scholarly journals Causes of death among hospitalized adults with dengue fever in Tainan, 2015: emphasis on cardiac events and bacterial infections

2018 ◽  
Author(s):  
Jen-Chieh Lee ◽  
Cong-Tat Cia ◽  
Nan-Yao Lee ◽  
Nai-Ying Ko ◽  
Po-Lin Chen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Dengue Fever ◽  
Causes Of Death ◽  
Fatal Case ◽  
Case Fatality ◽  
The Elderly ◽  
Severe Dengue ◽  
Do Not Resuscitate ◽  
Secondary Infections ◽  
Dengue Epidemic

Introduction. The 2015 dengue outbreak in southern Taiwan caused substantial mortality rates in the elderly. We analyzed here the causes of death among adults with dengue. Methods. The retrospective study was conducted at a medical center in Tainan from the 1st of August to 31th of December in the year 2015. The detection of the dengue NS1 antigen IgM or viral RNA in patients' blood were used to diagnose dengue. Clinical courses and causes of death were retrieved from chart reviews by two intensivists. Results. There were 4,488 cases of dengue diagnosed in the study hospital, and these cases had an in-hospital case fatality rate of 1.34% (60 cases). Of these, the mean age was 73 years and gender did not predict outcome. Twenty-eight (46.7%) cases died of severe dengue, and 29 (48.3%) deaths were possibly caused by dengue-related complications, which were mostly secondary infections (24 cases). Most of the families of fatal case (70%) signed do-not-resuscitate (DNR) orders prior to the patients' death. When the dengue epidemic peaked, 13 cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests at the emergency department, occurred within four weeks of the dengue epidemic. Notably, in half (7) of these cases, the patients did not search for medical aid prior to experiencing cardiac arrest. Of the 40 cases that had early death (occurring within one week after hospitalization), 60% died of severe dengue. In contrast, 50% of the 20 deaths that occurred later than one week after hospitalization were related to hospital-acquired infections, mainly pneumonia. Conclusion. The elderly that experience dengue fever may die of severe dengue early or die of secondary infections later. Cardiac arrests can also occur unpredictably at the first aids, which highlight the need of professional and patient education regarding the danger signs that are related to severe dengue in an epidemic setting.

scholarly journals A study on the outbreak of dengue fever in a tertiary care children’s hospital in southern Tamil Nadu, India

2019 ◽  
Vol 6 (3) ◽  
pp. 1194
Author(s):  
Belgin Premkumar ◽  
Baburaj S. ◽  
Margaret Hepzibah N. ◽  
Misha K. P. ◽  
Binu Abraham
Keyword(s):  
Dengue Fever ◽  
Tamil Nadu ◽  
Tertiary Care ◽  
Case Fatality ◽  
Dengue Shock Syndrome ◽  
Viral Disease ◽  
Severe Dengue ◽  
Care Hospital ◽  
Clinical Criteria ◽  
Public Health Challenge

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study’s objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.

scholarly journals Dengue Fever and Severe Dengue in Barbados, 2008–2016

2020 ◽  
Vol 5 (2) ◽  
pp. 68
Author(s):  
Kirk Osmond Douglas ◽  
Sudip Kumar Dutta ◽  
Byron Martina ◽  
Fatih Anfasa ◽  
T. Alafia Samuels ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Dengue Fever ◽  
Small Sample Size ◽  
Health Planning ◽  
Case Fatality ◽  
Small Sample ◽  
Severe Dengue ◽  
Medical Attention ◽  
Enzyme Linked Immunosorbent Assay ◽  
Virus Serotype

