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Jeewandara C, Karunananda MV, Fernando S, Danasekara S, Jayakody G, Arulkumaran S, Samaraweera NY, Kumarawansha S, Sivaganesh S, Amarasinghe PG, Jayasinghe C, Wijesekara D, Marasinghe MB, Mambulage U, Wijayatilake H, Senevirathne K, Bandara ADP, Gallage CP, Colambage NR, Udayasiri AAT, Lokumarambage T, Upasena Y, Weerasooriya WPKP, Ogg GS, Malavige GN. Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue? PLoS Negl Trop Dis 2024; 18:e0012248. [PMID: 38935620 PMCID: PMC11210816 DOI: 10.1371/journal.pntd.0012248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Obesity and diabetes are known risk factors for severe dengue. Therefore, we sought to investigate the association of obesity with increased risk of hospitalization, as there is limited information. METHODS AND FINDINGS Children aged 10 to 18 years (n = 4782), were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index (BMI) centile in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking. RESULTS Although the dengue seropositivity rates were similar in children of the different BMI centiles, 12/66 (18.2%) seropositive children with a BMI centile >97th, had been hospitalized for dengue, compared to 103/1086 (9.48%) of children with a BMI centile of <97th. The logistic regression model suggested that BMI centiles 50th to 85th (OR = 1.06, 95% CI, 1.00 to 1.11, p = 0.048) and BMI centile of >97th (OR 2.33, 95% CI, 1.47 to 3.67, p = 0.0003) was significantly associated with hospitalization when compared to children in other BMI categories. CONCLUSIONS Obesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue.
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Affiliation(s)
- Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Maneshka Vindesh Karunananda
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Saubhagya Danasekara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Graham S. Ogg
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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Mercado-Hernandez R, Myers R, Carillo FB, Zambrana JV, López B, Sanchez N, Gordon A, Balmaseda A, Kuan G, Harris E. Obesity is associated with increased pediatric dengue virus infection and disease: A 9-year cohort study in Managua, Nicaragua. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.02.24305219. [PMID: 38633790 PMCID: PMC11023673 DOI: 10.1101/2024.04.02.24305219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Obesity is on the rise globally in adults and children, including in tropical areas where diseases such as dengue have a substantial burden, particularly in children. Obesity impacts the risk of severe dengue disease; however, the impact on dengue virus (DENV) infection and dengue cases remains an open question. Methods We used 9 years of data from 5,940 children in the Pediatric Dengue Cohort Study in Nicaragua to examine whether pediatric obesity is associated with increased susceptibility to DENV infection and symptomatic presentation. Analysis was performed using Generalized Estimating Equations adjusted for age, sex, and pre-infection DENV antibody titers. Results From 2011 to 2019, children contributed 26,273 person-years of observation, and we observed an increase in the prevalence of overweight (from 12% to 17%) and obesity (from 7% to 13%). There were 1,682 DENV infections and 476 dengue cases in the study population. Compared to participants with normal weight, participants with obesity had higher odds of DENV infection (Adjusted Odds Ratio [aOR] 1.21, 95% confidence interval [CI] 1.03-1.42) and higher odds of dengue disease given infection (aOR 1.59, 95% CI 1.15-2.19). Children with obesity infected with DENV showed increased odds of presenting fever (aOR 1.46, 95% CI 1.05-2.02), headache (aOR 1.51, 95% CI 1.07-2.14), and rash (aOR 2.26, 95% CI 1.49-3.44) when compared with children with normal weight. Conclusions Our results indicate that obesity is associated with increased susceptibility to DENV infection and dengue cases in children, independently of age, sex, and pre-infection DENV antibody titers.
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Affiliation(s)
- Reinaldo Mercado-Hernandez
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Rachel Myers
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Fausto Bustos Carillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - José Victor Zambrana
- Sustainable Sciences Institute, Managua, Nicaragua
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Brenda López
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Nguyen TT, Nguyen DT, Vo TTH, Dang OTH, Nguyen BT, Pham DTT, Nguyen TTK, Duong YNH, Doan DH, Nguyen TH, Ho LT, Nguyen PH, Phan DN, Tran TV, Nguyen TK, Luong DC, Pham ATM, Dinh TTD, Do VC, Vo LT. Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome. Medicine (Baltimore) 2023; 102:e36054. [PMID: 37986332 PMCID: PMC10659721 DOI: 10.1097/md.0000000000036054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/13/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31-4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.
