Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis

Htun, Tha Pyai; Xiong, Zhonghui; Pang, Junxiong

doi:10.1080/22221751.2021.1935327

Cited by 27 publications

(43 citation statements)

References 63 publications

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“…Instead, the combined index, such as AST 2 /ALT, could improve discriminative performance [98]. On this point, our finding was inconsistent with most previous systematic reviews in which the ALT level was significantly higher in severe dengue [12,19,22]. This could be attributed to the time window that we used-the first 3 days versus 4 days or later in these studies-which could be premature for the hepatocellular damage to be noted.…”

Section: Discussioncontrasting

confidence: 95%

“…Nevertheless, the reported evidence is conflicting [12][13][14]. These conflicts arise from insufficient study power or inconsistency in the timeframe during which markers are recorded [15,16], often late in the disease course [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Previous systematic reviews offer insight as to predictive methods for severe dengue. Notwithstanding, the conclusions went hand in hand with the study limitations that formed the body of evidence, say the combination of DHF and DSS or late measurement [12,14,19,22,23]. Besides, studies have focused concern on immunogenetic markers that benefit pathophysiology rather than medical case management [18,[24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

et al. 2021

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Background Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. Methodology We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). Principal findings Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. Conclusion The findings suggest that alterations of platelet count and AST level—in the first 72 hours of fever onset—are independent markers predicting the development of severe dengue.

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Section: Discussioncontrasting

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

et al. 2021

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“…A leukocyte count of less than 3500 cells/µL was defined as leukopenia, mild neutropenia when neutrophils were in the range 1000-1500 cells/µL, and severe neutropenia when there were <500 neutrophils/µL. To segregate the patients into groups based on dengue with or without warning signs of severe dengue, we referred to the WHO 2009 dengue clinical classification guideline [37]. These include abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy or restlessness, liver enlargement, or evidence of hemoconcentration with rapid decline of platelet counts.…”

Section: Discussionmentioning

confidence: 99%

A Cluster of Dengue Cases in Travelers: A Clinical Series from Thailand

et al. 2021

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Dengue is an overlooked tropical disease for which billions of people are at risk. The disease, caused by a Flavivirus with four distinct serotypes, is transmitted primarily by urban Aedes mosquito species. The infection leads to a spectrum of clinical manifestations, with the majority being asymptomatic. Primary dengue fever and, to a greater extent, a subsequent infection with a different serotype is associated with increased severity. Increased global travel and recreational tourism expose individuals naïve to the dengue viruses, the most common arboviral infections among travelers. We describe a cluster of possible primary acute dengue infections in a group of 12 individuals who presented to Bangkok Hospital for Tropical Diseases in 2017. Infection was confirmed by dengue NS1 antigen and multiplex real-time RT-PCR. Nine individuals required hospitalization, and four developed dengue warning signs. Leukocytes, neutrophils, and platelets declined towards defervescence and were negatively correlated with day of illness. Six clinical isolates were identified as dengue serotype-1, with 100% nucleotide identity suggesting that these patients were infected with the same virus.

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“…Male may be at risk for SD because they spend more time outside as compared to girls and are more at risk of mosquito bites and secondary infections, which increases the risk for SD [ 16 ]. This suggests that SD depends on the viral load and host factors such as secondary immune response [ 17 ]. However, a meta-analysis revealed no association of gender with severe DF [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes

Farooq¹,

Aurangzeb

Sheikh³

et al. 2021

Journal of Tropical Medicine

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Background. There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method. This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results. Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender ( p = 0.049 ), lower normal mean platelet ( p = 0.02 ), and high mean hematocrit ( p = 0.001 ) were associated with disease progression. Conclusion. The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.

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Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis

Cited by 27 publications

References 63 publications

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

A Cluster of Dengue Cases in Travelers: A Clinical Series from Thailand

Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes

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