Analysis of the temporal, seasonal and demographic distribution of dengue virus (DENV) infections in Barbados was conducted using national surveillance data from a total of 3994 confirmed dengue cases. Diagnosis was confirmed either by DENV–specific real time reverse transcriptase polymerase chain reaction (rRT–PCR), or non–structural protein 1 (NS1) antigen or enzyme linked immunosorbent assay (ELISA) tests; a case fatality rate of 0.4% (10/3994) was observed. The dengue fever (DF) prevalence varied from 27.5 to 453.9 cases per 100,000 population among febrile patients who sought medical attention annually. DF cases occurred throughout the year with low level of transmission observed during the dry season (December to June), then increased transmission during rainy season (July to November) peaking in October. Three major dengue epidemics occurred in Barbados during 2010, 2013 and possibly 2016 with an emerging three–year interval. DF prevalence among febrile patients who sought medical attention overall was highest among the 10–19 years old age group. The highest DF hospitalisation prevalence was observed in 2013. Multiple serotypes circulated during the study period and Dengue virus serotype 2 (DENV–2) was the most prevalent serotype during 2010, whilst DENV–1 was the most prevalent serotype in 2013. Two DENV–1 strains from the 2013 DENV epidemic were genetically more closely related to South East Asian strains, than Caribbean or South American strains, and represent the first ever sequencing of DENV strains in Barbados. However, the small sample size (n = 2) limits any meaningful conclusions. DF prevalence was not significantly different between females and males. Public health planning should consider DENV inter–epidemic periodicity, the current COVID–19 pandemic and similar clinical symptomology between DF and COVID–19. The implementation of routine sequencing of DENV strains to obtain critical data can aid in battling DENV epidemics in Barbados.

scholarly journals Clinico-epidemiological study of dengue fever in Ajmer region

2019 ◽  
Vol 6 (5) ◽  
pp. 2046
Author(s):  
Dharmendra Rawat ◽  
Kanwar Singh ◽  
Pukhraj Garg
Keyword(s):  
Dengue Fever ◽  
Case Fatality Rate ◽  
Wide Spectrum ◽  
Dengue Infection ◽  
Case Fatality ◽  
Hemorrhagic Fever ◽  
Severe Dengue ◽  
Common Disease ◽  
Hemorrhagic Disease ◽  
Fatality Rate

Background: Dengue infection is a major challenge to public health, especially in South-East Asia. It present with a diverse clinical spectrum. Estimates suggest that annually over 50 million cases of dengue hemorrhagic fever (DHF) occur in Asian countries with a case fatality rate of less than 5%. Of those with DHF, at least 90% are children younger than 15 years old. In humans, dengue infection causes a spectrum of illness ranging from relatively mild, non-specific viral syndrome known as Dengue fever (DF) to severe hemorrhagic disease and death. Definitive early Dengue diagnosis requires laboratory tests and those suitable for use at this stage of illness are either costly, such as RT-PCR for Dengue; not sufficiently rapid, such as virus isolation. Currently test available are NS1 antigen detection and ELISA for dengue, IgM and IgG antibodies. Objective of this study is to study clinico-epidemiological and haematological features of Dengue infection.Methods: Prospective observational study involving initial 100 registered cases who were serologically confirmed dengue infection for a period of one year.Results: DF, DHF and DSS were found in 41%, 53% and 6% patients respectively. Most common presenting complaint and bleeding manifestation were fever and petechiae. Uncommonly altered sensorium and icterus were found in severe dengue infection. 6% patients had coagulopathy, 37 patients had hepatic involvement and 2 patients had deranged renal function who had DSS. Fever was present in (100%) cases of DF, DHF and DSS. 26% patients had their platelet count <50000/mm3.Conclusions: Dengue is a common disease in the India with wide spectrum of clinical presentations, affecting 5-15 years age group children commonly. It is one of the dreaded fevers but early diagnosis and management according to recent WHO guidelines can decrease case fatality rate significantly.

scholarly journals Dengue Outbreak in Children During 2019: Experience at A Tertiary Care teaching Hospital