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Affiliation(s)
- Thanh Tat Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Dat Tat Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Tien Thi-Hong Vo
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Oanh Tran-Hoang Dang
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Bao Trung Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Dung Thi-Thuy Pham
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Thuong Thi-Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | | | - Duong Hung Doan
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Truc Huynh Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Lien Thi Ho
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Phuc Hoang Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Dung Ngoc Phan
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Tin Van Tran
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Tuyet Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Duc Cong Luong
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Anh Thi-Mai Pham
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Thuy Thi-Diem Dinh
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Viet Chau Do
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
| | - Luan Thanh Vo
- Department of Infectious Diseases, Children’s Hospital No. 2, Ho Chi Minh City, Vietnam
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Chiu YY, Lin CY, Yu LS, Wang WH, Huang CH, Chen YH. The association of obesity and dengue severity in hospitalized adult patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:267-273. [PMID: 36055945 DOI: 10.1016/j.jmii.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is associated with unfavorable outcomes for infectious diseases. Most researches exploring the association between nutritional status and dengue severity have focused on pediatric populations, with only few studies assessing adult patients. METHODS Adult patients with laboratory-confirmed dengue admitted to a tertiary hospital in southern Taiwan between 2014 and 2015 were enrolled retrospectively. Demographics, comorbidities, clinical presentation, laboratory findings, and outcomes were obtained from case-record forms. Patients were categorized into obese group and nonobese group. The obese group comprised patients with a body mass index of ≥27.5 kg/m2. RESULTS A total of 1417 hospitalized patients with dengue were evaluated. The mean age was 57.9 years (range: 18-92 years). The obese and nonobese groups comprised 333 (23.5%) and 1084 (76.5%) patients, respectively. The obese group included more patients with hypertension (85%, p < 0.001), diabetes mellitus (33%, p < 0.001), and congestive heart failure (6.3%, p = 0.049). Multivariate analysis revealed that the obese group had more petechiae (AOR: 1.353, 95% CI: 1.025-1.786, p = 0.033), more dyspnea (AOR: 1.380, 95% CI: 1.015-1.876, p = 0.040), and more severe hepatitis (AOR: 2.061, 95% CI: 1.050-4.048, p = 0.036). The obese group also had higher peak hematocrit values (44.1%, p < 0.001) and lower nadir platelet count (45.3 × 103/μL, p = 0.049) than the nonobese group. CONCLUSION In adult patients with dengue, obese group had more petechiae, dyspnea, severe hepatitis, lower nadir of platelet count, and higher peak hematocrit level. We observed no difference in severe dengue or mortality between obese and nonobese group.
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Affiliation(s)
- Yu-Yao Chiu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, College of Medicine, Sepsis Research Center, Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, College of Medicine, Sepsis Research Center, Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Biochemistry and Microbiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Ling-Shan Yu
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Wen-Hung Wang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, College of Medicine, Sepsis Research Center, Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hao Huang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, College of Medicine, Sepsis Research Center, Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, College of Medicine, Sepsis Research Center, Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, HsinChu, Taiwan; Institute of Medical Science and Technology, School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Mariko R, Rachmawati N, Amelin F, Hadinegoro SR. The Role of Angiopoietin-2 on Plasma Leakage in the Critical Phase and Convalescence of Dengue Virus Infection in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background: The worst complication of dengue haemorrhagic fever (DHF) that lead to death is hypovolemic shock due to plasma leakage from intravascular to extravascular space caused by endothelial dysfunction. This study is aimed to analyze the difference of Ang-2 level in dengue haemorrhagic fever patients related to plasma leakage between critical phase and convalescence.
Aim: One hundred and ten children with DHF confirmed serologically with positive IgM anti-dengue or IgM and IgG anti-dengue were recruited in this study. We examine the clinical manifestations, laboratory parameters (platelet count, AST and ALT levels), and molecular test (Ang-2). The molecular indicator was tested by Enzyme-Linked Immunosorbent Assay (ELISA). Data were collected between July – November 2019. This is an observational study with cross-sectional comparative design.
Results: In our study, we found correlation of clinical symptoms (abdominal pain, persistent vomit, and hepatomegaly) with the occurrence of plasma leakage in DHF patients. We also found that Ang-2 level is significantly higher in children with DHF during critical phase compared to convalescence (p< 0.01).
Conclusion: There is a significant difference of Ang-2 level in DHF patients during critical phase and convalescence.
