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Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital.

Lam PK, Tam DT, Diet TV, Tam CT, Tien NT, Kieu NT, Simmons C, Farrar J, Nga NT, Qui PT, Dung NM, Wolbers M, Wills B - Clin. Infect. Dis. (2013)

Bottom Line: The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion.All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever.With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.

View Article: PubMed Central - PubMed

Affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases.

ABSTRACT

Background: Dengue shock syndrome (DSS) is a severe manifestation of dengue virus infection that particularly affects children and young adults. Despite its increasing global importance, there are no prospective studies describing the clinical characteristics, management, or outcomes of DSS.

Methods: We describe the findings at onset of shock and the clinical evolution until discharge or death, from a comprehensive prospective dataset of 1719 Vietnamese children with laboratory-confirmed DSS managed on a single intensive care unit between 1999 and 2009.

Results: The median age of patients was 10 years. Most cases had secondary immune responses, with only 6 clear primary infections, and all 4 dengue virus serotypes were represented during the 10-year study. Shock occurred commonly between days 4 and 6 of illness. Clinical signs and symptoms were generally consistent with empirical descriptions of DSS, although at presentation 153 (9%) were still febrile and almost one-third had no bleeding. Overall, 31 (2%) patients developed severe bleeding, primarily from the gastrointestinal tract, 26 of whom required blood transfusion. Only 8 patients died, although 123 of 1719 (7%) patients had unrecordable blood pressure at presentation and 417 of the remaining 1596 (26%) were hypotensive for age. The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion. All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever.

Conclusions: With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.

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Related in: MedlinePlus

Box plots describing changes in hematocrit (A) and platelet count (B) during the evolution of the illness. Hematocrit data are presented for the 24 hours following admission, whereas platelet data are presented daily for the first 4 days, together with the discharge day and follow-up values for both parameters. The numbers displayed below each box plot represent the number of patients included within that time interval. If multiple values were recorded during any time interval, we chose the highest hematocrit and the lowest platelet count, respectively, for that patient. The hematocrit graph excludes data from the 73 patients with dengue shock syndrome with mucosal bleeding at presentation.
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CIT594F1: Box plots describing changes in hematocrit (A) and platelet count (B) during the evolution of the illness. Hematocrit data are presented for the 24 hours following admission, whereas platelet data are presented daily for the first 4 days, together with the discharge day and follow-up values for both parameters. The numbers displayed below each box plot represent the number of patients included within that time interval. If multiple values were recorded during any time interval, we chose the highest hematocrit and the lowest platelet count, respectively, for that patient. The hematocrit graph excludes data from the 73 patients with dengue shock syndrome with mucosal bleeding at presentation.

Mentions: The evolution of hematocrit and platelet values is shown in Figure 1. The median maximum hematocrit was 50% (IQR, 47%–52%), documented at presentation in most cases (1484/1719 [86%]). Among patients with both enrollment and 1-month follow-up values, 755 of 832 (91%) had at least 20% hemoconcentration at enrollment. The hematocrit declined rapidly during the first 4 hours of resuscitation, later rising again in the majority of children. In contrast, the platelet nadir (median, 28 000 cells/µL [IQR, 19 000–40 000 cells/µL]) occurred most frequently 1 day after onset of shock (720/1718 [42%]). Although a transient drop in platelet count was seen in all cases, in 25 of 1718 cases the nadir remained >100 000 cells/µL. Coagulation profiles were performed infrequently and are not reported here, but the abnormalities observed were consistent with previous reports [17, 18]. Liver enzyme levels were checked in approximately 60% and were moderately elevated at shock, with aspartate aminotransferase levels consistently higher than alanine aminotransferase levels.Figure 1.


Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital.

Lam PK, Tam DT, Diet TV, Tam CT, Tien NT, Kieu NT, Simmons C, Farrar J, Nga NT, Qui PT, Dung NM, Wolbers M, Wills B - Clin. Infect. Dis. (2013)

Box plots describing changes in hematocrit (A) and platelet count (B) during the evolution of the illness. Hematocrit data are presented for the 24 hours following admission, whereas platelet data are presented daily for the first 4 days, together with the discharge day and follow-up values for both parameters. The numbers displayed below each box plot represent the number of patients included within that time interval. If multiple values were recorded during any time interval, we chose the highest hematocrit and the lowest platelet count, respectively, for that patient. The hematocrit graph excludes data from the 73 patients with dengue shock syndrome with mucosal bleeding at presentation.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814826&req=5

CIT594F1: Box plots describing changes in hematocrit (A) and platelet count (B) during the evolution of the illness. Hematocrit data are presented for the 24 hours following admission, whereas platelet data are presented daily for the first 4 days, together with the discharge day and follow-up values for both parameters. The numbers displayed below each box plot represent the number of patients included within that time interval. If multiple values were recorded during any time interval, we chose the highest hematocrit and the lowest platelet count, respectively, for that patient. The hematocrit graph excludes data from the 73 patients with dengue shock syndrome with mucosal bleeding at presentation.
Mentions: The evolution of hematocrit and platelet values is shown in Figure 1. The median maximum hematocrit was 50% (IQR, 47%–52%), documented at presentation in most cases (1484/1719 [86%]). Among patients with both enrollment and 1-month follow-up values, 755 of 832 (91%) had at least 20% hemoconcentration at enrollment. The hematocrit declined rapidly during the first 4 hours of resuscitation, later rising again in the majority of children. In contrast, the platelet nadir (median, 28 000 cells/µL [IQR, 19 000–40 000 cells/µL]) occurred most frequently 1 day after onset of shock (720/1718 [42%]). Although a transient drop in platelet count was seen in all cases, in 25 of 1718 cases the nadir remained >100 000 cells/µL. Coagulation profiles were performed infrequently and are not reported here, but the abnormalities observed were consistent with previous reports [17, 18]. Liver enzyme levels were checked in approximately 60% and were moderately elevated at shock, with aspartate aminotransferase levels consistently higher than alanine aminotransferase levels.Figure 1.

Bottom Line: The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion.All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever.With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.

View Article: PubMed Central - PubMed

Affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases.

ABSTRACT

Background: Dengue shock syndrome (DSS) is a severe manifestation of dengue virus infection that particularly affects children and young adults. Despite its increasing global importance, there are no prospective studies describing the clinical characteristics, management, or outcomes of DSS.

Methods: We describe the findings at onset of shock and the clinical evolution until discharge or death, from a comprehensive prospective dataset of 1719 Vietnamese children with laboratory-confirmed DSS managed on a single intensive care unit between 1999 and 2009.

Results: The median age of patients was 10 years. Most cases had secondary immune responses, with only 6 clear primary infections, and all 4 dengue virus serotypes were represented during the 10-year study. Shock occurred commonly between days 4 and 6 of illness. Clinical signs and symptoms were generally consistent with empirical descriptions of DSS, although at presentation 153 (9%) were still febrile and almost one-third had no bleeding. Overall, 31 (2%) patients developed severe bleeding, primarily from the gastrointestinal tract, 26 of whom required blood transfusion. Only 8 patients died, although 123 of 1719 (7%) patients had unrecordable blood pressure at presentation and 417 of the remaining 1596 (26%) were hypotensive for age. The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion. All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever.

Conclusions: With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.

Show MeSH
Related in: MedlinePlus