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Review of Dengue Hemorrhagic Fever Fatal Cases Seen Among Adults: A Retrospective Study

DOI:10.1371/journal.pntd.0002194
Authors:
Sing-Sin Sam at University of Malaya
Sing-Sin Sam
Sharifah Faridah Syed Omar at University of Malaya
Sharifah Faridah Syed Omar
Boon-Teong Teoh at University of Malaya
Boon-Teong Teoh
Juraina Abd-Jamil at University of Malaya
Juraina Abd-Jamil
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Background Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. Methodology/Principal Findings We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if there have been changes in the presentation of severe to fatal dengue. Nine of ten fatal cases involved adult females with a median age of 32 years. All had secondary dengue infection. The mean duration of illness prior to hospitalization was 4.7 days and deaths occurred at an average of 2.4 days post-admission. Gastrointestinal pain, vomiting, diarrhea, intravascular leakages and bleeding occurred in the majority of cases. DSS complicated with severe bleeding, multi-organ failure and coagulopathy were the primary causes of deaths. Seven patients presented with thrombocytopenia and hypoalbuminemia, five of which had hemoconcentration and increased ALT and AST indicative of liver damage. Co-morbidities particularly diabetes mellitus was common in our cohort. Prominent unusual presentations included acute renal failure, acute respiratory distress syndrome, myocarditis with pericarditis, and hemorrhages over the brain and heart. Conclusions In our cohort, dengue fatalities are seen primarily in adult females with secondary dengue infection. The majority of the patients presented with common clinical and laboratory warning signs of severe dengue. Underlying co-morbidities may contribute to the rapid clinical deterioration in severe dengue. The uncommon presentations of dengue are likely a reflection of the changing demographics where adults are now more likely to contract dengue in dengue endemic regions.
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Checklist S1
Data
May 2013
Sing-Sin Sam · Sharifah Faridah Syed Omar · Boon-Teong Teoh · Juraina Abd-Jamil · Sazaly AbuBakar
... A proporção de gênero entre os óbitos foi equilibrada (51,4% sexo masculino), mas, considerando a proporção entre os casos (45,7% sexo masculino), a mortalidade foi ligeiramente maior entre homens, o que difere da descrição de outros autores, onde as mulheres apresentam maior risco de óbito (13) . ...
... Divergindo de outros estudos, onde crianças e jovens apresen taram maior gravidade (13,14) , as maiores taxas de letalida de ocor re ram entre idosos, demonstrando maior vulnerabilidade deste grupo, associada à presença de comorbidades (destacando-se hi-pertensão arterial sistêmica (HAS) e cardiopatias, reforçando a importância do manejo clínico de dengue, também nessas condições. ...
... Os tempos médios para internação e óbito foram concordantes com o descrito na literatura (13,14) , reforçando a necessidade de maior atenção na transição da fase febril para a fase crítica (entre 4 a 7 dias da doença). Complicações hepáticas e neurológicas costumam ser um pouco mais tardias (2)(3)(4) , com o pico de alteração das aminotransferases no 9º dia de doença (15) . ...