Keywords: Dengue hemorrhagic fever, children, Ang-2, critical phase, convalescence
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Tiga-Loza DC, Martínez-Vega RA, Undurraga EA, Tschampl CA, Shepard DS, Ramos-Castañeda J. Persistence of symptoms in dengue patients: a clinical cohort study. Trans R Soc Trop Med Hyg 2021; 114:355-364. [PMID: 32125417 DOI: 10.1093/trstmh/traa007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dengue is commonly considered an acute illness and follows three phases: febrile, critical in some cases and recovery. However, a number of studies have described a continuation of dengue symptoms for weeks or months, extending the recovery phase. Here we evaluate this persistence of dengue symptoms during convalescence. METHODS Our clinical cohort study included patients who sought medical services 48 to 144 h from the onset of fever at seven hospitals or ambulatory centers in Morelos, Mexico. Seventy-nine laboratory-confirmed dengue patients were followed up regularly using clinic and/or home visits and telephone calls for as long as symptoms persisted or up to 6 mo. RESULTS In total, 55.7% of patients had dengue-related symptoms 1 mo after the onset of fever; pain and dermatological manifestations were the most common persistent symptoms. Prognostic factors for symptom persistence were: ≥4 d of fever (RR 1.72; 95% CI 1.35 to 2.19), platelet count ≤100 000/mm3 (RR 1.20; 95% CI 1.20 to 2.20), petechiae/bruises (RR 1.97; 95% CI 1.56 to 2.48) and abdominal pain/hepatomegaly (RR 1.79; 95% CI 1.41 to 2.28). CONCLUSIONS Persistence of dengue symptoms were common in laboratory-confirmed dengue patients. Manifestations related to tissue damage were associated with persistence after 30 d; host characteristics, such as age and health status before infection, were associated with prolonged persistence (>60 d). The burden of dengue may be higher than previously estimated.
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Affiliation(s)
- Diana Carolina Tiga-Loza
- Programa de enfermería, Universidad Manuela Beltrán, Bucaramanga, Santander, Colombia.,Centro de investigaciones sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ruth A Martínez-Vega
- Escuela de Microbiología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
| | - Cynthia A Tschampl
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - Donald S Shepard
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - José Ramos-Castañeda
- Centro de investigaciones sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.,Universidad Anahuac, Centro de Investigación en Ciencias de la Salud. México
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Seropositivity and history of hospitalisation for dengue in relation to anthropometric indices among Colombian children and adults. Epidemiol Infect 2021; 149:e58. [PMID: 33583455 PMCID: PMC8060849 DOI: 10.1017/s0950268821000388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The role of anthropometric status on dengue is uncertain. We investigated the relations between anthropometric characteristics (height, body mass index and waist circumference (WC)) and two dengue outcomes, seropositivity and hospitalisation, in a cross-sectional study of 2038 children (aged 2–15 years) and 408 adults (aged 18–72 years) from Bucaramanga, Colombia. Anthropometric variables were standardised by age and sex in children. Seropositivity was determined through immunoglobulin G antibodies; past hospitalisation for dengue was self-reported. We modelled the prevalence of each outcome by levels of anthropometric exposures using generalised estimating equations with restricted cubic splines. In children, dengue seropositivity was 60.8%; 9.9% of seropositive children reported prior hospitalisation for dengue. WC was positively associated with seropositivity in girls (90th vs. 10th percentile adjusted prevalence ratio (APR) = 1.19; 95% confidence interval (CI) 1.03–1.36). Among adults, dengue seropositivity was 95.1%; 8.1% of seropositive adults reported past hospitalisation. Height was inversely associated with seropositivity (APR = 0.90; 95% CI 0.83–0.99) and with hospitalisation history (APR = 0.19; 95% CI 0.04–0.79). WC was inversely associated with seropositivity (APR = 0.89; 95% CI 0.81–0.98). We conclude that anthropometry correlates with a history of dengue, but could not determine causation. Prospective studies are warranted to enhance causal inference on these questions.
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Nandwani S, Bhakhri BK, Singh N, Rai R, Singh DK. Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis. Rev Soc Bras Med Trop 2021; 54:e05192020. [PMID: 33533817 PMCID: PMC7849329 DOI: 10.1590/0037-8682-0519-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.
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Affiliation(s)
- Sumi Nandwani
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Microbiology, Noida, Uttar Pradesh, India
| | - Bhanu Kiran Bhakhri
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
| | - Nupur Singh
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
| | - Ruchi Rai
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Neonatology, Noida, Uttar Pradesh, India
| | - Dharmender Kumar Singh
- Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Department of Pediatrics, Noida, Uttar Pradesh, India
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Baiduri S, Husada D, Puspitasari D, Kartina L, Basuki PS, Ismoedijanto I. PROGNOSTIC FACTORS OF SEVERE DENGUE INFECTIONS IN CHILDREN. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i1.10721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The incidence of dengue fever increase annually and can increase morbidity and mortality. Dengue fever is mosquito-borne disease and caused by one of four serotype dengue viruses. Severe dengue is characterized either by plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Mortality and serious morbidity of dengue were caused by several factors including the late recognition of the disease and the changing of clinical signs and symptoms. Understanding the prognostic factors in severe dengue will give early warning to physician thus decreasing the morbidity and mortality, and also improving the treatment and disease management. The aim of this study was to analyze the prognostic factors of severe dengue infection in children. This study was observational cohort study in children (2 months-18 years) with dengue infection according to WHO 2009 criteria which admitted in Soetomo and Soewandhie Hospital Surabaya. Analysis with univariate, bivariate and multivariate with IBM SPSS Statistic 17. All patients were confirmed by serologic marker (NS-1 or IgM/IgG Dengue). Clinical and laboratory examination such as complete blood count, aspartate aminotrasnferase (AST), alanine aminotrasferase (ALT), albumin, and both partial trombocite time and activated partial trombosit time (PTT and aPPT) were analyzed comparing nonsevere dengue and severe dengue patients. There were 40 subjects innonsevere and 27 subjects with severe dengue infection. On bivariate analysis, there were significant differences of nutritional status, abdominal pain, petechiae, pleural effusion, leukopenia, thrombocytopenia, hypoalbuminemia, history of transfusion, increasing AST>3x, prolonged PPT and APTT between severe and nonsevere dengue group. After multivariate analyzed, the prognostic factors of severe dengue were overweight/obesity (p=0.003, RR 94), vomiting (p=0.02, RR 13.3), hepatomegaly (p=0.01, RR=69.4), and prolonged APTT (p=0.005, RR=43.25). In conclusion, overweight/obesity, vomiting, hepatomegaly, and prolonged APTT were prognostic factors in severe dengue infection in children.Those factors should be monitored closely in order to reduce the mortality and serious morbidity.
