Expanded dengue syndrome in secondary dengue infection: A case of biopsy proven rhabdomyolysis induced acute kidney injury with intracranial and intraorbital bleeds

Tansir, Ghazal; Gupta, Charu; Mehta, Samira K.; Kumar, Prabhat; Soneja, Manish; Biswas, Ashutosh

doi:10.5582/irdr.2017.01071

Cited by 16 publications

(22 citation statements)

References 16 publications

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“…5 There has been increasing atypical and rare presentations of DF resulting in the expanded dengue definition. 28 , 29 Some studies similar to ours from other parts of the country have reported significant differences in the incidence of atypical presentation like neurological signs or the incidence of serositis 11 , 12 while others have reported similar findings. 23 These differences may be due to co-infection with other pathogens 28 or secondary heterotypic dengue virus infections.…”

Section: Discussionsupporting

confidence: 65%

Clinical and Hematological Profile of Patients With Dengue Fever at a Tertiary Care Hospital – An Observational Study

Tewari¹,

Tewari²,

Mehta³

2018

Mediterr J Hematol Infect Dis

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BackgroundDengue is a major health issue with seasonal rise in dengue fever cases imposing an additional burden on hospitals, necessitating bolstering of services in the emergency department, laboratory with creation of additional dengue fever wards.ObjectivesTo study the clinical and hematological profile of dengue fever cases presenting to a hospital.MethodsPatients with fever and other signs of dengue with either positive NS1 antigen test or IgM or IgG antibody were included. Age, gender, clinical presentation, platelet count and hematocrit were noted and patients classified as dengue fever without warning signs (DF) or with warning signs (DFWS), and severe dengue (SD) with severe plasma leakage, severe bleeding or severe organ involvement. Duration of hospitalization, bleeding manifestations, requirement for platelet component support and mortality were recorded.ResultsThere were 443 adults and 57 children between 6 months to 77 year age. NS1 was positive in 115 patients (23%). Fever (99.8%) and severe body ache (97.4%) were the commonest presentation. DF was seen in 429 (85.8 %), DFWS in 55 (11%), SD with severe bleeding in 10 (2%) and SD with severe plasma leakage in 6 cases (1.2%). Outpatient department (OPD) treatment was needed in 412 (82%) and hospitalization in 88 (18%). Intravenous fluid resuscitation was needed in 16 (3.2%) patients. Thrombocytopenia was seen in 335 (67%) patients at presentation. Platelet transfusion was needed in 46 (9.2%). Packed red blood cell (PRBC) transfusion was given in 3 patients with DFWS and 10 of SD with severe bleeding. Death occurred in 3 patients of SD with severe plasma leak and 2 patients with SD and severe bleeding.ConclusionsMajority of DF cases can be managed on OPD basis. SD with severe bleeding or with severe plasma leakage carries high mortality. Hospitals can analyze annual data for resource allocation for capacity expansion.

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Section: Discussionsupporting

confidence: 65%

Clinical and Hematological Profile of Patients With Dengue Fever at a Tertiary Care Hospital – An Observational Study

Tewari¹,

Tewari²,

Mehta³

2018

Mediterr J Hematol Infect Dis

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“…The term “expanded dengue” was thus frequently used by the informants. A change in disease pattern has indeed been documented elsewhere, 27 , 28 and it has been found that dengue comes with a wider spectrum of symptoms than previously observed. 29 – 31 …”

Section: Discussionsupporting

confidence: 55%

“…The term "expanded dengue" was thus frequently used by the informants. A change in disease pattern has indeed been documented elsewhere, 27,28 and it has been found that dengue comes with a wider spectrum of symptoms than previously observed. [29][30][31] To overcome the diagnostic challenges mentioned, a solid system must be in place, which gives the clinicians the best possible prerequisites for making the correct diagnosis and, thus, the health authorities a correct picture of the disease burden.…”

Section: Discussionsupporting

confidence: 54%

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System

Sulistyawati

Nilsson

Ekasari

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis "Dengue surveillance stands and falls by the rigor of the health system." The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.

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“…Since urea is reabsorbed by the kidney, its altered levels in the blood may indicate renal dysfunction. Increased levels of BUN are often reported is renal involvement during DENV infections [ 22 , 34 , 37 , 76 , 77 ], and can be a consequence of glomerular injury or hypotension [ 37 ]. Mice blood samples were collected at 24, 48 and 72 hpi, and BUN levels were measured.…”

Section: Discussionmentioning

confidence: 99%

“…Glomerular changes affecting the kidney are often reported in dengue human cases [ 31 , 34 , 43 ] and, DENV inducing glomerulopathies is well documented [ 34 , 67 , 77 , 78 ]. Deposition of immuno complexes has been suggested as a mechanism of glomerular injury in AKI induced by dengue [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Brazilian Dengue Virus Type 2-Associated Renal Involvement in a Murine Model: Outcomes after Infection by Two Lineages of the Asian/American Genotype

et al. 2021

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Dengue virus type 2 (DENV-2) is, traditionally, the most studied serotype due to its association with explosive outbreaks and severe cases. In Brazil, almost 20 years after the first introduction in the 1990s, a new lineage (Lineage II) of the DENV-2 Asian/American genotype emerged and caused an epidemic with severe cases and hospitalizations. Severe dengue includes multiple organ failure, and renal involvement can be potentially related to increased mortality. In order to better understand the role of DENV infection in renal injury, here we aimed to investigate the outcomes of infection with two distinct lineages of DENV-2 Asian/American genotype in the kidney of a murine model. BALB/c mice were infected with Lineages I and II and tissues were submitted to histopathology, immunohistochemistry, histomorphometry and ultrastructural analysis. Blood urea nitrogen (BUN) was detected in blood sample accessed by cardiac puncture. A tendency in kidney weight increase was observed in mice infected with both lineages, but urea levels, on average, were increased only in mice infected with Lineage II. The DENV antigen was detected in the tissue of mice infected with Lineage II and morphological changes were similar to those observed in human dengue cases. Furthermore, the parameters such as organ weight, urea levels and morphometric analysis, showed significant differences between the two lineages in the infected BALB/c, which was demonstrated to be a suitable experimental model for dengue pathophysiology studies in kidneys.

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Expanded dengue syndrome in secondary dengue infection: A case of biopsy proven rhabdomyolysis induced acute kidney injury with intracranial and intraorbital bleeds

Cited by 16 publications

References 16 publications

Clinical and Hematological Profile of Patients With Dengue Fever at a Tertiary Care Hospital – An Observational Study

Clinical and Hematological Profile of Patients With Dengue Fever at a Tertiary Care Hospital – An Observational Study

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System

Brazilian Dengue Virus Type 2-Associated Renal Involvement in a Murine Model: Outcomes after Infection by Two Lineages of the Asian/American Genotype

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