Hypocalcemia is associated with disease severity in patients with dengue

Constantine, Godwin; Rajapakse, Senaka; Ranasinghe, Priyanga; Parththipan, Balasundaram; Wijewickrama, Ananda; Jayawardana, Priyankara

doi:10.3855/jidc.4974

Cited by 16 publications

(23 citation statements)

References 19 publications

(17 reference statements)

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“…We observed a decrease in albumin, along with elevated alanine transaminase (ALT) and aspartate transaminase (AST) in both PI and SI (Table 4) denoting liver inflammation, which has been associated with severity (Oliveira et al 2016, Posadas-Mondragón et al 2017; however, there were no cases of acute hepatitis marked by >10 times ALT increase, unlike in other studies (Souza et al 2004). It has been reported that Ca 2+ levels correlate with disease severity, with hypocalcemia being more prevalent in DHF than in DF (Constantine et al 2014). Our results agree with that report, although hypocalcemia was found at a similar percentage in PI and SI (Table 4).…”

Section: Discussionsupporting

confidence: 92%

Primary Dengue Infection in Patients Requiring Hospitalization During an Outbreak in a Low Incidence Mexican Region

Cárdenas-Perea

Flores-Mendoza

Pérez-Contreras

et al. 2020

Vector-Borne and Zoonotic Diseases

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Background: Dengue manifestations can range from subclinical to fatal. The study of factors that influence dengue's clinical severity can provide information to potentially limit or predict severe cases. Secondary infection (SI) with a different dengue serotype has been recognized as an important determinant of severity. However, severe dengue (SD) manifestations, including shock, can happen during primary infection (PI) too and the mechanisms involved are less understood. To characterize the severe manifestations associated to PI, we distinguished between primary and secondary dengue cases in hospitalized patients from a region of low and recent dengue incidence in central Mexico. This region can serve as a model for dengue's behavior as it spreads to new areas worldwide. Methods: Dengue-specific immunoglobulin M (IgM) and IgG concentrations were measured in the serum of 78 hospitalized patients with dengue hemorrhagic fever, and their ratios were used to discriminate between PI and SI, as recommended by World Health Organization. Clinical and laboratory manifestations were compared between PI and SI. Results and Conclusions: PI was detected in 23% of hospitalized dengue cases, a proportion similar to that reported in high-incidence regions in Mexico. PI was more frequent in 16-to 40-year-olds, and was absent in patients older than 60 years. Only dengue with warning signs and SD were present in the studied population of hospitalized patients, and case frequency decreased with clinical severity both in PI and SI groups. No significant differences in demographics, laboratory tests, or symptoms were found between PI and SI, which illustrates that cases requiring hospitalization during outbreaks can be severe, even if they are PI. This information can help plan for sanitary contingencies in places where dengue is recently emergent and numerous PI cases are expected. The mechanisms involved in PI clinical severity need to be studied further.Keywords: dengue primary infection, dengue outbreak, dengue IgG and IgM Introduction D engue is a common infection worldwide, with 4.0 billion people (half the world's population) currently at risk (Brady et al. 2012). It is caused by dengue virus (DENV), an arbovirus (arthropod-borne virus) with four serotypes (DENV-1 to 4) that circulate periodically (Wash et al. 2015). Because of its recent and rapid spread all over the world, DENV is considered an emerging pathogen and it is endemic in at least 128 countries (Brady et al.

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Section: Discussionsupporting

confidence: 92%

Primary Dengue Infection in Patients Requiring Hospitalization During an Outbreak in a Low Incidence Mexican Region

Cárdenas-Perea

Flores-Mendoza

Pérez-Contreras

et al. 2020

Vector-Borne and Zoonotic Diseases

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“…Unlike serum total calcium, serum ionized calcium (SIC) is not affected by other factors. A recent study revealed that SIC levels were significantly lower and hypocalcaemia was more prevalent in patients with dengue haemorrhagic fever (DHF) than in patients with DF [2]. …”

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confidence: 99%

“…Ultrasound Scan provides a quick assessment of TSFA. In previous studies TSFA was not objectively measured and ionized calcium levels were not serially done during hospital stay [1,2].…”

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confidence: 99%

Dengue fever and ionized calcium levels: significance of detecting hypocalcaemia to predict severity of dengue

Dahanayaka

Agampodi

Arachchi³

et al. 2017

Ceylon Med. J.

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“…However, no real correlation was seen with severity of dengue and reduction in LVEF occurring in all stages of clinical severity. Constantine et al [47] described echocardiographic features of myocarditis in 8 out of 37 adult and pediatric patients with dengue, and all of these patients belonged to the category of DHF. Reduced LVEF below 60% was noted only in four patients.…”

Section: Echocardiography and Cardiac Imagingmentioning

confidence: 99%

Cardiac involvement in dengue infection

Shivanthan

Navinan

Constantine

et al. 2015

J Infect Dev Ctries

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Introduction: Dengue is endemic in the tropics, and complications involving organ systems are seen with varying incidence. Methodology: We performed a systematic review. MEDLINE, EMBASE, Scopus SciVerse, Google Scholar, and LILACS were searched for papers providing information on cardiac involvement in dengue. Results: Cardiac involvement is not uncommon in dengue infection and is often transient, but may be associated with significant morbidity and even mortality. Direct viral invasion, immune mechanisms, electrolyte imbalance, derangement of intracellular calcium ion storage, lactic acidosis, and ischemia due to hypotension all play a role in myocardial dysfunction. The manifestations of cardiac involvement include clinical, electrocardiographic, echocardiographic, cardiac enzyme, and histopathologic abnormalities. Echocardiography appears to be a useful tool for detecting myocardial involvement and should be performed in patients with electrocardiographic abnormalities or hemodynamic instability. Treatment is largely supportive, though there are some anecdotal reports of improvements with specific agents. Conclusions: Knowledge on cardiac manifestations in dengue is limited, and further studies are needed to establish the exact pathophysiology and role of specific agents in the prevention and treatment of cardiac complications in dengue.

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Hypocalcemia is associated with disease severity in patients with dengue

Abstract: Introduction: Dengue hemorrhagic fever (DHF) is a major cause of morbidity and mortality in tropical regions. Serum free calcium (Ca

Cited by 16 publications

References 19 publications

Primary Dengue Infection in Patients Requiring Hospitalization During an Outbreak in a Low Incidence Mexican Region

Primary Dengue Infection in Patients Requiring Hospitalization During an Outbreak in a Low Incidence Mexican Region

Dengue fever and ionized calcium levels: significance of detecting hypocalcaemia to predict severity of dengue

Cardiac involvement in dengue infection

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