medigraphic.com
ISSN 1561-3054 (Electronic)

2022, Number 2

<< Back Next >>

Rev Cubana Med Trop 2022; 74 (2)

Usefulness of warning signs in the management of dengue patients

Castro PO, Martínez TE, Martínez-Rodríguez A, González RD, Guzmán TMG

Language: English
References: 52
Page:
PDF size: 304.75 Kb.


ABSTRACT

Introduction: The dengue case classifications proposed by World Health Organization (WHO, 2009) include warning signs (WS) for recognizing early progression of disease toward the critical phase.
Objective: To analyze the usefulness WS and challenges of the 2009 WHO dengue case classification in preventing and managing severe dengue cases.
Methods: Data from 1439 adult patients diagnosed as dengue cases (2001-2002, 2006, 2012) at the Pedro Kourí Institute Hospital, in Havana Cuba, was revised. The WS were described and their predictive utility was considered in preventing shock in these patients with the use of crystalloids by calculating the sensitivity, specificity and positive / negative predictive values using both the 1997 and 2009 WHO dengue case classifications.
Results: Plasma-leakage with shock was the main clinical form of severe dengue (95.3%). All severe cases due to plasma leakage had WS. The most frequent WS were mucosal bleeding (926 cases; 64.4%), frequent vomiting (361; 39.0%), abdominal pain or tenderness (404; 35.5%) and prostration (408; 28.4%). Mucosal bleeding and abdominal pain were good predictors of severity, appearing one day before shock. More than 75% of patients without WS there were not severe dengue. Most patients with warning signs were managed correctly and had an uneventful recovery.
Conclusions: Identifying the WS recommended by WHO 2009 classification for crystalloid intravenous fluid treatment was crucial for the successful outcome of dengue cases.


REFERENCES

  1. Guzman MG, Gubler DJ, Izquierdo A, Martinez E, Halstead SB. Dengue infection. Nature Reviews Disease Primers. 2016;2:16055.

  2. Hasan S, Jamdar SF, Alalowi M, Al Beaiji SMAA. Dengue virus: A global human threat: Review of literature. Journal of International Society of Preventive & Community Dentistry. 2016;6(1):1.

  3. Halstead S. Recent advances in understanding dengue. F1000Research. 2019;8.

  4. Chen C-M, Chan K-S, Yu W-L, Cheng K-C, Chao H-C, Yeh C-Y, et al. The outcomes of patients with severe dengue admitted to intensive care units. Medicine [Internet]. 2016;95(31):e4376. DOI: http://dx.doi.org/10.1097/MD.00000000000043764.

  5. Branco MdRFC, Luna EJdA, Junior B, Lopes L, Oliveira RVBd, Rios LTM, et al. Risk factors associated with death in Brazilian children with severe dengue: a case-control study. Clinics. 2014;69(1):55-60.

  6. World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. New Edition ed. Geneva: WHO Press; 2009.

  7. Barniol J, Gaczkowski R, Barbato EV, da Cunha RV, Salgado DM, Martinez E, et al. Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries. BMC Infect Dis. 2011;11:106.

  8. Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, Hung NT, et al. Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health. 2011;16(936-948).

  9. Pan American Health Organization. Dengue: guidelines for patient care in the Region of the Americas. 2nd. ed. Washington, D.C, United States: PAHO; 2016.

  10. Ministério da Saúde Brasília. Transmissíveis MdSSdVeSDdVdD. Dengue: diagnóstico e manejo clínico: adulto e criança. Brasília: Ministério da Saúde Brasília; 2013.

  11. Correa Martínez L, Cabrera Morales C, Martínez Licor M, Martínez Núñez M. Consideraciones clínicas y terapéuticas sobre el dengue. Correo Científico Médico. 2016;20(1):80-97.

  12. Soria Segarra C, González Rubio D, Izquierdo Estévez A, Martínez Torres E. Aplicación y aceptabilidad de la Guía Clínica de Dengue OMS-2009: la percepción de Ecuador. Revista Médica Electrónica. 2018 [cited 2019 May 12];40:[989-1001 pp.]. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1684-18242018000400007&nrm=iso12.

  13. Hegazi MA, Bakarman MA, Alahmadi TS, Butt NS, Alqahtani AM, Aljedaani BS, et al. Risk Factors and Predictors of Severe Dengue in Saudi Population in Jeddah, Western Saudi Arabia: A Retrospective Study. Am J Trop Med Hyg. 2020;102(3):613-21.