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Weger-Lucarelli J, Carrau L, Levi LI, Rezelj V, Vallet T, Blanc H, Boussier J, Megrian D, Coutermarsh-Ott S, LeRoith T, Vignuzzi M. Host nutritional status affects alphavirus virulence, transmission, and evolution. PLoS Pathog 2019; 15:e1008089. [PMID: 31710653 PMCID: PMC6872174 DOI: 10.1371/journal.ppat.1008089] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/21/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Malnourishment, specifically overweight/obesity and undernourishment, affects more than 2.5 billion people worldwide, with the number affected ever-increasing. Concurrently, emerging viral diseases, particularly those that are mosquito-borne, have spread dramatically in the past several decades, culminating in outbreaks of several viruses worldwide. Both forms of malnourishment are known to lead to an aberrant immune response, which can worsen disease outcomes and reduce vaccination efficacy for viral pathogens such as influenza and measles. Given the increasing rates of malnutrition and spread of arthropod-borne viruses (arboviruses), there is an urgent need to understand the role of host nutrition on the infection, virulence, and transmission of these viruses. To address this gap in knowledge, we infected lean, obese, and undernourished mice with arthritogenic arboviruses from the genus Alphavirus and assessed morbidity, virus replication, transmission, and evolution. Obesity and undernourishment did not consistently influence virus replication in the blood of infected animals except for reductions in virus in obese mice late in infection. However, morbidity was increased in obese mice under all conditions. Using Mayaro virus (MAYV) as a model arthritogenic alphavirus, we determined that both obese and undernourished mice transmit virus less efficiently to mosquitoes than control (lean) mice. In addition, viral genetic diversity and replicative fitness were reduced in virus isolated from obese compared to lean controls. Taken together, nutrition appears to alter the course of alphavirus infection and should be considered as a critical environmental factor during outbreaks. Over- and undernutrition, collectively known as malnutrition, affect over 2.5 billion people worldwide. Associations between malnutrition and mosquito-borne virus infection and resulting disease have been identified in epidemiological studies but have not been explored in controlled studies. Here, we infect obese or undernourished mice with different arthritis inducing viruses in the genus Alphavirus and measure disease symptoms, viral replication, transmission, and evolution. We found that markers of disease, namely weight loss and footpad swelling, were increased in obese mice. We also found that replication differences between mice fed different diets were minimal except late in infection for obese mice when levels of virus dropped significantly. When mosquitoes were allowed to feed on mice fed different diets, we observed reduced infection and transmission rates, depending on the diet. Finally, we found reduced genetic diversity and replicative fitness of virus isolated from obese mice. This study provides insights into the influence of nutrition on alphavirus pathogenesis and evolution.