2021 ◽  
Vol 20 (1) ◽  
pp. 46-50
Author(s):  
Mitra Datta ◽  
Asma Ferdousi ◽  
Salina Haque ◽  
Rifat Jahan ◽  
Aparup Das ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pleural Effusion ◽  
Dengue Fever ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Warning Signs ◽  
Severe Dengue ◽  
College Hospital ◽  
Dengue Outbreak

 Background: Dengue outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. This study was aimed to describe the clinico-epidemiological profile and outcome of dengue infected children during 2019 dengue outbreak in Chattogram. Materials and methods: This hospital based prospective observational study was carried out in the Department of Pediatrics in Chattogram Medical College Hospital. Serologically positive dengue cases (Aged £12 years) admitted from July 2019 to December 2019 were enrolled in the study. Hospital outcome of the patient’s was recorded in terms of mortality, Length of Hospital Stay (LOS) need for ICU. Results: Out of total 192 patients as per the National Guideline 66.7% cases were classified as dengue fever without warning signs, 21.9% as dengue fever with warning signs and 11.5% as severe dengue. Overall the mean age was 7.04 (±3.23) years with male preponderance (59%). Along with fever main complaints were abdominal pain (91.7%), vomiting (47.9%) and headache (23.6%). Marked thrombocytopenia (Below 50,000) was present in 37.9%, leucopenia in 27.9% and raised haematocrit in 10.9% of cases. Average LOS was 5.2 (±1.9) days, 18 (9.5%) patients need ICU admission and there was no fatality in this series. Some clinical (Vomiting, flusihing, shock, reduced urinary output) and laboratory (Marked thrombocytopenia, leucopenia, hemoconcentration, pleural effusion and hepatomegaly) variables were associated with severity. Conclusion: Fever with abdominal pain were common presentations of dengue fever. Severe dengue patients presented with vomiting, flashing and shock. Marked thrombocytopenia and pleural effusion and/or ascites were related to shock. Appropriate and timely management is very effective in reducing case fatality. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 46-50

scholarly journals The Pathogenesis and Immune-Response in Dengue Haemorrhagic Fever

2019 ◽  
pp. 1-12
Author(s):  
A. M. Meer Ahmad ◽  
S. Arumugam ◽  
Chee Loon Leong
Keyword(s):  
Immune Response ◽  
Dengue Fever ◽  
Dengue Hemorrhagic Fever ◽  
Case Fatality ◽  
Hemorrhagic Fever ◽  
Severe Dengue ◽  
Robust Immune Response ◽  
Different Strains ◽  
Original Antigenic Sin ◽  
Near Future

Introduction: Dengue fever has spread to be endemic in addition of 100 countries to a total estimate incidence of 50 – 100 million cases annually globally. About 0.7% of these cases become the complication that is dengue hemorrhagic fever which is severe and leads to about 22,000 deaths annually. The pathogenesis of benign dengue fever becoming dengue hemorrhagic fever, and aspects of the immune-response behind it, have remained relatively unknown. Methods: Existing literature on the Topic was retrieved through Google Scholar and PubMed searches, and the literature reviewed. Results: Dengue hemorrhagic fever appears commoner in females and those with co-morbids such as diabetes-mellitus and obesity. Also, the case-fatality rate in severe dengue appears much bigger in females. The reasons for this are largely unknown but the additionally robust immune response in females, resulting in females to be additionally prone to develop bigger inflammatory response or enhanced susceptibility to capillary permeability could be the reason. It has been shown that viremic-load, including the initial viremic-load at the bite of the Aedes-mosquito may be a factor leading to dengue hemorrhagic fever. Yet different factors felt to be causative in the pathogenesis of dengue hemorrhagic fever include the role of the viral-protein, and then that which is termed the original antigenic-sin, the antibody-directed enhancement, autoimmunity, inhibition of interferon-alpha and cytokine-storm within the memory-cells. Regionally, certain different strains of the DENV also seem to be associated with dengue hemorrhagic fever. Newer-vaccines, based on the immunology of the disease, offer much hope in the near future. Conclusion: Much knowledge has been forthcoming in realizing the pathogenesis of dengue hemorrhagic fever. But, additional studies need to be done.

