesh. Since the first recorded outbreak in 2000, dengue epidemiology has shown the typical epidemic pattern with more frequent and bigger outbreaks and gradual geographic expansion to non-endemic regions in Bangladesh. For instance, highly confined Rohingya refugee camps that provide shelters to nearly 1.2 million forcibly displaced vulnerable Myanmar nationals in Cox's Bazar district confronted a massive outbreak in 2022. Recent major outbreaks are found to be associated with the emergence of serotype DENV-3, which was undetected for a long time. Consequently, changes in serotypes might be attributed to increased severity in clinical manifestation in recent years. The existing weak surveillance and risk management systems are inadequate to deal with impending dengue risks. The healthcare system, particularly at the district level, is not prepared to manage impending large-scale dengue outbreaks in Bangladesh. Our findings would contribute to the development of strategies for dengue control and management in Bangladesh as well as other similar settings elsewhere in the world.
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Affiliation(s)
- Mohammad Sorowar Hossain
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh.
- Department of Environmental Science and Management, Independent University, Bangladesh, Dhaka, Bangladesh.
| | - Abdullah Al Noman
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - S M Abdullah Al Mamun
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Abdullah Al Mosabbir
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Hematology & BMT Unit, Dhaka Medical College Hospital, Dhaka, Bangladesh
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9
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Epidemiological Investigation of the 2019 Dengue Outbreak in Dhaka, Bangladesh. J Trop Med 2023; 2023:8898453. [PMID: 36968192 PMCID: PMC10036172 DOI: 10.1155/2023/8898453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction. Bangladesh experienced its largest dengue epidemic in 2019. Our objective was to investigate the epidemiological, clinical, and laboratory characteristics of the hospital-admitted dengue patients during this epidemic. Methods. This cross-sectional study was conducted among 369 adult dengue patients admitted to two tertiary care hospitals in Dhaka, Bangladesh, from June to September 2019. The disease severity was determined according to the WHO’s 2009 classification. Results. The average age of the patients was 33.3 (SD 14) years with a predominance of men. Almost 10% developed severe dengue (plasma leakage 67%, clinical bleeding 25%, and organ involvement 25%). Fever, headache, retro-orbital pain, diarrhea, and warning signs such as abdominal pain, clinical fluid accumulation, and persistent vomiting were the most common clinical presentations. Thrombocytopenia, leukopenia, elevated HCT levels, and ALT/AST were common laboratory findings. Conclusions. Severe dengue was mostly attributable to plasma leakage with warning signs, especially abdominal pain, clinical fluid accumulation, persistent vomiting, and altered hematological parameters which might assist in the early prediction of severe dengue.
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Yang J, Mosabbir AA, Raheem E, Hu W, Hossain MS. Demographic characteristics, clinical symptoms, biochemical markers and probability of occurrence of severe dengue: A multicenter hospital-based study in Bangladesh. PLoS Negl Trop Dis 2023; 17:e0011161. [PMID: 36921001 PMCID: PMC10042364 DOI: 10.1371/journal.pntd.0011161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/27/2023] [Accepted: 02/10/2023] [Indexed: 03/16/2023] Open
Abstract
Establishing reliable early warning models for severe dengue cases is a high priority to facilitate triage in dengue-endemic areas and optimal use of limited resources. However, few studies have identified the complex interactive relationship between potential risk factors and severe dengue. This research aimed to assess the potential risk factors and detect their high-order combinative effects on severe dengue. A structured questionnaire was used to collect detailed dengue outbreak data from eight representative hospitals in Dhaka, Bangladesh, in 2019. Logistic regression and machine learning models were used to examine the complex effects of demographic characteristics, clinical symptoms, and biochemical markers on severe dengue. A total of 1,090 dengue cases (158 severe and 932 non-severe) were included in this study. Dyspnoea (Odds Ratio [OR] = 2.87, 95% Confidence Interval [CI]: 1.72 to 4.77), plasma leakage (OR = 3.61, 95% CI: 2.12 to 6.15), and hemorrhage (OR = 2.33, 95% CI: 1.46 to 3.73) were positively and significantly associated with the occurrence of severe dengue. Classification and regression tree models showed that the probability of occurrence of severe dengue cases ranged from 7% (age >12.5 years without plasma leakage) to 92.9% (age ≤12.5 years with dyspnoea and plasma leakage). The random forest model indicated that age was the most important factor in predicting severe dengue, followed by education, plasma leakage, platelet, and dyspnoea. The research provides new evidence to identify key risk factors contributing to severe dengue cases, which could be beneficial to clinical doctors to identify and predict the severity of dengue early.