  14. Mathew A. The Role of the Dengue Severity Scale in Predicting Prognosis in Patients Admitted to the Medicine Wards of a Tertiary Care Hospital during an Epidemic. JMSCR. 2020;8(5):116-23. DOI: http://dx.doi.org/10.18535/jmscr/v8i5.2214.

  15. Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2021;21(7):1014-26.

  16. Organización Panamericana de la Salud. Dengue y dengue hemorrágico en las Américas: guías para su prevención y control. Washington DC: Organización Panamericana de la Salud; 1995.

  17. Organización Panamericana de la Salud. Dengue. Guía de atención para enfermos en la región de las Américas. Washington DC: Organización Panamericana de la Salud; 2010. Available from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  18. World Health Organization. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. Geneva: World Health Organization; 1997.

  19. Bernard GR, Artigas A, Brigham KL. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24.

  20. González D, Castro OE, Kourí G, Perez J, Martinez E, Vazquez S, et al. Classical dengue hemorrhagic fever resulting from two dengue infections spaced 20 years or more apart: Havana, Dengue 3 epidemic, 2001-2002. International Journal of Infectious Diseases 2005;9:280-5.

  21. Lima FR, Croda MG, Muniz DA, Gomes IT, Soares KR, Cardoso MR, et al. Evaluation of the traditional and revised world health organization classifications of dengue cases in Brazil. Clinics. 2013;68(10):1299-304.

  22. Lovera D, Araya S, Mesquita MJ, Avalos C, Ledesma S, Arbo A. Prospective Applicability Study of the New DengueClassification System for Clinical Management in Children. Pediatr Infect Dis J. 2014;33(9):933-5.

  23. Thein T-L, Gan VC, Lye DC, Yung C-F, Leo Y-S. Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity. PLoS Negl Trop Dis. 2013;7(1):e2023.

  24. Gibson G, Souza-Santos R, Brasil P, Pacheco AG, Cruz OG, Honório NA, et al. From primary care to hospitalization: clinical warning signs of severe dengue fever in children and adolescents during an outbreak in Rio de Janeiro, Brazil. Cad Saúde Pública. 2013;29(1):82-90.

  25. González Perrota N, Araya S, Lovera D, Martínez de Cuellar C, Arbo Sosa A. Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue. Pediatría (Asunción). 2020;47(1):05-10.

  26. Pamplona Cavalcanti L, Mota LAM, Lustosa GP, Fortes MC, Mota DAM, Lima AAB, et al. Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil. Mem Inst Oswaldo Cruz. 2014;109(1):93-8. DOI: http://dx.doi.org/10.1590/0074-027614038426.

  27. Horstick O, Martinez E, Guzman MG, San Martin JL, Runge Ranzinger S. WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas. Pathogens and Global Health. 2015;109(1):19-25.

  28. Pan American Health Organization. State of the Art in the Prevention and Control of Dengue in the Americas. Meeting Report. PAHO. Washington, D.C.; 2014.

  29. Rojo Pérez N, Valenti Pérez C, Martínez Trujillo N, Morales Suárez I, Martínez Torres E, Fleitas Estévez I, et al. Science and technological innovation in health in Cuba: results in selected problemsCiência e inovação tecnológica em saúde em Cuba: resultados em problemas selecionados. Revista Panamericana de Salud Publica. 2018;42:e32-e.

  30. Matta L, Barbosa MM, Morales-Plaza CD. Caracterización clínica de pacientes que consultaron por dengue en un hospital de tercer nivel en Cali, Colombia, 2013. Biomédica. 2016;36(1):133-9.

  31. García Gómez C, Rodríguez Roque MO, García Escudero V, Peña Batista AP, Ramírez Martínez M, Rodríguez Chávez O. Organización de los servicios hospitalarios a propósito de un brote de arbovirosis. Cienfuegos 2018. MediSur. 2019;17:476-9.

  32. IDAMS Project. International Research Consortium on Dengue Risk Assessment, Management and Surveillance 2011-2017. 2017. Available from: http://www.idams.eu/index.php/idams32.

  33. Zhang H, Zhou Y, Peng H, Zhang X, Zhou F, Liu Z, et al. Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis. BioMed Research International. 2014. DOI: https://doi.org/10.1155/2014/35930833.

