Clinical experience in dengue: experience of specialized service

Abstract

Although known for centuries, the infection by dengue virus is starting to exhibit different and more exuberant manifestations from the previously known forms from the middle of last century with the description of the hemorrhagic form of the disease.The World Health Organization, aiming to standardize the different manifestations of dengue fever, has proposed a classification that would not only standardize the information, but mainly suggest actions to reduce the risk of death by this disease.Despite the importance and need for guidance on the different clinical forms and procedures to be instituted, new manifestations, unexpected and expected, of dengue began to emerge with the spread of disease.Different studies have pointed to regional differences regarding the clinical manifestations due to not only the prevalent serotype, but also the genetic polymorphism that can provide protection and also induce more severe forms of disease 8 .The pattern of dengue prevalence among children, so common in regions where this disease is endemic for a long time, began to emerge in the Brazilian population in places where infection has occurred annually.We present here the experience from a healthcare center providing assistance to patients with dengue in Brazil, which demonstrates the data exposed above.The Reference Center of Dengue (Centro de Referência da Dengue, CRD), located in the city of Campos dos Goytacazes, unique in the country, is important for the population of this city and neighboring cities due to the high incidence of dengue in this region, and also contributing to a better understanding of dengue in Brazil and suggesting new approaches to provide care to a patient affected by this virus.In 2010, CRD provided assistance to children which represented 11.44% of cases of dengue and in 2011, the cases in children up to 14 years were 14.99% by September. This data indicates worsening of this disease in younger children in the near future.The clinical signs are always initiated by fever, headache, myalgia, anorexia, retro-orbital pain, nausea, prostration, vomiting, diarrhea and rash in lower percentage.In the second or third day after the onset of symptoms, warning signs of hemorrhagic dengue appears in severe cases: abdominal pain, severe prostration, persistent vomiting and hypotension, which are conditions that require more vigorous action by doctors and other healthcare professionals.These conditions, based on the pathophysiology of the dengue fever, occur due to increased vascular permeability with consequent leakage of liquids, dehydration, hemoconcentration, conditions which must be reversed immediately with intravenous hydration based on crystalloid solutions (saline or Lactated Ringer), introduced at high rates on the basis of 20mL/kg/h and lower rates in order to stabilize the patient during hospitalization.In the 2010 survey, based on medical records from 206 patients aged over 13 years, we observed the presence of serositis (pleural effusion and ascitis) in 55 patients, i.e., more than 25% of the ho...

Proteinuria asociada al dengue

“…Se realizó un correlación entre la proteinuria y el recuento más bajo de plaquetas, obteniéndose una correlación negativa imperfecta (r -0,1) (gráfico 5). El ligero predominio de mujeres en esta muestra es un fenómeno común observado en el país y en la 25 región. Posiblemente esto se deba a los hábitos domiciliarios del vector.…”