É possível identificar a dengue em crianças a partir do critério de caso suspeito preconizado pelo Ministério da Saúde?

Abstract

Objectives: To identify clinical characteristics indicative of dengue and to evaluate the applicability to children of the Health Ministry criteria for suspected cases. Methods:A cross-sectional study undertaken at the General Pediatrics Center of the Fundação Hospitalar de Minas Gerais. Children were enrolled if presenting acute febrile conditions with no definite etiology, lasting > 24 hours and < 7 days and if resident in the Metropolitan Region of Belo Horizonte. Clinical variables were investigated, specific tests were performed and aspartate-aminotransferase assayed, during a period considered both endemic and epidemic for the disease. The subset of children who did have dengue was compared with the subset of nonspecific acute febrile diseases. The Health Ministry criteria for suspected cases was evaluated.Results: Dengue was diagnosed in 50.4% of the 117 children studied. There were no statistically significant associations between the disease and the majority of the symptoms analyzed. Only exanthema was more often associated with dengue (Prevalence Ratio = 1.49; 95% CI: 1.05-2.11). The criteria for suspected cases of dengue had a sensitivity of just 50.8% and a positive predictive value of 62.5%. These values were greater among schoolchildren and during the period of greater disease incidence. Conclusions:Dengue is common among febrile diseases of childhood, with prevalence that varies according to the epidemiological situation. The clinical status of children with dengue was very similar to that of children with other nonspecific diseases. The Health Ministry criteria for suspected cases were shown to be of little use, particularly with smaller children and during periods of reduced incidence.J Pediatr (Rio J). 2005;81(3):209-15: Dengue/diagnosis, fever, signs and symptoms, child, preschool, exanthema.

Um modelo bayesiano para investigação de sobremortalidade durante epidemia de dengue na Região Metropolitana do Rio de Janeiro, Brasil, 2007-2008

“…Além disso, na infância, é difícil diferenciar o dengue de outras doenças febris agudas, e a maioria das infecções por dengue é assintomática ou oligossintomática 28,29 . Um inquérito realizado no Rio de Janeiro verificou sorologia positiva para dengue em 33% dos escolares, apesar de os pais informarem que eles não tinham tido a doença 30 .…”

Dynamics of nonstructural glycoprotein‐1 in dengue patients presenting with different clinical manifestations from 1986 to 2012 in Rio de Janeiro, Brazil

“…However, after analyzing 20 to 29 year, 30 to 39 year, 40 to 49 year, and 50 to 59 year olds, we observed that there was no significant difference regarding changes in the epidemiological profile of the disease or the variables studied. For this reason, the population was grouped in children, youth, adults, and the elderly as described in previous studies …”

“…For this reason, the population was grouped in children, youth, adults, and the elderly as described in previous studies. 22…”

The challenge of diagnosing dengue in children

“…Estudo recente do Ministério da Saúde (MS) 2 , analisando os dados de dengue e FHD de 1980 a 2002, refere que, atualmente, três sorotipos (1, 2 e 3) co-circulam em 22 dos 27 estados brasileiros e que, apesar dos adultos serem os mais afetados, está havendo um aumento da ocorrência de FHD em crianças no Norte do Brasil, o que sugere que está ocorrendo uma mudança das formas mais graves para faixas etárias mais jovens. No presente número do Jornal de Pediatria, o excelente trabalho de Rodrigues et al 3 discute a baixa sensibilidade e especificidade do critério de caso suspeito de dengue do MS 4 . É clássico que formas assintomáticas ou oligossintomáticas de dengue ocorram mais em crianças 5,6 .…”