Formas de apresentação e evolução clínica dos óbitos por dengue em residentes no Município do Rio de Janeiro em 2012 Forms of clinical presentation and course of the deaths from dengue in the Municipality of Rio de Janeiro in 2012
Article
Full-text available
RESUMO OBJETIVO: A dengue tem importância mundial por sua mor-bidade e abrangência. O presente artigo teve como objetivo descrever as principais características dos óbitos por dengue, ocorridos no Município do Rio de Janeiro (MRJ), durante a epidemia de 2012. MÉTODOS: Foram descritos os 35 casos de óbitos por dengue ocorridos em 2012 neste município. As variáveis estudadas foram coletadas a partir das fichas de inves-tigação de óbitos por dengue, padronizadas pelo Ministério da Saúde. RESULTADOS: Encontrou-se maior proporção de óbi-tos entre 50 e 59 e acima de 70 anos, presença de comorbidades em 77,8%, ligeiro predomínio do sexo masculino e da raça/cor preta. Principais achados hematológicos: leucopenia em 46,8%, leucocitose em 78,1%, hemoconcentração em 39,4% e plaque-topenia em 87,9%. Na parte bioquímica: aumento de amilase em 50%, gama GT em 92,8%, transaminase glutâmico oxa-loacética (TGO) em 95,2%, transaminase glutâmico pirúvica (TGP) em 80,9%, bilirrubinas em 69,2%, creatina-fosfoquinase (CPK) em 50% e lactato desidrogenase (LDH) em 100%. Der-rame cavitário foi descrito em 64,3% e espessamento de parede da vesícula biliar em 37,5%. Manifestações atípicas evidencia-das: neurológicas 8,6%, insuficiência hepática 11,4%, insufi-ciência renal 25,7% e sangramento 22,8%. CONCLUSÃO: O acompanhamento de exames laboratoriais e de imagem auxilia o manejo clínico e a predição da gravidade da dengue. Este acom-panhamento, juntamente com a estabilização das morbidades preexistentes, pode reduzir sua letalidade. ABSTRACT OBJECTIVES: Dengue has global significance for its morbidity and scope. This article aims to describe the main features of deaths due to dengue, during the dengue epidemic in Rio de Janeiro (MRJ) in 2012. METHODS: The 35 cases of obit by dengue occurred in 2012 in this municipality were described. The studied variables were collected from the records of investigation of obit by dengue, standardized by the Ministry of Health. RESULTS: Review of 35 deaths due to dengue that occurred in the city of Rio de Janeiro in 2012 showed a higher proportion between ages of 50 and 59 and also greater than 70 years old, the presence of comorbidities in 77.8% and a slight prevalence in male gender and in race/color black. Major hematologic findings were leukopenia (46.8%), leukocytosis (78.1%), hemoconcentration (39.4%) and thrombocytopenia (87.9%). Other lab abnormalities were amylase (50%), gamma GT (92.8%), aspartate aminotransferase (AST) (95.2%), serum glutamate pyruvate transaminase (SGPT) alanine transferase (ALT) in 80.9%, bilirubin in 69.2%, creatine phosphokinase in 50% (5/10) and lactate dehydrogenase in 100%. Cavity effusions were described in 60% and thickened gallbladder in 37.5%. Atypical symptoms that were evident: neurological 8.6%, liver failure, 11.4%, kidney failure, 25.7% and bleeding 22.8%. CONCLUSION: Monitoring the levels of hematocrit, platelets, aminotransferases and imaging tests help the clinical management and prediction of severity of dengue and, along with the stabilization of preexisting comorbidities, may reduce its lethality. A dengue configura-se importante problema de saúde públi-ca, por seu potencial de endemicidade e grande impacto social por sua morbidade.
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... 6 . This observation might be due to females having a higher tendency to progress to having Dengue haemorrhagic fever (DHF)/ Dengue Shock Syndrome (DSS) with higher fatality numbers in comparison to males 13 . On the contrary, out of 15 mortality cases over 32 months seen in another retrospective study, 73% of them were males 14 . ...
... According to current and previous studies, in the presence of both dengue infection and underlying comorbidities as mentioned earlier, fatality rates were higher than in individuals with no underlying comorbidities. The reason for death in dengue cases with co-morbidities may be due to the progression of concomitant diseases itself, and not due to the dengue infection straightforwardly, especially in adults 13 . This data shows that patients who have comorbidities that are infected with dengue infection should be monitored closely and more particularly compared to patients who do not have comorbidities, as each patient should be managed differently according to their conditions. ...