  34. Dinh The T LTTT, Nguyen Minh D, Tran Van N, Tran Tinh H, Thu TLT, Minh DN, et al. Clinical features of dengue in a large Vietnamese cohort: intrinsically lower platelet counts and greater risk for bleeding in adults than children. PLoS Negl Trop Dis. 2012;6(6):e1679.

  35. Lye DC, Archuleta S, Syed-Omar SF, Low JG, Oh HM, Wei Y, et al. Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial. The Lancet. 2017;389(10079):1611-8.

  36. Jayaratne SD, Atukorale V, Gomes L, Chang T, Wijesinghe T, Fernando S, et al. Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection. BMC Res Notes. 2012;5:645.

  37. Tamayo Escobar OE, García Olivera TM, Escobar Yéndez NV, González Rubio D, Castro Peraza O. Signos de alarma en pacientes cubanos con dengue según nueva clasificación revisada de la Organización Mundial de la Salud. MEDISAN. 2018;22:707-19.

  38. Consuegra Otero A, Martínez Torres E, González Rubio D, Castro Peraza M. Caracterización clínica y de laboratorio en pacientes pediátricos en la etapa crítica del dengue. Rev Cubana Pediatr. 2019 Jun [Access 15/08/2022];91(2):e645. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75312019000200003&lng=es38.

  39. Izquierdo Estevez A, Martinez Torres E. Utilidad de la identificación de los signos de alarma en niños y adolescentes con dengue. Ev Cubana Pediatr. 2019 [Accesso 18/05/2019];91(2). Available from: http://www.revpediatria.sld.cu/index.php/ped/article/view/64439.

  40. Pamplona Cavalcanti L, Braga DNdM, Pompeu MMdL, Lima AAB, Silva LMAd, Aguiar MG, et al. Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2015;48(6):658-64. DOI: http://dx.doi.org/10.1590/0037-8682-0287-201540.

  41. Gan VC, Lye DC, Thein TL, Dimatatac F, Tan AS, Leo Y-S. Implications of discordance in world health organization 1997 and 2009 dengue classifications in adult dengue. PloS One. 2013;8(4):e60946.

  42. Carrasco LR, Leo YS, Cook AR, Lee VJ, Thein TL, Go CJ, et al. Predictive tools for severe dengue conforming to World Health Organization 2009 criteria. PLoS Negl Trop Dis. 2014;8(7):e2972.

  43. Sahana K, Sujatha R. Clinical profile of dengue among children according to revised WHO classification: Analysis of a 2012 outbreak from southern India. The Indian Journal of Pediatrics. 2015;82(2):109-13.

  44. Rosenberger KD, Lum L, Alexander N, Junghanss T, Wills B, Jaenisch T. Vascular leakage in dengue-clinical spectrum and influence of parenteral fluid therapy. Tropical Medicine & International Health. 2016;21(3):445-53.

  45. Salgado DM, Eltit JM, Mansfield K, Panqueba C, Castro D, Vega MR, et al. Heart and skeletal muscle are targets of dengue virus infection. Pediatr Infect Dis J. 2010;29(3):238-42.

  46. Yacoub S, Griffiths A, Chau TTH, Simmons CP, Wills B, Hien TT, et al. Cardiac function in Vietnamese patients with different dengue severity grades. Crit Care Med. 2012;40:477-83.

  47. Miranda CE, Borges MC, Matsuno AK, Vilar FC, Gali LG, Volpe GJ, et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. Clinical Infectious Diseases 2013;57(6):812-9.

  48. Li Y, Hu Z, Huang Y, Li J, Hong W, Qin Z, et al. Characterization of the Myocarditis during the worst outbreak of dengue infection in China. Medicine. 2016;95(27).

  49. Póvoa TF, Alves AM, Oliveira CA, Nuovo GJ, Chagas VL, Paes MV. The pathology of severe dengue in multiple organs of human fatal cases: histopathology, ultrastructure and virus replication. PloS One. 2014;9(4):e83386.

  50. Oliveira JFP, Burdmann EA. Dengue-associated acute kidney injury. Clinical kidney journal. 2015;8(6):681-5.

  51. Cruz Queiroz P, Souza Jorge AE, Vaz Mourão PH, Moreira Guimarães Penido MG. Collapsing focal segmental glomerulosclerosis probably triggered by dengue virus infection - two case reports. Brazilian Journal of Nephrology. 2020;42(4):489-93. DOI: https://doi.org/10.1590/2175-8239-JBN-2019-023751.

  52. Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. Lancet. 2013;12:906-19.




2020     |     www.medigraphic.com