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Affiliation(s)
- James Weger-Lucarelli
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France.,Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Lucia Carrau
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Laura I Levi
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France.,Ecole doctorale BioSPC, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Veronica Rezelj
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Thomas Vallet
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Hervé Blanc
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Jérémy Boussier
- Institut Pasteur, Immunobiology of Dendritic Cells, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Daniela Megrian
- Institut Pasteur, Evolutionary Biology of the Microbial Cell, Department of Microbiology, Paris, France
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Marco Vignuzzi
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
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11
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Gelu A, Edris M, Derso T, Abebe Z. Undernutrition and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia: a cross-sectional study. Pediatric Health Med Ther 2018; 9:81-88. [PMID: 30215624 PMCID: PMC6118270 DOI: 10.2147/phmt.s172317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people, especially in developing countries such as Ethiopia, are migrating to cities. The majority of these people have settled in slum areas, which often have poor sanitation and housing conditions. Therefore, this study was conducted to gather evidence on nutritional status and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia. METHODS A community-based cross-sectional study was carried out from 3 to 28 May 2017. A total of 593 children from the slum areas aged 6-59 months were included in the study. Bivariable and multivariable logistic regression analyses were carried out to identify the independent determinants of stunting and wasting. RESULTS The overall prevalences of stunting and wasting were 42.3% (95% CI 38.34, 46.3%) and 7.3% (95% CI 5.3, 9.4%), respectively. Poor wealth status (adjusted odds ratio [AOR] =1.79; 95% CI 1.19, 2.70) and age of child 24-35 months (AOR=2.56; 95% CI 1.32, 4.96), 36-47 months (AOR=2.27; 95% CI 1.14, 4.54) and 48-59 months (AOR=2.69; 95% CI 1.35, 5.32) were independently associated with stunting. Similarly, presence of a fever in the previous 2 weeks (AOR=2.29; 95% CI 1.20, 4.38) and paternal control over resources (AOR=3.66; 95% CI 1.12, 11.04) were associated with wasting. Children of uneducated mothers (AOR=3.30; 95% CI 1.29, 8.46) were also more likely to be wasted. CONCLUSION This study illustrates that undernutrition is prevalent in the slum areas of Gondar city and is a critical public health problem. Therefore, attention should be targeted at economically disadvantaged children living in slum areas. In addition, there is a need to improve medical awareness of families with young children in these areas and increase the health-seeking behavior of these families, primarily by focusing on maternal education. Increasing women's decision-making autonomy over household resources is also recommended to address the problem.
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Affiliation(s)
- Atanaw Gelu
- Comprehensive Specialized Hospital, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkie Edris
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
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12
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The association between obesity and dengue virus (DENV) infection in hospitalised patients. PLoS One 2018; 13:e0200698. [PMID: 30016369 PMCID: PMC6049924 DOI: 10.1371/journal.pone.0200698] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
Both obesity and DENV infections are growing public health concerns that have far-ranging socioeconomic effects, especially in developing countries. Despite the increasing prevalence of these conditions, there is a scarcity of data investigating the potential relationships between these two entities. Our study aims to examine the influence of obesity on various clinical and laboratory parameters amongst patients with DENV infections. A total of 335 hospitalized patients aged >12 years who were DENV non-structural protein 1 (NS1) antigen-positive were enrolled in this study. Clinical and laboratory variables were compared between patients with and without obesity. Multivariate analysis showed that the following admission clinical findings and laboratory results were independently associated with obesity; chills and rigors (AOR:2.653, 95% CI: 1.286–5.474), higher temperature (AOR:1.485, 95% CI: 1.080–2.042), higher systolic BP (AOR:1.057, 95% CI:1.037–1.078), raised haematocrit (AOR: 1.953, 95% CI: 1.010–3.778), elevated creatinine (AOR:3.504, 95% CI:1.351–9.008) and elevated ALT (AOR: 4.146, 95% CI:1.878–9.154). Obesity was found to be significantly associated with hospitalization >3 days (AOR: 1.990, 95% CI: 1.134–3.494) and the presence of increasing haematocrit with decreasing platelets (AOR: 2.134, 95% CI = 1.235–3.688). Serial assessment of laboratory data revealed that peak haematocrit was significantly higher and nadir platelets levels were significantly lower in obese patients. Both peak and admission levels of leukocyte counts, AST, ALT and creatinine were significantly higher in the obese group. Conversely, both admission and nadir albumin levels were lower for the obese group, although only nadir albumin levels achieved statistical significance. These findings support closer clinical monitoring of obese patients who present with DENV infections, as this patient cohort may possess an increased tendency towards developing more severe clinical manifestations of DENV infections as compared to non-obese patients.
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13
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Weger-Lucarelli J, Auerswald H, Vignuzzi M, Dussart P, Karlsson EA. Taking a bite out of nutrition and arbovirus infection. PLoS Negl Trop Dis 2018; 12:e0006247. [PMID: 29596427 PMCID: PMC5875747 DOI: 10.1371/journal.pntd.0006247] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Nutrition is a key factor in host–pathogen defense. Malnutrition can increase both host susceptibility and severity of infection through a number of pathways, and infection itself can promote nutritional deterioration and further susceptibility. Nutritional status can also strongly influence response to vaccination or therapeutic pharmaceuticals. Arthropod-borne viruses (arboviruses) have a long history of infecting humans, resulting in regular pandemics as well as an increasing frequency of autochthonous transmission. Interestingly, aside from host-related factors, nutrition could also play a role in the competence of vectors required for transmission of these viruses. Nutritional status of the host and vector could even influence viral evolution itself. Therefore, it is vital to understand the role of nutrition in the arbovirus lifecycle. This Review will focus on nutritional factors that could influence susceptibility and severity of infection in the host, response to prophylactic and therapeutic strategies, vector competence, and viral evolution. As the old adage goes, you are what you eat. Proper nutrition is a cornerstone of health, and malnutrition can seriously impair the function of the immune system, resulting in increased infections or a more severe disease. Imbalanced or inadequate nutrition can also affect responses to vaccines or drugs that are vital for protection and treatment against viruses. A mosquito is also a product of what it eats. Nutrition during development and adult lifecycle can affect the feeding behavior of mosquitoes, thereby affecting transmission of viral diseases. Arthropod-borne viruses (arboviruses) are a major global health concern, especially in areas impacted by malnutrition. Understanding how nutrition can affect both humans and mosquitoes in the context of these viruses is vital to combating these diseases.