Systematic review on factors of mortality among dengue patients in Malaysia
Article
Full-text available
  • Sep 2022
Introduction: Malaysia has a high concentration of dengue cases. Even though the case fatality rate is low among dengue patients, identification of the risk factors of dengue mortality helps in the management of these patients. Findings from previous studies were inconclusive, thus, we systematically review studies to identify the factors of mortality among dengue patients in Malaysia. Methods: Three main search engines such as PubMed, ScienceDirect and EBSCO were used to screen the articles. This systematic review follows PRISMA guidelines. Results: The initial search yielded a total of 523 articles to be reviewed. However, after screening, four articles were left with all of them being quantitative studies. From the four studies accepted, thirty-six factors were identified. The factors include age, gender, nausea, vomiting, bleeding, lethargy, body ache, abdominal pain, retro-orbital pain, dysuria, shock, pleural effusion, ascites, prolonged Prothrombin Time (PT), Haematocrit (HCT)>20%, Serum pH <7.35, Serum ferritin >10,000 ni/mL, serum creatinine, serum lactate >2, white blood cell (WBC) count, insulin dependant diabetes, ischemic cardiovascular disease and progressive renal disease. Conclusions: To conclude, age and bleeding were found as the most important health risk for Dengue patients and poses a great liability towards mortality among patients infected with dengue in Malaysia.
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... 32 Sebuah penelitian di Malaysia yang mengkaji kematian akibat dengue menunjukkan 100% kasus tersebut merupakan infeksi dengue sekunder. 33 Penelitian lain di Pakistan menunjukkan 75% kasus kematian yang berhubungan dengan DSS merupakan infeksi dengue sekunder. 34 ...
Infeksi Dengue Sekunder: Patofisiologi, Diagnosis, dan Implikasi Klinis
Article
Full-text available
  • Feb 2023
Infeksi dengue sekunder merupakan infeksi dengue yang terjadi kali kedua. Infeksi kedua dengan serotipe berbeda dapat menyebabkanpenyakit dengue yang lebih berat. Penelitian menunjukkan bahwa 98% kasus dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) merupakan infeksi dengue sekunder. Patofisiologi yang menjadikan infeksi dengue sekunder lebih berat belum sepenuhnya dipahami, diduga berkaitan dengan mekanisme antibody dependent enhancement (ADE). Membedakan infeksi dengue primer dan sekunder penting agar dokter dan tenaga kesehatan mampu memprediksi prognosis dan keluaran klinis pasien. Dengue secondary infection is the second dengue infection. A second infection with different serotype tend to be more severe. Data shown that 98% cases of dengue hemorrhagic fever/ dengue shock syndrome (DHF/DSS) are dengue secondary infection. The pathophysiology of more severe cases is not fully understood; it is suspected to be related to antibody dependent enhancement (ADE) mechanism. Differentiating primary and secondary dengue infection is important to predict patient’s prognosis and clinical outcome
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... higher mortality rate for men than women (21). Also, according to evidence from different studies, biological differences in gender affect the severity and outcomes of COVID-19, with men experiencing more severe and worse outcomes (22)(23)(24). Our data also showed that the risk of severe cases of COVID-19 was higher in men than women, although there was no signi cant difference (Table 1). ...
Clinical Characteristics and Outcomes of Almost 24000 Hospitalized Patients with COVID-19 by Sex and Severity During the First 12 Months of the Pandemic in Yazd, the Central City of Iran
Preprint
Full-text available
  • Aug 2022
This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median duration of hospitalization was 13 days for patients with severe cases of COVID-19 (IQR-7-23). The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third and early fourth waves (HR=1.672, 95% CI: 1.48-1.89, P<0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR=2.1, 95%CI: 1.1.93-2.72, P<0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P<0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease.
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... This is consistent with other studies that had raised hematocrit levels in DHF/ DSS as compared to dengue fever. 28,29 Our analysis proved that high hematocrit is linked to SD, and its measurement has been the most common method used to identify hemoconcentration. ...