Fatal outcomes of imported dengue fever in adult travelers from non-endemic areas are associated with primary infections

2021 ◽  
Author(s):  
Ralph Huits ◽  
Eli Schwartz
Keyword(s):  
Health Care Providers ◽  
Case Reports ◽  
Secondary Infection ◽  
Fatal Outcome ◽  
Case Fatality ◽  
Severe Dengue ◽  
Care Providers ◽  
Denv Serotypes ◽  
Secondary Infections ◽  
The Impact

Abstract Background The case-fatality rate of dengue in travelers is low. Secondary dengue virus (DENV) infections are considered a risk factor for fatal outcome in endemic populations; however, the impact of secondary infections on mortality in travelers has not been studied systematically. We performed a descriptive analysis of case reports of dengue fatalities in travelers. Methods We searched Medline for clinical case reports, using the free terms and MeSH headings: ‘Dengue’ OR ‘Severe Dengue’ AND ‘Travel-Related Illness’ OR ‘travel’ AND ‘Mortality’ OR ‘Fatal Outcome’. We analyzed case reports of fatal dengue in returning travelers published from 1995 to 2020, with the objective to detail risk factors for dengue mortality in this population. We verified the authors’ classifications of primary or secondary dengue infections; infections were considered as primary by absence of anti-DENV immunoglobulin (Ig)G or by IgM-to-IgG ratios greater than or equal to 1.8 in the first 7 days post symptom onset. Results We identified nine detailed reports of dengue with fatal outcome among travelers from non-endemic countries. Eight fatalities were female. The median age was 32 years (range 21–63). Out of nine fatal cases, seven travelers had a primary DENV infection, one had a secondary infection and, in one, these data were not reported. The infecting DENV serotypes were DENV-1 (n = 2), DENV-2 (n = 2) and DENV-3 (n = 3); DENV-1 or 2 (n = 1) and in one case, the serotype could not be determined. Conclusions Dengue-related deaths in travelers are rare. Most dengue cases in travelers are primary infections. Contrary to prevailing conceptions, we found that fatal outcomes of dengue in travelers from non-endemic countries were reported mainly with primary DENV infections. We alert health care providers that primary DENV infections are not always harmless and that in adult travelers from non-endemic countries, primary infections may contribute more to dengue-related mortality than secondary infections.

scholarly journals Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Shubhankar Mishra ◽  
Ramya Ramanathan ◽  
Sunil Kumar Agarwalla
Keyword(s):  
Dengue Fever ◽  
Viral Infections ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Case Fatality ◽  
Clinical Profile ◽  
Severe Dengue ◽  
High Morbidity ◽  
Care Hospital ◽  
The Mean

Background. In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality.Objectives. To assess the clinical profile of the dengue infection in children less than 14 years of age and to evaluate the outcomes of dengue fever from September 2013 to August 2015 at the Pediatric Department of Maharaja Krishna Chandra Gajapati Medical College, the largest tertiary care hospital of southern Odisha.Results. A total of 97 cases were classified into 84 (86.59%) nonsevere and 13 (13.40%) severe dengue cases. The most common age of presentation was above 11 yrs. The mean age of admission was 8.7 yrs. The most common presenting symptom was fever seen in 100% and hepatomegaly (43.8%), the most common physical finding. Gastrointestinal bleeding was markedly seen in severe dengue (76.9%). Elevation in aspartate transaminase (SGOT) was found in 47.42% and thrombocytopenia in 27.5%. The correlation between hepatomegaly and elevated SGOT was significant (Pvalue 0.0346). Case fatality rate (CFR) was 1.03%. The mean duration of hospitalisation was 3.8 days.Conclusion. In children, if symptoms like fever, pain, rashes, and vomiting are associated with hepatomegaly and elevated SGOT in context of low TPC, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

scholarly journals Clinical and laboratory profile of dengue fever in children during an outbreak - one year study at tertiary care hospital, Chennai, Tamilnadu, India