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Affiliation(s)
- James Weger-Lucarelli
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Marco Vignuzzi
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Phillipe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Erik A. Karlsson
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
- * E-mail:
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14
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Zulkipli MS, Dahlui M, Jamil N, Peramalah D, Wai HVC, Bulgiba A, Rampal S. The association between obesity and dengue severity among pediatric patients: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006263. [PMID: 29415036 PMCID: PMC5819989 DOI: 10.1371/journal.pntd.0006263] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/20/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe dengue infection often has unpredictable clinical progressions and outcomes. Obesity may play a role in the deterioration of dengue infection due to stronger body immune responses. Several studies found that obese dengue patients have a more severe presentation with a poorer prognosis. However, the association was inconclusive due to the variation in the results of earlier studies. Therefore, we conducted a systematic review and meta-analysis to explore the relationship between obesity and dengue severity. METHODS We performed a systematic search of relevant studies on Ovid (MEDLINE), EMBASE, the Cochrane Library, Web of Science, Scopus and grey literature databases. At least two authors independently conducted the literature search, selecting eligible studies, and extracting data. Meta-analysis using random-effects model was conducted to compute the pooled odds ratio with 95% confidence intervals (CI). FINDINGS We obtained a total of 13,333 articles from the searches. For the final analysis, we included a total of fifteen studies among pediatric patients. Three cohort studies, two case-control studies, and one cross-sectional study found an association between obesity and dengue severity. In contrast, six cohort studies and three case-control studies found no significant relationship between obesity and dengue severity. Our meta-analysis revealed that there was 38 percent higher odds (Odds Ratio = 1.38; 95% CI:1.10, 1.73) of developing severe dengue infection among obese children compared to non-obese children. We found no heterogeneity found between studies. The differences in obesity classification, study quality, and study design do not modify the association between obesity and dengue severity. CONCLUSION This review found that obesity is a risk factor for dengue severity among children. The result highlights and improves our understanding that obesity might influence the severity of dengue infection.
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Affiliation(s)
- Mohd Syis Zulkipli
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Maznah Dahlui
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor’ashikin Jamil
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Devi Peramalah
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hoe Victor Chee Wai
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Trang NTH, Long NP, Hue TTM, Hung LP, Trung TD, Dinh DN, Luan NT, Huy NT, Hirayama K. Association between nutritional status and dengue infection: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:172. [PMID: 27097934 PMCID: PMC4839161 DOI: 10.1186/s12879-016-1498-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
Background Dengue infection has various clinical manifestations, often with unpredictable clinical evolutions and outcomes. Several factors including nutritional status have been studied to find the relationship with dengue severity. However, the nutritional status had conflicting effects on the complication of dengue in some previous studies. Therefore, we conducted a systematic review and performed a meta-analysis to analyze the association between nutritional status and the outcome of dengue infection. Methods Eleven electronic databases and manual searching of reference lists were used to identify the relevant studies published before August 2013. At least two authors worked independently in every step to select eligible studies and extract data. Dengue severity in the included studies must be classified into three categories: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Results Thirteen articles that met the inclusion criteria came to final analysis. A meta-analysis using fixed- or random-effects models was conducted to calculate pooled odds ratios (OR) with corresponding 95 % confidence intervals. It has shown that there was no statistically significant association between DHF group and DSS group in malnutritional and overweight/obesity patients with OR: 1.17 (95 % CI: 0.99–1.39), 1.31 (0.91–1.88), respectively. A significantly inverse relation between DF and DHF groups of malnutritional patients was revealed (OR = 0.71, 95 % CI: 0.56–0.90). Our meta-analysis also indicated a statistically significant negative correlation between malnourished children with dengue virus infection and healthy children (OR = 0.46, 95 % CI: 0.3–0.70). When analyzing patients with normal nutrition status, we found out that there was a significantly negative relationship between DHF and DSS groups (0.87; 95 % CI: 0.77–0.99). Other comparisons of DSS with DF/DHF groups, DSS/DHF with DF groups, and DHF with DF groups in normal nutritional patients showed no significant correlation. However, the findings should be interpreted cautiously because all significant associations were lost after removing of the largest study. Conclusions Results from previous studies failed to show any solid consistency regarding the association between the nutritional status and dengue infection. Consequently, the effects of nutritional status on dengue disease outcome has been controversial. Further studies are recommended to clarify the impact of nutritional status on dengue infection. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1498-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nguyen Thi Huyen Trang