The Roles of C-X-C Motif Chemokine Ligand 10 (CXCL10) in Dengue
Article
Full-text available
  • Jul 2022
Early diagnosis of dengue is crucial to prevent the progression to severe dengue (SD) leading to mortality rate reduction. This study aimed to determine the role of the CXCL10 in dengue and its potential utilization as one of the biomarkers for the early diagnosis of dengue. A case-control study was conducted involving healthy subjects as control (n = 10) and 193 subjects as dengue cases. The cases were categorized into dengue without warning signs (DwoWS: n = 70; 34.5 %), dengue with warning signs (DWWS: n = 108; 23.2 %), and severe dengue (SD: n = 15; 7.4 %). The socio-demographic characteristics, clinical presentations, and laboratory parameters (platelet and hematocrit) were documented. Serum CXCL10 quantification was performed using an enzyme-linked immunosorbent assay (ELISA). The descriptive analysis and Pearson’s correlation test were used to analyze demographic data and the correlation between CXCL10, hematocrit, and platelet respectively. The difference in age (p = 0.02) and ethnicity (p = 0.02) were significant between cases and control. Males more frequently had SD in contrast to females (4:1). The frequent warning signs were abdominal pain (42.0 %), severe vomiting (38.3 %), bleeding tendency (15.0 %), and fluid accumulation (7.2 %). The increase in hematocrit (p = 0.039) and platelet reduction (p = 0.0005) were significant in SD. The mean of CXCL10 in control (134.85 ± 48.52 rg/mL) was significantly lower than in cases (545.22 ± 76.33 rg/mL, p = 0.0005). The CXCL10 is evident to be a potential biomarker in the early diagnosis of dengue.
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... To help clinicians evaluate the likelihood of severe disease, risk factors for SD have been reported, such as secondary infection, gastrointestinal pain, vomiting, diarrhea, intravascular leakage and bleeding [12]. Efforts have been consistently made to identify predictive markers for SD [13][14][15]. ...
Risk and predictive factors for severe dengue infection: A systematic review and meta-analysis
Article
Full-text available
Background Dengue is a major public health issue worldwide and severe dengue (SD) is life threatening. It is critical to triage patients with dengue infection in the early stage. However, there is limited knowledge on early indicators of SD. The objective of this study is to identify risk factors for the prognosis of SD and try to find out some potential predictive factors for SD from dengue fever (DF) in the early of infection. Methods The PubMed, Cochrane Library and Web of Science databases were searched for relevant studies from June 1999 to December 2020. The pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CI) of identified factors was calculated using a fixed or random effect model in the meta-analysis. Tests for heterogeneity, publication bias, subgroup analyses, meta-regression, and a sensitivity analysis were further performed. Findings A total of 6,848 candidate articles were retrieved, 87 studies with 35,184 DF and 8,173 SD cases met the eligibility criteria. A total of 64 factors were identified, including population and virus characteristics, clinical symptoms and signs, laboratory biomarkers, cytokines, and chemokines; of these factors, 34 were found to be significantly different between DF and SD, while the other 30 factors were not significantly different between the two groups after pooling the data from the relevant studies. Additionally, 9 factors were positive associated with SD within 7 days after illness when the timing subgroup analysis were performed. Conclusions Practical factors and biomarkers for the identification of SD were established, which will be helpful for a prompt diagnosis and early effective treatment for those at greatest risk. These outcomes also enhance our knowledge of the clinical manifestations and pathogenesis of SD.
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... A previous multivariate analysis 8 has also reported prior dengue infection as one of the risk factors of DHF 8 . Two other studies 21,22 from Southeast Asia reported that secondary dengue infection were risk factors of dengue shock syndrome (DSS) encompassing grade 3 and grade 4 DHF, and even associated with deaths. ...