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Affiliation(s)
- Jingli Yang
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, China
| | - Abdullah Al Mosabbir
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Enayetur Raheem
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- * E-mail: (WH); (MSH)
| | - Mohammad Sorowar Hossain
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
- School of Environment and Life Sciences, Independent University, Dhaka, Bangladesh
- * E-mail: (WH); (MSH)
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El-Qushayri AE, Kamel AMA, Reda A, Ghozy S. Does dengue and COVID-19 co-infection have worse outcomes? A systematic review of current evidence. Rev Med Virol 2022; 32:e2339. [PMID: 35213764 PMCID: PMC9111070 DOI: 10.1002/rmv.2339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 12/13/2022]
Abstract
In dengue-endemic regions, the co-infection with SARS-CoV-2 and dengue is a significant health concern. Therefore, we performed a literature search for relevant papers in seven databases on 26 Spetember 2021. Out of 24 articles, the mortality rate and intensive care unit (ICU) admission were 19.1% and 7.8%, respectively. The mean hospital stay was 11.4 days. In addition, we identified two pregnancies with dengue and COVID-19 co-infection; one ended with premature rupture of membrane and intrauterine growth restriction fetus, while the other one ended with maternal mortality and intrauterine fetal death. COVID-19 and dengue co-infection had worse outcomes regarding mortality rates, ICU admission, and prolonged hospital stay. Thus, wise-decision management approaches should be adequately offered to these patients to enhance their outcomes. Establishing an early diagnosis might be the answer to reducing the estimated significant burden of these conditions.
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Affiliation(s)
| | | | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sherief Ghozy
- Neuroradiology Department, Mayo Clinic, Rochester, Minnesota, USA.,Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC Program), Oxford University, Oxford, UK
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12
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Khan A, Ndenga B, Mutuku F, Bosire CM, Okuta V, Ronga CO, Mutai NK, Musaki SK, Chebii PK, Maina PW, Jembe Z, Amugongo JS, Malumbo SL, Ng'ang'a CM, LaBeaud D. Majority of pediatric dengue virus infections in Kenya do not meet 2009 WHO criteria for dengue diagnosis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000175. [PMID: 36962138 PMCID: PMC10021889 DOI: 10.1371/journal.pgph.0000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022]
Abstract
From 1975-2009, the WHO guidelines classified symptomatic dengue virus infections as dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. In 2009 the case definition was changed to a clinical classification after concern the original criteria was challenging to apply in resource-limited settings and not inclusive of a substantial proportion of severe dengue cases. Our goal was to examine how well the current WHO definition identified new dengue cases at our febrile surveillance sites in Kenya. Between 2014 and 2019 as part of a child cohort study of febrile illness in our four clinical study sites (Ukunda, Kisumu, Msambweni, Chulaimbo) we identified 369 dengue PCR positive symptomatic cases and characterized whether they met the 2009 revised WHO diagnostic criteria for dengue with and without warning signs and severe dengue. We found 62% of our PCR-confirmed dengue cases did not meet criteria per the guidelines. Our findings also correlate with our experience that dengue disease in children in Kenya is less severe as reported in other parts of the world. Although the 2009 clinical classification has recently been criticized for being overly inclusive and non-specific, our findings suggest the 2009 WHO dengue case definition may miss more than 50% of symptomatic infections in Kenya and may require further modification to include the African experience.
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Affiliation(s)
- Aslam Khan
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Bryson Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Francis Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Carren M Bosire
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Victoria Okuta
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles O Ronga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Noah K Mutai
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sandra K Musaki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Philip K Chebii
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Priscilla W Maina
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Zainab Jembe
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Jael S Amugongo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Said L Malumbo
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Charles M Ng'ang'a
- Vector-Borne Diseases Unit, Msambweni County Referral Hospital, Msambweni, Kwale, Kenya
| | - Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
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