Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

Jayaratne, S D; Atukorale, Vajini; Gomes, Laksiri; Chang, Thashi; Wijesinghe, Tharindu; Fernando, Sumadhya Deepika; Ogg, Graham S.; Malavige, Gathsaurie Neelika

doi:10.1186/1756-0500-5-645

Cited by 61 publications

(73 citation statements)

References 27 publications

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“…In addition to hypoproteinemia, we found that raised ALT levels were associated with severe form ofdisease. This is in contrast to observations made by Jayaratne et al,stated that raised AST levels were associated with severe dengue and have better predictive value in predicting severe disease [28]. Ours findings indicate that in addition to evaluating hemoconcentration and decreased platelet counts, the presence of low serum protein and raised ALT levels may be taken as a marker for predicting severe disease.…”

Section: Pereira Et Alcontrasting

confidence: 98%

Factors Associated With Severity of Illness in Patients With Dengue Fever in a Tertiary Care Hospital in Southern India

Pereira

Kudru

Nair

et al. 2018

Asian J Pharm Clin Res

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Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue. Methods:A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue. Conclusion:This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

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Section: Pereira Et Alcontrasting

confidence: 98%

Factors Associated With Severity of Illness in Patients With Dengue Fever in a Tertiary Care Hospital in Southern India

Pereira

Kudru

Nair

et al. 2018

Asian J Pharm Clin Res

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“…They are known to play an important role in both acute [11] and chronic viral infections [14,28], including a recent report on their role in dengue infection [12]. Acute dengue is known to associate with a marked lymphopenia [29], especially with reduction of T cells due to massive T cell apoptosis [8,9]. We have also observed that DENV-specific IFN-g T cell responses are impaired during acute dengue, especially in those with more severe forms of dengue [7].…”

Section: Discussionmentioning

confidence: 58%

Expansion of highly activated invariant natural killer T cells with altered phenotype in acute dengue infection

Kamaladasa

Wickramasinghe

Adikari

et al. 2016

Clinical and Experimental Immunology

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1These authors contributed equally to this study. SummaryInvariant natural killer T (iNKT) cells are capable of rapid activation and production of cytokines upon recognition of antigenic lipids presented by CD1d molecules. They have been shown to play a significant role in many viral infections and were observed to be highly activated in patients with acute dengue infection. In order to characterize further their role in dengue infection, we investigated the proportion of iNKT cells and their phenotype in adult patients with acute dengue infection. The functionality of iNKT cells in patients was investigated by both interferon (IFN)-g and interleukin (IL)24 ex-vivo enzyme-linked immunospot (ELISPOT) assays following stimulation with alpha-galactosyl-ceramide (aGalCer). We found that circulating iNKT cell proportions were significantly higher (P 5 0Á03) in patients with acute dengue when compared to healthy individuals and were predominantly of the CD4 1 subset. iNKT cells of patients with acute dengue had reduced proportions expressing CD8a and CD161 when compared to healthy individuals. The iNKT cells of patients were highly activated and iNKT activation correlated significantly with dengue virusspecific immunoglobulin (Ig)G antibody levels. iNKT cells expressing Bcl-6 (P 5 0Á0003) and both Bcl-6 and inducible T cell co-stimulator (ICOS) (P 5 0Á006) were increased significantly in patients when compared to healthy individuals. Therefore, our data suggest that in acute dengue infection there is an expansion of highly activated CD4 1 iNKT cells, with reduced expression of CD161 markers.

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“…(1) For the prospective studies, the DENCO study provided limited evidence on three warning signs (severe abdominal pain, lethargy, and mucosal bleeding), all predicting severity within 24 hours in advance; 16 also, the combination of five warning signs is a very good predictor of severe disease; 17 2) Retrospective studies on this issue have limited value; 18 however, studies examining the warning signs included the following results: no warning sign alone or combined had a sensitivity of more than 64% in predicting severe disease in one study; 19 however, when warning signs were used for criteria for admission, these were good indicators for severity; 20 ascites, mucosal bleeding, hematemesis, and thrombocytopaenia were identified as good indicators for warning signs; 21 and abdominal pain and hematemesis were identified for the same purpose in another study. 22 The expert panel agreed that D/SD can be used very effectively to identify both pediatric and adult cases of dengue with a risk of progression to shock, specially based on the use of warning signs.…”

Section: Resultsmentioning

confidence: 99%

WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas

Horstick

Martínez

Guzmán

et al. 2015

Pathogens and Global Health

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Introduction: In 2009, the new World Health Organization (WHO) dengue case classification -dengue/ severe dengue (D/SD) -was introduced, replacing the 1997 WHO dengue case classification: dengue fever/dengue haemorrhagic fever/dengue shock syndrome (DF/DHF/DSS). Methods: A 2-day expert consensus meeting in La Habana/Cuba aimed to (1) share the experiences from Pan American Health Organization (PAHO) member states when applying D/SD, (2) present national and local data using D/SD, and (3) agree with the presented evidence on a list of recommendations for or against the use of D/SD for PAHO, and also globally. Results: Eight key questions were discussed, concluding: (1) D/SD is useful describing disease progression because it considers the dynamic nature of the disease, (2) D/SD helps defining dengue cases correctly for clinical studies, because it defines more precisely disease severity and allows evaluating dynamically the progression of cases, (3) D/SD describes correctly all clinical forms of severe dengue. Further standards need to be developed regionally, especially related to severe organ involvement, (4) D/SD allows for pathophysiological research identifying -in a sequential manner -the clinical manifestations of dengue related to pathophysiological events, (5) the warning signs help identifying early cases at risk of shock (children and adults), pathophysiology of the warning signs deserves further studies, (6) D/SD helps treating individual dengue cases and also the reorganization of health-care services for outbreak management, (7) D/SD helps diagnosing dengue, in presumptive diagnosis and follow-up of the disease, because of its high sensitivity and high negative predictive value (NPV), and (8) there is currently no update of the International Disease Classification10 (ICD10) to include the new classification of dengue (D/SD); therefore, there are not enough experiences of epidemiological reporting. Once D/SD has been implemented in epidemiological surveillance, D/SD allows to (1) identify severity of dengue cases in real time, for any decision-making on actions, (2) measure and compare morbidity and mortality in countries, and also globally, and (3) trigger contingency plans early, not only based on the number of reported cases but also on the reported severity of cases. Conclusion: The expert panel recommends to (1) update ICD10, (2) include D/SD in country epidemiological reports, and (3) implement studies improving sensitivity/specificity of the dengue case definition.

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Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

Cited by 61 publications

References 27 publications

Factors Associated With Severity of Illness in Patients With Dengue Fever in a Tertiary Care Hospital in Southern India

Factors Associated With Severity of Illness in Patients With Dengue Fever in a Tertiary Care Hospital in Southern India

Expansion of highly activated invariant natural killer T cells with altered phenotype in acute dengue infection

WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas

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