Clinical characteristics and laboratory parameters in differentiating pediatric Dengue fever and Dengue hemorrhagic fever
Article
Full-text available
- Objective: The mortality of dengue hemorrhagic fever (DHF) infection in children is still high. Discriminating dengue fever (DF) and DHF during the early phase is difficult, especially with limited diagnostic tools in peripheral areas. Hence, early identification of significant factors in diagnosing DHF is important, with rapid disease progression may lead to mortality. This study aims to determine early clinical and laboratory parameters significant in differentiating DF and DHF. — Materials and methods: This is a cross-sectional study using secondary data from medical records collected by purposive sampling from January 2015 to December 2020. This study included children aged 0-18 years old diagnosed with DF and DHF based on World Health Organization (WHO) 2011 criteria. — Results: From multivariate analysis of 528 dengue patients, presence of prior dengue infection (OR = 7.1; 95% CI: 2.1-23.7, p=0.001), transfusion administration (OR = 34; 95% CI: 8.7-132, p<0.001), present hepatomegaly (OR = 7.2; 95% CI 1.3-38.2, p=0.02) and other bleeding manifestations (OR = 3.5; 95% CI 1.3-9.3, p=0.012) are significant parameters to differentiate DF and DHF with good quality of discrimination (AUC value = 0.83) and the model is a good fit (Hosmer-Lemeshow value = 0.65). ROC analysis showed two significant variables yielded 55.6% of sensitivity and 86.3% of specificity. — Conclusions: Two or more characteristics of present hepatomegaly, other bleeding manifestations, transfusion received, and prior dengue infection are specific to dengue infections yet less sensitive to differentiate DF and DHF
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A novel intervention altering disease course in children with dengue: an observational study
Article
Full-text available
  • Aug 2022
Background: Dengue fever has emerged as a global public health problem in recent decade, clinical spectrum of disease ranges from mild fever to life threatening dengue shock syndrome. The disease is characterized by thrombocytopenia, hypoalbuminemia and increased capillary permeability leading to third space fluid loss viz ascites, pleural effusion pericardial effusion. This study aims to show that therapeutic intervention (viz albumin transfusion under supervised diuretic cover) during onset of critical phase significantly reduces progression of disease, morbidity and mortality.Methods: In this observational study enrolled confirmed dengue cases, requiring hospitalization. Basic lab parameters viz complete blood count, liver functions, renal functions, C-reactive proteins, chest X-ray were obtained. Pre requisites prior to albumin infusion were; urine output >0.8 ml/kg/hour, normal renal functions and no shock/hypotension.Results: We found improved outcomes using this intervention in dengue patients early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality. Out of remaining 78 cases, 24 children developed critical phase, they were managed and transfused albumin infusion under diuretic cover. None of children who received albumin transfusion had mortality.Conclusions: Early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality as well duration of ICU/hospital stay. We believe albumin transfusion under supervised diuretic cover, also preventing development of major life-threatening complications viz dengue shock syndrome.
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Clinical Spectrum of XDR and MDR Enteric Fever in Children Aged Between 6 Months to 15 Years at The Children’s Hospital, Lahore
Article
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This article is about clinical presentations of pediatric patients suffering from MDR and XDR typhoid fever
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INFECTIOUS DISEASES JOURNAL Published by the Medical Microbiology & Infectious Diseases Society of Pakistan of Pakistan
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XDR typhoid has dominated as a culture pattern in recent years in Pakistan. We present the clinical spectrum of MDR VS XDR Typhoid fever in children
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Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
Article
Full-text available
In 2009, the World Health Organization (WHO) proposed seven warning signs (WS) as criteria for hospitalization and predictors of severe dengue (SD). We assessed their performance for predicting dengue hemorrhagic fever (DHF) and SD in adult dengue. DHF, WS and SD were defined according to the WHO 1997 and 2009 dengue guidelines. We analyzed the prevalence, sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of WS before DHF and SD onset. Of 1507 cases, median age was 35 years (5(th)-95(th) percentile, 17-60), illness duration on admission 4 days (5(th)-95(th) percentile, 2-6) and length of hospitalization 5 days (5(th)-95(th) percentile, 3-7). DHF occurred in 298 (19.5%) and SD in 248 (16.5%). Of these, WS occurred before DHF in 124 and SD in 65 at median of two days before DHF or SD. Three commonest warning signs were lethargy, abdominal pain/tenderness and mucosal bleeding. No single WS alone or combined had Sn >64% in predicting severe disease. Specificity was >90% for both DHF and SD with persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, clinical fluid accumulation, and any 3 or 4 WS. Any one of seven WS had 96% Sn but only 18% Sp for SD. No WS was highly sensitive in predicting subsequent DHF or SD in our confirmed adult dengue cohort. Persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, and clinical fluid accumulation, as well as any 3 or 4 WS were highly specific for DHF or SD.