- Hue University of Medicine and Pharmacy, Hue City, Vietnam.,Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nguyen Phuoc Long
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tran Thi Minh Hue
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Hanoi Medical University, Ha Noi, Vietnam
| | - Le Phi Hung
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tran Dinh Trung
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Da Nang University of Medical Technology and Pharmacy, Da Nang city, Vietnam
| | - Doan Ngoc Dinh
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Health Strategy and Policy Institute (HSPI), Ha Noi, Vietnam
| | - Nguyen Thien Luan
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nguyen Tien Huy
- Online Research Club, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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16
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Rosenberger KD, Lum L, Alexander N, Junghanss T, Wills B, Jaenisch T. Vascular leakage in dengue--clinical spectrum and influence of parenteral fluid therapy. Trop Med Int Health 2016; 21:445-53. [PMID: 26752720 DOI: 10.1111/tmi.12666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Clinical management of dengue relies on careful monitoring of fluid balance combined with judicious intravenous (IV) fluid therapy. However, in patients with significant vascular leakage, IV fluids may aggravate serosal fluid accumulation and result in respiratory distress. METHODS Trained physicians followed suspected dengue cases prospectively at seven hospitals across Asia and Latin America, using a comprehensive case report form that included daily clinical assessment and detailed documentation of parenteral fluid therapy. Applying Cox regression, we evaluated risk factors for the development of shock or respiratory distress with fluid accumulation. RESULTS Most confirmed dengue patients (1524/1734, 88%) never experienced dengue shock syndrome (DSS). Among those with DSS, 176/210 (84%) had fluid accumulation, and in the majority (83%), this was detectable clinically. Among all cases with clinically detectable fluid accumulation, 179/447 (40%) were diagnosed with shock or respiratory distress. The risk for respiratory distress with fluid accumulation increased significantly as the infused volume over the preceding 24 h increased (hazard ratio 1.18 per 10 ml/kg increase; P < 0.001). Longer duration of IV therapy, use of a fluid bolus in the preceding 24 h, female gender and poor nutrition also constituted independent risk factors. CONCLUSIONS Shock and respiratory distress are relatively rare manifestations of dengue, but some evidence of fluid accumulation is seen in around 50% of cases. IV fluids play a crucial role in management, but they must be administered with caution. Clinically and/or radiologically detectable fluid accumulations have potential as intermediate severity endpoints for therapeutic intervention trials and/or pathogenesis studies.
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Affiliation(s)
- Kerstin D Rosenberger
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucy Lum
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Junghanss
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Bridget Wills
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thomas Jaenisch
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
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17
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Lam PK, Hoai Tam DT, Dung NM, Hanh Tien NT, Thanh Kieu NT, Simmons C, Farrar J, Wills B, Wolbers M. A Prognostic Model for Development of Profound Shock among Children Presenting with Dengue Shock Syndrome. PLoS One 2015; 10:e0126134. [PMID: 25946113 PMCID: PMC4422752 DOI: 10.1371/journal.pone.0126134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/30/2015] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To identify risk factors and develop a prediction model for the development of profound and recurrent shock amongst children presenting with dengue shock syndrome (DSS). METHODS We analyzed data from a prospective cohort of children with DSS recruited at the Paediatric Intensive Care Unit of the Hospital for Tropical Disease in Ho Chi Minh City, Vietnam. The primary endpoint was "profound DSS", defined as ≥2 recurrent shock episodes (for subjects presenting in compensated shock), or ≥1 recurrent shock episodes (for subjects presenting initially with decompensated/hypotensive shock), and/or requirement for inotropic support. Recurrent shock was evaluated as a secondary endpoint. Risk factors were pre-defined clinical and laboratory variables collected at the time of presentation with shock. Prognostic model development was based on logistic regression and compared to several alternative approaches. RESULTS The analysis population included 1207 children of whom 222 (18%) progressed to "profound DSS" and 433 (36%) had recurrent shock. Independent risk factors for both endpoints included younger age, earlier presentation, higher pulse rate, higher temperature, higher haematocrit and, for females, worse hemodynamic status at presentation. The final prognostic model for "profound DSS" showed acceptable discrimination (AUC=0.69 for internal validation) and calibration and is presented as a simple score-chart. CONCLUSIONS Several risk factors for development of profound or recurrent shock among children presenting with DSS were identified. The score-chart derived from the prognostic models should improve triage and management of children presenting with DSS in dengue-endemic areas.
