Predicting outcome from dengue

Abstract

Dengue is emerging as one of the most abundant vector-borne disease globally. Although the majority of infections are asymptomatic or result in only a brief systemic viral illness, a small proportion of patients develop potentially fatal complications. These severe manifestations, including a unique plasma leakage syndrome, a coagulopathy sometimes accompanied by bleeding, and organ impairment, occur relatively late in the disease course, presenting a window of opportunity to identify the group of patients likely to progress to these complications. However, as yet, differentiating this group from the thousands of milder cases seen each day during outbreaks remains challenging, and simple and inexpensive strategies are urgently needed in order to improve case management and to facilitate appropriate use of limited resources. This review will cover the current understanding of the risk factors associated with poor outcome in dengue. We focus particularly on the clinical features of the disease and on conventional investigations that are usually accessible in mid-level healthcare facilities in endemic areas, and then discuss a variety of viral, immunological and vascular biomarkers that have the potential to improve risk prediction. We conclude with a description of several novel methods of assessing vascular function and intravascular volume status non-invasively.

Markers of dengue severity: a systematic review of cytokines and chemokines

“…Two earlier published reviews did not apply and justify quality assessments (Chaturvedi et al, 2000;Yacoub & Wills, 2014). This is worth highlighting as the restriction of studies according to a set of inclusion/exclusion criteria, and the introduction of quality assessments, retained studies with better-defined methodologies.…”

“…Although a few immuno-modulating proteins are potentially promising as prognostic markers, prospective observation cohort trials, such as the one by International Research Consortium on Dengue Risk Assessment, Management, and Surveillance (IDAMS; https://ClinicalTrials.gov; identifier: NCT01550016), may aid further endorsement of the utility of an acute phase prognostic marker for SD. In addition, immuno-modulating proteins, in reflecting the cardinal symptoms of SD, plasma leakage and thrombocytopenia, should be given research priority (Yacoub & Wills, 2014;Zapata et al, 2014). One promising example is TNFa, which was reported to induce endothelial cell apoptosis and was also noted in this review as an elevated cytokine in DHF.…”

Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue

“…4,11,20 Improvements in platelet counts have been shown after therapy to indicate good prognosis. 12 Lymphocytosis (>45% in adults and >60% in children) was noted in 64% of cases in our study in concordance with others.…”

“…5,6,10,[16][17][18] Present study explores this line of thought by drawing parallels between the degree of atypical lymphocytosis and thrombocytopenia, and thus the progression to severe dengue; as thrombocytopenia has been associated with bleeding tendencies and increased vascular leakage with shock. [3][4][5]9,11,20 Aim of this study is to assess the utility of simple, easily available tests like platelet counts and atypical lymphocytes as predictors of severity in dengue.…”

Virulence of Dengue Fever and Bleeding Tendency: Understanding Clinical and Laboratory Manifestations

“…From a mild febrile illness called dengue fever to life-threatening complications known as dengue hemorrhagic fever (DHF) which can then progress to dengue shock syndrome (DSS) 2,3 …”