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Retrospective Study of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) Patients at University Malaya Medical Center, Kuala Lumpur, Malaysia in the Year 2005
Article
Full-text available
retroSpective Study of dengue fever (df) and dengue heMorrhagic fever (dhf) patientS at univerSity Malaya Medical center, Kuala luMpur, MalaySia in the year 2005 Abstract. The aim of this retrospective study was to determine the number of dengue fever (DF) and dengue hemorrhagic fever (DHF) cases admitted to University Malaya Medical Center (UMMC) in the year 2005 together with their clinical presentations and epidemiology. The data for 2005 was collected from the medical records department of UMMC. A total of 1,279 cases were admitted in 2005 with DF (81%, n=1,040) and DHF (19%, n=239). January had the greatest number of cases of DF and DHF (22%, n=281) and April had the least (4%, n=49). The greatest number of DF cases (38%, n=392) were seen in the 20-29 year age group, while the greatest number of DHF cases (32%, n=76) were in the 10-19 year age group. In regard to race, the greatest number of cases were seen in Malays (48%, DF; 49%, DHF). Males were more commonly infected than females. The majority of patients infected were students (30%, n=385). All patients with DF and DHF presented with fever. The symptoms reported included nausea and vomiting, joint pain, gum bleeding and dehydration. The mean value hemoglobin, white blood cell count and platelet count were 14.4 g/dl, 4 ×10 3 /dl, 75 ×10 6 /dl, respectively for DF and 15.1 g/dl, 4 ×10 3 /dl, 52 ×10 6 /dl respectively for DHF. The majority of patients were treated with hydration therapy. There were three deaths reported, caused by dengue shock syndrome (DSS).
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Cytokines and chemokines are both expressed by human myoblasts: possible relevance for the immune pathogenesis of muscle inflammation.
Article
The idiopathic inflammatory myopathies are characterized by antibody- or cell-mediated immune response against unknown muscle tissue antigens. In these diseases a cellular infiltrate, composed of T and B lymphocytes, macrophages and NK cells, may invade muscle tissue with a gradient from the perivascular space to the endomysial compartment. Muscle cells may be actively involved in the processes of mononuclear cell recruitment and activation from the blood stream to the areas of inflammation. In order to verify this hypothesis, cultured human myoblasts were tested for their capacity to express different pro-inflammatory cytokines [IL-1α, IL-1β, IL-6 and tumor necrosis factor (TNF)-α] and chemokines (IL-8, MCP-1 and RANTES) at the mRNA level and protein secretion, in the presence of the pro-inflammatory cytokines IFN-γ and TNF-α alone or in combination. We confirmed that human myoblasts expressed IL-1α and IL-6 constitutively, while IL-1β and TNF-α are detected only after treatment with pro-inflammatory cytokines; moreover, we observed that TNF-α was expressed on an autocrine fashion by myoblasts. IL-8 and RANTES were expressed constitutively while MCP-1 after proper induction. These molecular data were further confirmed by specific ELISA in the supernatant from cultured myoblasts. Our results underline the importance of human myoblasts in the recruitment of leukocytes from the blood stream and, most probably, in the cross-talk between infiltrating inflammatory cells and muscle cells, creating the conditions for a chronic inflammation. Moreover, the capacity of muscle cells to behave as cells of the immune system has to be kept in mind, also in view of i.m. vaccination and use of molecular engineered myoblasts as vehicles in gene therapy.
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Epidemiological Analysis of Deaths Associated with Dengue Haemorrhagic Fever in Southern Viet Nam in 1999 -2000
Article
  • Jan 2001
A retrospective epidemiological study of deaths due to dengue haemorrhagic fever (DHF) in 19 provinces of southern Viet Nam in 1999 and 2000 was undertaken. Most deaths occurred among those less than 15 years old (92.7%), especially those aged 5-9 years; 81.6% of them were in the south-west provinces (Mekong delta region). Almost all the cases were hospitalized too late (3-4 days after the onset of the disease). One-half of the deaths occurred during the first 24 hours and one-third of the remaining deaths between the third and the sixth day of hospitalization. Most of the deaths occurred in provincial hospitals rather than in district hospitals.
