Clinical and Laboratory Signs as Dengue Markers During an Outbreak in Rio de Janeiro

Passos, Sônia Regina Lambert; Bedoya, Santiago; Hökerberg, Yara Hahr Marques; Maia, Saulo; Georg, Ingebourg; Nogueira, Rita Maria Ribeiro; Souza, Rogério Valls de; Marzochi, Keyla Belízia Feldman

doi:10.1007/s15010-008-7334-6

Cited by 13 publications

(13 citation statements)

References 38 publications

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“…The pruritus usually coincides with the exanthema, but sometimes patients have only pruritus. Consistent with previous studies 25,26 , we observed a higher ratio of patients with pruritus compared to rash. It is known that pruritus is a common manifestation of cholestatic hepatitis 27 .…”

Section: Discussionsupporting

confidence: 93%

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Tristão-Sá

Kubelka

Zandonade

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction:To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. Methods: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. Results: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. Conclusions: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

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Section: Discussionsupporting

confidence: 93%

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Tristão-Sá

Kubelka

Zandonade

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…We did not find that fever, exanthema, thrombocytopenia (< 150,000), leukopenia (< 4,000) or vomiting were criteria to differentiate between patients who subsequently developed SDD versus N-SDD, as found in Brazil [39]. In another study, leukocyte count (< 4,500/μl) and thrombocyte count (< 90,000/μl), but not positive tourniquet test, were associated with spontaneous bleeding in patients from a DENV-endemic area [40].…”

Section: Discussionmentioning

confidence: 87%

Simple Prognostic Criteria Can Definitively Identify Patients Who Develop Severe Versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses

Falconar

Romero-Vivas

2012

J Clin Med Res

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BackgroundSevere dengue disease (SDD) (DHF/DSS: dengue hemorrhagic fever/dengue shock syndrome) results from either primary or secondary dengue virus (DENV) infections, which occur 4 - 6 days after the onset of fever. As yet, there are no definitive clinical or hematological criteria that can specifically identify SDD patients during the early acute febrile-phase of disease (day 0 - 3: < 72 hours). This study was performed during a SDD (DHF/DSS) epidemic to: 1) identify the DENV serotypes that caused SDD during primary or secondary DENV infections; 2) identify simple clinical and hematological criteria that could significantly discriminate between patients who subsequently developed SDD versus non-SDD (N-SDD), or had a non-DENV fever of unknown origin (FUO) during day 0 - 3 of fever; 3) assess whether DENV serotype co-infections resulted in SDD.MethodsFirst serum samples, with clinical and hematological criteria, were collected from 100 patients during the early acute febrile-phase (day 0 - 3: < 72 hours), assessed for DENV or FUO infections by IgM- and IgG-capture ELISAs on paired serum samples and by DENV isolations, and subsequently graded as SDD, N-SDD or FUO patients.ResultsIn this study: 1) Thirty-three patients had DENV infections, predominantly secondary DENV-2 infections, including each SDD (DHF/DSS) case; 2) Secondary DENV-2/-3 and DENV-2/-4 serotype co-infections however resulted in N-SDD; 3) Each patient who subsequently developed SDD, but none of the others, displayed three clinical criteria: abdominal pain, conjunctival injection and veni-puncture bleeding, therefore each of these criteria provided definitively significant prognostic (P < 0.001) values; 4) Petechia, positive tourniquet tests and hepatomegaly, and neutrophilia or leukopenia also significantly identified those who: a) subsequently developed SDD versus N-SDD, or had a FUO; b) subsequently developed SDD versus N-SDD; c) subsequently developed N-SDD versus FUOs, respectively.ConclusionsThis is the first report of simple definitively prognostic criteria for SDD patients, including the first assessment and confirmation of conjunctival injection. The three definitive clinical criteria used alone, or supported by the other four criteria, could be essential for specifically identifying those patients needing prompt hospital-based therapies to lessen or avert SDD, without unnecessary hospitalization of the other patients.KeywordsDengue virus; Severe dengue; Dengue fever; Diagnostic; Criteria; Hemorrhage; Shock

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“…Considering that the differential diagnosis of AFI and the notification of suspicious cases are based on combinations of those signs and symptoms, structured clinical history taken in sentinel units enables the acquisition of information useful for epidemiological surveillance. For instance, elevated agreement rates were found for the presence of exanthema (k = 0.941; 0.883-0.998) and history of itching (k = 0.755; 0.607-0.876), two clinical signs previously identified as useful for dengue diagnosis in the state of Rio de Janeiro [21]. It is worth noting that the possibility of collecting more detailed data, comprising information on intensity grading, is potentially innovative for clinical research in the field.…”

Section: Discussionmentioning

confidence: 99%

Interobserver agreement on signs and symptoms of patients with acute febrile illness

et al. 2011

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High agreement was observed for most of the clinical data assessed, and symptom grading was feasible. Some physical findings were rare and their inclusion in a structured form may not be justified in this setting. The questionnaire application showed good reliability for the most frequent signs and symptoms and may prove to be useful at gathering data for surveillance and research at sentinel sites.

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Clinical and Laboratory Signs as Dengue Markers During an Outbreak in Rio de Janeiro

Abstract: A combination of symptoms not necessarily considered indicative of dengue diagnosis could improve surveillance and medical decision-making in simple clinical settings.

Cited by 13 publications

References 38 publications

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Simple Prognostic Criteria Can Definitively Identify Patients Who Develop Severe Versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses

Interobserver agreement on signs and symptoms of patients with acute febrile illness

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