2016 ◽  
Vol 4 (1) ◽  
pp. 110 ◽  
Author(s):  
Natwar Lal Sharma ◽  
Vasuki Balasubramanyam ◽  
Jithendra Kandati ◽  
Munilakshmi Ponugoti
Keyword(s):  
Dengue Fever ◽  
Tertiary Care Hospital ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Case Fatality ◽  
Severe Dengue ◽  
Care Hospital ◽  
Duration Of Stay ◽  
Laboratory Profile ◽  
One Year

Background: Dengue fever is a mosquito borne arboviral disease which is of global concern. It is endemic in tropical countries with annual incidence of 7.5 to 32.5 million cases. It commonly affects the young adults and paediatric cases of Dengue haemorrhagic fever has high mortality. The objective of this study was to assess the clinical and laboratory profile and outcomes of dengue fever in children of less than 18 years of age. The study was conducted for a period of one year during an outbreak, in a tertiary care hospital of Chennai, Tamilnadu, India.Methods: This was a prospective cross sectional study and 200 cases of dengue fever were enrolled and classified as per WHO guidelines. The clinical profile and demographic profile was recorded in a structured questionnaire form. Haematological parameters were recorded and followed till the day of discharge. The duration of stay was recorded and outcomes were noted.Results: A total of 200 cases with 113 males and 87 females, 177 non severe dengue cases and 23 severe cases of dengue fever were classified. The mean age of admission was 9 years and mean duration of stay in hospital was 4.61 days. Fever was most common presenting symptom (100%) and hepatomegaly (58.5%) was common clinical finding. Bleeding manifestations were seen in severe dengue cases. Statistical significance was seen in rise in SGOT levels, rise in haematocrit and pleural effusion with severe dengue cases and non-severe dengue cases. The case fatality rate was zero.Conclusions: Understanding the knowledge of presentations and associated features would help to predict the severity of the disease. In children, if symptoms like fever, pain, rashes, and vomiting are associated with Hepatomegaly and elevated SGOT in context of low total platelet count, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

scholarly journals A study of sterile pyuria in dengue fever

2019 ◽  
Vol 6 (5) ◽  
pp. 1393
Author(s):  
Prashanth V. N. ◽  
Sneha .
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Dengue Fever ◽  
Age Distribution ◽  
Case Fatality ◽  
Severe Dengue ◽  
Cross Sectional ◽  
Sterile Pyuria ◽  
Risk Of Disease

Background: Dengue fever is an important tropical disease which is endemic in around 110 countries. It infects 50-100 million people worldwide per year. In India case fatality rate is 1-5% for severe Dengue. Between 2015-2017, 790 deaths have been recorded according to NVBDCP data. Global burden of Dengue has increased at least fourfold over last three decades and now 2.5 billion people at risk of disease. This study aims at determining sterile pyuria as a manifestation  in patients presenting with Dengue fever, as patients may present with similar symptoms as that of urinary tract infection, thereby preventing  unnecessary use of antibiotics.Methods: It is a Cross sectional observational study conducted on 100 consecutive patients with serologically proven Dengue fever. Patients satisfying inclusion and exclusion criteria underwent relevant investigations and in patients with urine routine showing pyuria, urine culture and sensitivity was done to rule out urinary tract infection and look for sterile pyuria.Results: Among 100 patients of dengue studied, age distribution being 18years to 70years, mean age was 33.27±13.2 years of them 78 were male and 22 were female. 41% patients showed pyuria in urine. 25 % patients were culture positive most common being E. coli and 16% patients had sterile pyuria.Conclusions: Sterile pyuria is not a well-recognized entity in Dengue fever and is often missed. This study shows that sterile pyuria is quite common manifestation in dengue fever which resembles urinary tract infection and therefore does not require any empirical antibiotic treatment.  

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