Dengue Fever: Clinical, Laboratory Profile and Outcome in Pediatric Patient

Introduction: Infection with any of the 4 dengue virus serotypes results in a diverse range of symptoms, from mild undifferentiated fever to life-threatening hemorrhagic fever and shock. Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient management. So a study was carried out to know its clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients. Aim: To study the clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients at tertiary care center. Method: Retrospective Observational study from 1st May 2019 to 31st April 2021. Result: Total 323 patients were studied during 1st May 2019 to 31st April 2021. Most common presentation was fever (100%), most common clinical finding is hepatomegaly (14.2%). All severe dengue infection has platelet count < 50000/cumm. In study of 323 patients 194(60%) of dengue fever,85(26.4%) of DHF GRADE 1,9(2.8%) of DHF GRADE 2 were discharged .13(4%) patients of DSS were expired.22 patients (6.8%) went DAMA. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases. Keywords: dengue fever, platelet count, outcome

The fewer, the better fare: Can the loss of vegetation in the Cerrado drive the increase in dengue fever cases infection?

Several studies have reported the relationship of deforestation with increased incidence of infectious diseases, mainly due to the deregulation caused in these environments. The purpose of this study was to answer the following questions: a) is increased loss of vegetation related to dengue cases in the Brazilian Cerrado? b) how do different regions of the tropical savanna biome present distinct patterns for total dengue cases and vegetation loss? c) what is the projection of a future scenario of deforestation and an increased number of dengue cases in 2030? Thus, this study aimed to assess the relationship between loss of native vegetation in the Cerrado and dengue infection. In this paper, we quantify the entire deforested area and dengue infection cases from 2001 to 2019. For data analyses, we used Poisson generalized linear model, descriptive statistics, cluster analysis, non-parametric statistics, and autoregressive integrated moving average (ARIMA) models to predict loss of vegetation and fever dengue cases for the next decade. Cluster analysis revealed the formation of four clusters among the states. Our results showed significant increases in loss of native vegetation in all states, with the exception of Piauí. As for dengue cases, there were increases in the states of Minas Gerais, São Paulo, and Mato Grosso. Based on projections for 2030, Minas Gerais will register about 4,000 dengue cases per 100,000 inhabitants, São Paulo 750 dengue cases per 100,000 inhabitants, and Mato Grosso 500 dengue cases per 100,000 inhabitants. To reduce these projections, Brazil will need to control deforestation and implement public health, environmental and social policies, requiring a joint effort from all spheres of society.

In Acute Dengue Infection, High TIM-3 Expression May Contribute to the Impairment of IFNγ Production by Circulating Vδ2 T Cells

γδ T cells are innate cells able to quickly eliminate pathogens or infected/tumoral cells by their antiviral and adjuvancy activities. The role of γδ T cells during Dengue Viral Infection (DENV) infection is not fully elucidated. Nevertheless, human primary γδ T cells have been shown to kill in vitro DENV-infected cells, thus highlighting their possible antiviral function. The aim of this work was to characterize the phenotype and function of Vδ2 T cells in DENV patients. Fifteen DENV patients were enrolled for this study and peripheral blood mononuclear cells (PBMC) were used to analyze Vδ2-T-cell frequency, differentiation profile, activation/exhaustion status, and functionality by multiparametric flow cytometry. Our data demonstrated that DENV infection was able to significantly reduce Vδ2-T-cell frequency and to increase their activation (CD38 and HLA-DR) and exhaustion markers (PD-1 and TIM-3). Furthermore, Vδ2 T cells showed a reduced capability to produce IFN-γ after phosphoantigenic stimulation that can be associated to TIM-3 expression. Several studies are needed to depict the possible clinical impact of γδ-T-cell impairment on disease severity and to define the antiviral and immunoregulatory activities of γδ T cells in the first phases of infection.

Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience

Peritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36–89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients (n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.

Haemophagocytic Lymphohistiocytosis (HLH) in Adult with Dengue Infection

Haemophagocytic lymphohistiocytosis (HLH) or haemophagocytic syndrome is a rare but life-threatening syndrome of excessive immune activation with nonspecific clinical presentation. HLH is one of the complications in dengue infection. A 69-year-old lady was treated for severe dengue with multi-organ dysfunction with superimposed pneumonia, requiring mechanical ventilation. However, persistent cytopenia despite blood transfusion without evidence of haemorrhage raised the suspicion of HLH. Further blood investigations revealed hypertriglyceridaemia, hypofibrinogenaemia and hyperferritinaemia. Bone marrow aspiration showed haemophagocytosis. Patient fulfilled the diagnostic criteria for HLH by HLH-2004 trial. Her HScore is 281, with the probability of having HLH is 99.9%. Patient’s condition improved after administration of intravenous immunoglobulin (IVIG) and intravenous dexamethasone in tapering doses. Early specific treatment of HLH with IVIG and/or corticosteroid is important but diagnosis is usually delayed due to nonspecific clinical findings and laboratory results. High index of suspicion with the aid of diagnostic criteria by HLH-2004 trial and HScore is helpful to recognise this syndrome.

