Early Clinical and Laboratory Indicators of Acute Dengue Illness

Kalayanarooj, Siripen; Vaughn, David W.; Nimmannitya, Suchitra; Green, S.; Suntayakorn, Saroj; Kunentrasai, N.; Viramitrachai, W.; Ratanachu-eke, S.; Kiatpolpoj, S.; Innis, Bruce L.; Rothman, Alan L.; Nisalak, Ananda; Ennis, Francis A.

doi:10.1086/514047

Cited by 530 publications

(507 citation statements)

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“…Prolonged thrombin time reflects alterations in fibrinogen levels and / or fibrinogen / fibrin degradation products [41]. Dengue virus infected patients frequently develop hepatic inflammation that is reflected by higher activity of hepatic transaminases AST/ALT [42], and sST2 levels were higher in patients with higher AST/ALT activity. We do not know which cells are responsible for the production of the sST2 protein in vivo during dengue virus infections; preliminary results using quantitative RT-PCR (Low Density Arrays) have shown increased expression of ST2 mRNA in peripheral blood mononuclear cells from dengue infected patients compared to OFI (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Elevated levels of soluble ST2 protein in dengue virus infected patients

et al. 2008

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Levels of the soluble form of the interleukin-1 receptor like 1 protein (IL-1RL-1 / ST2) are elevated in the serum of patients with diseases characterized by an inflammatory response. The objective of this study was to determine the concentration of soluble ST2 (sST2) in dengue infected patients during the course of the disease. Twenty four patients with confirmed dengue infection, classified as dengue fever, and eleven patients with other febrile illness (OFI) were evaluated. Levels of sST2 in serum and laboratory variables usually altered during dengue infections were measured. Dengue infected patients had higher serum sST2 levels than OFI at the end of the febrile stage and at defervescence (p=0.0088 and p=0.0004 respectively). Patients with secondary dengue infections had higher serum sST2 levels compared with patients with primary dengue infections (p=0.047 at last day of fever and p=0.030 at defervescence). Furthermore, in dengue infected patients, we found a significant negative correlation of sST2 with platelet and WBC counts, and positive correlation with thrombin time and transaminases activity. We suggest that sST2 could be a potential marker of dengue infection, could be associated with severity or could play a role in the immune response in secondary dengue virus infection.

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Section: Discussionmentioning

confidence: 99%

Elevated levels of soluble ST2 protein in dengue virus infected patients

et al. 2008

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“…La prueba del torniquete, que fue la principal manifestación hemorrágica en los pacientes con dengue, también parece útil para llegar al diagnóstico, como también se ha documentado en otros estudios de pacientes pediátricos en Asia (22,23).…”

Section: Discussionunclassified

“…Los bajos recuentos de plaquetas y leucocitos también se han descrito como indicadores tempranos de dengue (23). En el presente trabajo se proponen parámetros de ≤180.000/mm 3 para las plaquetas y de ≤4.000/mm 3 para los leucocitos como herramientas significativamente asociadas al dengue en las primeras 48 a 96 horas de enfermedad.…”

Section: Discussionunclassified

Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad.

Díaz¹,

Martínez²,

Villar³

2006

biomedica

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Introducción. La definición de caso de dengue de la Organización Mundial de la Salud (OMS) tiene alta sensibilidad, pero es muy inespecífica. Objetivo. Formular una escala diagnóstica de mayor exactitud que la definición de la OMS para la identificación clínica temprana del dengue en áreas endémicas. Materiales y métodos. En una cohorte de adultos (>12 años) con síndrome febril agudo sin causa aparente en Bucaramanga, Colombia, compuesta por 125 casos de dengue (confirmados serológica o virológicamente) y 126 de síndrome febril de otra etiología, se determinaron las manifestaciones clínicas tempranas (en los primeros cuatro días de la enfermedad) asociadas al dengue y con ellas se formularon y evaluaron diversas combinaciones diagnósticas. Resultados. La escala compuesta por exantema, prueba de torniquete positiva, ausencia de rinorrea, artralgias, ausencia de diarrea (1 punto por cada hallazgo), recuentos de leucocitos <4.000/mm 3 (3 puntos) y plaquetas <180.000/mm 3 (2 puntos) exhibió un área bajo la curva de características operador-receptor de 81,04%, superior a la observada con los criterios de la OMS de 69,96% (p=0,0003). Con ≥3 puntos se obtuvo una sensibilidad de 95,2%; una especificidad de 27,8%; un valor diagnóstico positivo de 56,7%; un valor diagnóstico negativo de 85,4%. Con ≥6 puntos se obtuvo una sensibilidad de 70,4%; una especificidad de 78,6%; un valor diagnóstico positivo de 76,5%; un valor diagnóstico negativo de 72,8%. Con ≥8 puntos se obtuvo una sensibilidad de 42,4%; una especificidad de 96%; un valor diagnóstico positivo de 91,4%; un valor diagnóstico negativo de 62,7%. Con 9 o 10 puntos, la especificidad y el valor diagnóstico positivo fueron de 100%. Conclusión. La escala descrita puede ser útil para el diagnóstico clínico temprano del dengue en áreas endémicas.Palabras clave: dengue, diagnóstico clínico, Organización Mundial de la Salud, recuento de leucocitos, recuento de plaquetas. Clinical criteria to diagnose dengue in its early stagesIntroduction. Clinical differentiation of dengue from other diseases with similar symptoms is difficult. The case definition of the World Health Organization (WHO) has high sensitivity but its specificity is very low. Objective. A diagnostic scale was formulated for early clinical diagnosis of dengue that provided greater accuracy than that of the WHO definition. Materials and methods. A cohort of 251 adults (>12 years of age) with unspecific acute febrile syndrome was selected from clinics located in Bucaramanga, Colombia. They consisted of 125 cases of dengue (serologically and/or virologically confirmed) and 126 with other febrile diseases. Clinical manifestations encountered during the first four days of dengue disease were determined, along with the diverse diagnostic combinations that were presented. Results: The scale consisted of the following criteria: presence of rash, positive tourniquet test, absence of nasal discharge, arthralgias, absence of diarrhea (1 point for each finding), leukocyte count < 4,000/mm3 (3 points) and platelet count <1...

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“…[2][3][4] Dengue is an icosahedral, enveloped virus with a single-stranded positive sense genome; it is a member of the flaviviridae family and has 4 antigenically distinct serotypes (DENV1-4). 3,5,6 After infection of a susceptible host, an acute, selflimiting febrile systemic syndrome ensues. Resolution of infection occurs within 4-7 days and is associated with a robust innate and adaptive immune response.…”

Section: Introductionmentioning

confidence: 99%