Characteristics of dengue shock syndrome match WHO markers of severe disease
Clinical and laboratory characteristics of dengue shock syndrome in children complied with current WHO guidelines as markers of severe disease and presented variables to predict risk of shock progression and outcomes, according to a recently published findings.
“In patients with [dengue shock syndrome], early appropriate treatment can reduce mortality,” Dolores Lovera, MD, of the department of pediatrics at the Institute of Tropical Medicine in Asunción, Paraguay, and colleagues wrote. “Therefore, tools that permit identification of which patient will develop shock or other severe manifestations of dengue, can reduce the health care burden of dengue infection in endemic countries and decrease the mortality. Therefore, determination of risk factors of [dengue shock syndrome] is crucial for early detection and proper management of shock.”
Lovera and colleagues conducted data analysis on 471 children younger than 15 years admitted to the Institute of Tropical Medicine for dengue fever during an outbreak of dengue serotype 2 in Paraguay between 2011 and 2013. The researchers examined cases for dengue shock syndrome based on 2009 WHO guidelines for markers for severe disease using demographic, clinical and laboratory data to test the efficacy of WHO guidelines and determine additional predicting tools for shock progression and outcomes.
The mean age of children who presented with dengue shock syndrome (n = 354; 75%) was 10.2 years. Patients younger than 5 years developed shock more frequently compared with older patients or patients younger than 24 months (OR = 1.6; 95% CI, 1-2.8). In addition, patients with abdominal pain (OR = 2.5; 95% CI, 1.3-4.9), an activated partial thromboplastin time prolonged (OR = 4; 95% CI, 1.6-10) and decreased fibrinogen levels (OR = 2.5; 95% CI, 1-5.9) also developed dengue shock syndrome more frequently.
“Various symptoms and signs were included as warning signs in the last WHO dengue guideline,” the researchers wrote. “Although they have been shown to be very useful for early intervention, in the present series only few signs of dengue severity were identified to be associated with the development of shock, such as abdominal pain as well as effusion in more than one cavity. These findings are manifestations of the severe increase in capillary leakage, the main pathological cause of development of shock and are consistent with findings in the pediatric population in Puerto Rico, Cuba and Colombia.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.