Autokorelasi Spasial Demam Berdarah Dengue di Kota Tasikmalaya

Tasikmalaya city is a high endemic dengue area which contributes to the high number ofdengue cases in West Java province. This study aims to analyze the geographic distribution patternof dengue infection at the village level and identify high-risk urban villages in Tasikmalaya City. Thisstudy analyzed the surveillance data of dengue cases in 2016–2020 which was routinely managed bythe Tasikmalaya City Health Office. Variables analyzed included date, patient’s name and address(villages). The map data in the form of a shape file (shp.) were obtained from BPS in 2019. The spatialautocorrelation analysis uses two approaches, (the global Moran Index and LISA). The results showedthat DHF cases in the Tasikmalaya city tend to increase in the last 5 years (2016–2020). The highestnumber of annual and monthly dengue cases occurred in 2020, (1,744 cases and 307 cases) withthe incidence rate peaked at 262.6561 per 100,000 population. The global Moran index test using asignificance level of 5 showed that there is a spatial autocorrelation between adjacent sub-districts ofdengue cases in Tasikmalaya city every year for the last 5 years (2016–2020, and cumulative). Thevalue of the global moran index (I) shows a positive correlation between urban villages to the numberof annual dengue cases for the last 5 years and is cumulative. It can be concluded that there aresimilarities in the characteristics of DHF cases in adjacent villages or the relationship between DHFcases tends to be spatially clustered.

Correlation Analysis between Ratio of C-Reactive Protein/Albumin and Severity of Dengue Hemorrhagic Fever in Children

Dengue Hemorrhagic Fever (DHF) is a dengue infection which can cause shock and leads to mortality. Hypoalbuminemia is a marker of plasma leakage in DHF and correlated with severity of in fl ammatory response triggered by infection, including DHF. C-Reactive Protein (CRP) is a proin fl ammatory marker that also increases in DHF. This study aims to determine a correlation of CRP/albumin ratio with severity of DHF. Cross sectional study on pediatric patients diagnosed as DHF at Saiful Anwar Malang Hospital was done in July-December 2016. CRP levels were examined using immunoturbidimetry method, while albumin was examined by using Bromocresol Green (BCG) method. Correlation of CRP/albumin ratio with DHF severity was analyzed by using Pearson correlation test.The result showed that there were signi fi cant diff erences in CRP levels and CRP/albumin ratios in the Dengue Shock Syndrome (DSS) and non-DSS group (p = 0.002, p = 0.001, α<0.05). There was no signi fi cant diff erence in albumin level in the same group (p = 0.207, α <0.05). Positive correlation found in CRP and CRP/albumin ratio (r = 0.46, r = 0.49, α <0.01). On the contrary the negative correlation was found in albumin (r = -0.21, α <0.01). This is presumably because albumin is an acute phase protein which will decrease along with the severity of infection. In contrast, CRP will increase during the critical phase of infection. It can be concluded that the CRP/albumin ratio was positively correlated with DHF severity, as well as CRP levels, but not positively correlatedwith albumin.

Role of platelet parameters and hematological profile in dengue positive cases

<p class="abstract"><strong>Background:</strong> Dengue is an endemic in tropical and sub-tropical regions of the world and also in various parts of India. Recent evidence indicates that platelet indices can be used to assess the severity and prognosis of dengue. This study aimed to assess the role of the platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), platelet to large cell ratio (P-LCR), plateletcrit (Pct) and hematological parameters like hemoglobin (Hb), hematocrit (Hct) with the platelet count in dengue NS1 antigen positive cases.</p><p class="abstract"><strong>Methods:</strong> An observational cross-sectional study conducted on cases of dengue over a period of 3 months admitted with serological positivity (NS1 antigen) in a tertiary care hospital, Loni. The platelet indices like MPV, PDW, Pct, P-LCR and hematological parameters like Hb, Hct were noted using Sysmex XN-3100 Automated hematology analyzer and compared with platelet count.</p><p class="abstract"><strong>Results:</strong> Relationship between various platelet indices like MPV, PDW, P-LCR and PCT and hematological parameters like Hb, TLC and Hct were related with platelet count. Dengue positive cases were inversely related to MPV, PDW, P-LCR, Hb and Hct and directly related to Pct. In the present study Pct, P-LCR, Hb and Hct were statistically significant in correlation with platelet count.</p><p class="abstract"><strong>Conclusions:</strong> Pct, P-LCR, Hb and Hct along with platelet count can be used to assess the predictive outcomes in case of dengue infection.</p><p>.</p>

Pharyngeal-cervical-brachial variant of Landry Guillain Barre syndrome after dengue infection: a case report

Dengue is a common mosquito-borne infection in India. We reported a rare Pharyngeal cervical brachial (PCB) variant of Landry Guillain Barre syndrome (LGBS) associated with the dengue virus infection. The pathogenesis seems to be molecular mimicry between gangliosides and microbial lipo-oligosaccharides. PCB usually presents with oropharyngeal or cervicobrachial weakness. Therefore, it must be recognised early and distinguished from conditions presenting with cephalocaudal progressing weakness, such as Myasthenia Gravis, Miller-Fisher syndrome, botulism, diphtheria, porphyria or brain stem stroke. The aim of the study was to add to the limited literature on the PCB variant of LGBS after dengue infection and shed some light on presentation and management options for this rare entity.