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Prevalence of Chronic Illness and Health Seeking Behaviour in Malaysian Population: Results from the Third National Health Morbidity Survey (NHMS III) 2006
Article
The third National Health Morbidity Survey was conducted in 2006 on a nationally representative sample of population in Malaysia in order to obtain community-based data and information on the prevalence of chronic illness. Of 57,500 eligible respondents 56710 (98.6%) participated in the study. Estimated overall prevalence of chronic illness in the Malaysian population within a recall period of one year was 15.5% (95% CI 15.1% - 15.9%). Chronic illness was reported significantly higher among the females, 16.8% (16.3 - 17.3). The most common chronic illness was hypertension (7.9%, 7.6 - 8.2), followed by diabetes mellitus (4.0%, 3.8 - 4.2) and highest reported by the Indians (19.7%, 18.4 - 21.0). Among the respondents who had sought treatment for chronic illness from government health facilities, Malays (65.8%) and those with monthly household income of less than RM400 (76.6%) were the highest. Chinese (44.5%) and those with household income of RM5000 and above (54.3%) were the highest groups who sought treatment from the private health facilities. Most of the respondents reported mild illness was the main reason for not seeking treatment for their chronic illness. It is hoped that the results of this survey will help the Ministry of Health Malaysia to enhance health programmes and planning resource allocation in order to improve health status of the population.
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Current Status of the Knowledge of Dengue/DHF/DS S in Malaysia: Clinical Aspects
Article
There is a definite increase in the severe manifestations of dengue virus infection. Improved management of shock has greatly reduced the incidence of dcath due toplasma leakage, and may therefore be causing an "apparent" increase of patients succumbing to acute liver failure and severe intracranial hemorrhage. However Innes et al 15 has detected dengue antigen in 15 out of 18 serologically confirmed cases where liver biopsy was done: Lam16 has been able to detect dengue 3 virus by polymerase chain reaction from the liver biopsy specimen in one child from the University Hospital. This may explain a direct injury to the liver caused by the virus infection. Similarly, Chan et al (1990) and Lam have detected IgM antibodies in the cerebrospinal fluid of dengue patients, implying a direct invasion of the central nervous sytem by the virus. The potential importance of natural variation among the dengue viruses has been stated by M onath17 and Pang18 and the suggestion that such variation may influence the virulence of dengue strains for human hosts is probably more important than generally appreciated. It must he erflphasized that a high index of suspicion is needed to diagnose the cases early and start correct management. Prolonged uncontrolled shock, often complicated with acidosis can give rise to acomplicated course where DIVC and shock perpetuate each other leading to a stage of irreversibility, multi-organ involvement and death. It is likely that, parallel to the formation of immune complexes and complement activation, the clotting mechanisms are also activated to the extent that DIVC develops (Sriehakul et al).19 (Phil J Microbiol Infect Dis 1992; 21(2):41-45)
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Hemophagocytosis in dengue: Comprehensive report of six cases
Article
  • Jul 2012
Hemophagocytic syndrome is a potentially fatal disorder. It is being increasingly reported but remained under-recognized in dengue. Most reported cases were in association with plasma leakage and shock but multi-organ impairment was also observed. We describe the time-lines of 6 cases of confirmed dengue with varying severities of hemophagocytosis. All had persistent fever, cytopenia and elevated transaminases with markedly elevated ferritin levels during and beyond the plasma leakage phase. Acute renal failure and central nervous system manifestation were observed in two patients. Morphological hemophagocytosis was demonstrated in three patients. All survivors showed clinical and biochemical resolution of hemophagocytosis indicating its transient nature. Persistence of fever and cytopenia together with multi-organ dysfunction, out of proportion to and beyond the plasma leakage phase should prompt clinicians to consider this phenomenon.
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