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Affiliation(s)
- Phung Khanh Lam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Dong Thi Hoai Tam
- University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | - Nguyen Thi Hanh Tien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Nguyen Tan Thanh Kieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Cameron Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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18
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Ahmed S, Finkelstein JL, Stewart AM, Kenneth J, Polhemus ME, Endy TP, Cardenas W, Mehta S. Micronutrients and dengue. Am J Trop Med Hyg 2014; 91:1049-56. [PMID: 25200269 DOI: 10.4269/ajtmh.14-0142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dengue virus infection is the most widespread mosquito-borne viral infection in humans and has emerged as a serious global health challenge. In the absence of effective treatment and vaccine, host factors including nutritional status, which may alter disease progression, need investigation. The interplay between nutrition and other infections is well-established, and modulation of nutritional status often presents a simple low-cost method of interrupting transmission, reducing susceptibility, and/or ameliorating disease severity. This review examines the evidence on the role of micronutrients in dengue virus infection. We found critical issues and often inconsistent results across studies; this finding along with the lack of sufficient literature in this field have limited our ability to make any recommendations. However, vitamins D and E have shown promise in small supplementation trials. In summary, the role of micronutrients in dengue virus infection is an exciting research area and needs to be examined in well-designed studies with larger samples.
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Affiliation(s)
- Sundus Ahmed
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Anna M Stewart
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - John Kenneth
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Mark E Polhemus
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Timothy P Endy
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Washington Cardenas
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
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Al-alimi AA, Ali SA, Al-Hassan FM, Idris FM, Teow SY, Mohd Yusoff N. Dengue virus type 2 (DENV2)-induced oxidative responses in monocytes from glucose-6-phosphate dehydrogenase (G6PD)-deficient and G6PD normal subjects. PLoS Negl Trop Dis 2014; 8:e2711. [PMID: 24625456 PMCID: PMC3953068 DOI: 10.1371/journal.pntd.0002711] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dengue virus is endemic in peninsular Malaysia. The clinical manifestations vary depending on the incubation period of the virus as well as the immunity of the patients. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is prevalent in Malaysia where the incidence is 3.2%. It has been noted that some G6PD-deficient individuals suffer from more severe clinical presentation of dengue infection. In this study, we aim to investigate the oxidative responses of DENV2-infected monocytes from G6PD-deficient individuals. METHODOLOGY Monocytes from G6PD-deficient individuals were infected with DENV2 and infection rate, levels of oxidative species, nitric oxide (NO), superoxide anions (O2-), and oxidative stress were determined and compared with normal controls. PRINCIPAL FINDINGS Monocytes from G6PD-deficient individuals exhibited significantly higher infection rates compared to normal controls. In an effort to explain the reason for this enhanced susceptibility, we investigated the production of NO and O2- in the monocytes of individuals with G6PD deficiency compared with normal controls. We found that levels of NO and O2- were significantly lower in the DENV-infected monocytes from G6PD-deficient individuals compared with normal controls. Furthermore, the overall oxidative stress in DENV-infected monocytes from G6PD-deficient individuals was significantly higher when compared to normal controls. Correlation studies between DENV-infected cells and oxidative state of monocytes further confirmed these findings. CONCLUSIONS/SIGNIFICANCE Altered redox state of DENV-infected monocytes from G6PD-deficient individuals appears to augment viral replication in these cells. DENV-infected G6PD-deficient individuals may contain higher viral titers, which may be significant in enhanced virus transmission. Furthermore, granulocyte dysfunction and higher viral loads in G6PD-deificient individuals may result in severe form of dengue infection.
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Affiliation(s)
| | - Syed A. Ali
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | - Faisal Muti Al-Hassan
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | - Fauziah Mohd Idris
- Department of Microbiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Sin-Yeang Teow
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | - Narazah Mohd Yusoff
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
- * E-mail:
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20
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TREM-1 modulation during early stages of dengue virus infection. Immunol Lett 2014; 158:183-8. [DOI: 10.1016/j.imlet.2014.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
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21
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Torres-Galicia I, Cortés-Poza D, Becker I. [Dengue in Mexico: Increase in the juvenile population during the last decade]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2014; 71:196-201. [PMID: 29421251 DOI: 10.1016/j.bmhimx.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/27/2014] [Indexed: 11/24/2022] Open
Abstract
Dengue is one of the principal vector-transmitted diseases leading to important public health problems in Mexico and Latin America. On the American continent this disease has been reported mostly in adults, which contrasts with Asian countries where pediatric dengue is more prominent. During the last decade a shift towards pediatric dengue has been reported in various countries of the American continent. This review, elaborated from data published by the Mexican Ministry of Health, focuses on dengue in Mexico during the last three decades, showing that during the last decade dengue fever and dengue hemorrhagic fever has begun to shift towards a juvenile and pediatric population.
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Affiliation(s)
- Ivonne Torres-Galicia
- Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
| | - David Cortés-Poza
- Core de Bioestadística, Dirección de Investigación, Hospital General de México, México D.F., México
| | - Ingeborg Becker
- Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México.
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