Clinical characterization of dengue with warning signs and severe dengue in adults. Roosevelt Hospital, Guatemala
Abstract
Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022.
Objective: Clinical characterization of dengue with warning signs and severe dengue.
Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023.
Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue.
Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.
Downloads
References
Patterson J, Sammon M, Garg M. Dengue, zika and chikungunya: Emerging arboviruses in the new world (Internet). Western Journal of Emergency Medicine. eScholarship. 2016; 17. p. 671–9. Available from: https://pubmed. ncbi.nlm.nih.gov/27833670/
World Health Organization (WHO). Global Strategy for dengue prevention and control, 2012-2020. (Internet). World Health Organization; 2012. Vols. 2012–2020. 1–43 p. Available from: https://iris.who.int/bitstream/
handle/10665/75303/9789241504034_eng.pdf?sequence=1
Guzman MG, Harris E. Dengue. The Lancet (Internet). 2015. p. 453–65. Available from: https://pubmed.ncbi.nlm.nih.gov/25230594/
MSPAS. Guía para el manejo clínico del dengue primero, segundo y tercer nivel de atención (Internet). Guatemala; 2022 Jan. Available from: https://www.studocu.com/gt/document/universidad-de-san-carlos-de-guatemala/medicina/guia-manejo-dengue-mspas-2022/42057070
Frantchez V, Fornelli R, Perez G, Arteta Z, Cabrera S, Sosa L, et al. Dengue en adultos: diagnóstico, tratamiento y abordaje de situaciones especiales. Revista Médica Uruguaya (Internet). 2016;32(1):43–51. Available from:
http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-03902016000100006&lng=es.
Gonçalves De Castro M, Bruycker De Nogueira F, Ribeiro Nogueira RM, Lourenço-De-Oliveira R, Barreto F, Santos D. Genetic variation in the 3’ untranslated region of dengue virus serotype 3 strains isolated from
mosquitoes and humans in Brazil (Internet). 2013. Available from: http://www.virologyj.com/content/10/1/3
Rivera-Osorio P, Vaughan G, Ramírez-González JE, Fonseca-Coronado S, Ruíz-Tovar K, Cruz-Rivera MY, et al. Molecular epidemiology of autochthonous dengue virus strains circulating in Mexico. J Clin Microbiol (Internet). 2011 Sep;49(9):3370–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165623/
Harapan H, Michie A, Sasmono RT, Imrie A. Dengue: A minireview (Internet). Viruses. MDPI AG. 2020;12. (cited 2024 Mar 4). Available from: https://pubmed.ncbi.nlm.nih.gov/32751561/
Velandia ML, Castellanos JE. Virus del dengue: estructura y ciclo viral Dengue virus: structure and viral cycle (Internet). 2011;15. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-93922011000100006&lng=en
Martina BEE, Koraka P, Osterhaus ADME. Dengue virus pathogenesis: An integrated view (Internet). Clinical Microbiology Reviews. 2009; 22. p. 564–81. Available from: https://pubmed.ncbi.nlm.nih.gov/19822889/
Murgue B. Severe dengue: questioning the paradigm (Internet). Microbes and Infection. 2010;12 (cited 2024 Mar 4). p. 113–8. Available from: https://pubmed.ncbi.nlm.nih.gov/19925879/
OMS. Disease Outbreak News. 2023. Dengue - Situación Mundial. Available from: https://www.who.int/es/emergencies/disease-outbreaknews/item/2023-DON498#:~:text=Entre%20el%201%20de%20enero,pa%C3%ADses%20y%20territorios%20de%20la
MSPASa. Alerta Institucional. Ministerio de Salud emite Alerta por temporada de transmisión de dengue (Internet). Guatemala; 2023. Available from: https://prensa.gob.gt/node/15040/printable/pdf
MSPASb. Salud reitera a la población que medidas preventivas son vitales para combatir el dengue. In: MSPASb, editor. Salud reitera a la población que medidas preventivas son vitales para combatir el dengue (Internet). Guatemala: MSPAS; 2023. p. 1–3. Available from: https://prensa.gob.gt/node/18502/printable/pdf
de Souza LJ, Bastos Pessanha L, Carvalho Mansur L, Assed de Souza L, Barbosa Tâmega Ribeiro M, do Vale da Silveira M, et al. Comparison of clinical and laboratory characteristics between children and adults with dengue.
Brazilian Journal of Infectious Diseases (Internet). 2013 Jan;17(1):27–31. Available from: https://pubmed.ncbi.nlm.nih.gov/23318285/
Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, et al. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue. Ann Intern Med (Internet). 2023 Jul;176(7):940–8. Available from: https://
pubmed.ncbi.nlm.nih.gov/37335991/
Real J, Ronceros S, Gómez M, Roby A, Ordñez J. Caracterización clínica del Dengue con signos de alarma y grave, en niños y adultos en hospitales de Guayaquil. Revista Científica Digital INSPILIP (Internet). 2017;1(1):1–18.
Available from: https://docs.bvsalud.org/biblioref/2019/04/987761/29-caracterizacion-clinica-del-dengue-con-signos-de-alarma-y.pdf
Kuo HJ, Lee IK, Liu JW. Analyses of clinical and laboratory characteristics of dengue adults at their hospital presentations based on the World Health Organization clinical-phase framework: Emphasizing risk of severe dengue in the elderly. Journal of Microbiology, Immunology and Infection (Internet). 2018 Dec 1;51(6):740–8. Available from: https://www.sciencedirect.com/science/article/pii/S1684118217300671
Byrne AB, Gutierrez GF, Bruno A, Córdoba MT, Bono MM, Polack FP, et al. Age-associated differences in clinical manifestations and laboratory parameters during a dengue virus type 4 outbreak in Argentina. J Med Virol
(Internet). 2018 Feb 1;90(2):197–203. Available from: https://ri.conicet.gov.ar/handle/11336/98544
Guzman MG, Vazquez S. The complexity of antibody-dependent enhancement of dengue virus infection. Viruses (Internet). 2010 Dec;2(12):2649–62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185591/
World Health Organization (WHO). Dengue Guías para el diagnóstico, tratamiento, Prevención y Control (Internet). 2009. 1–170 p. Available from: https://www.paho.org/es/documentos/dengue-guias-para-diagnosticotratamiento-prevencion-control-2009
OPS/OMS. Dengue. Guías para la atención de enfermos en la Región de Las Américas (Internet). Washington, D.C.; 2015. Available from: https://iris.paho.org/bitstream/handle/10665.2/28232/9789275318904_esp.pdf?sequence=1&isAllowed=y
CDC. National Notifiable Diseases Surveillance System. 2015. Dengue Virus Infections 2015 Case Definition. Available from: https://ndc.services.cdc.gov/case-definitions/dengue-virus-infections-2015/
Diamond M, Edgil D, Roberts T, Lu B, Harris E. Infection of Human Cells by Dengue Virus Is Modulated by Different Cell Types and Viral Strains. J Virol (Internet). 2000 Sep;74(17):7814–23. Available from: https://pubmed.ncbi.nlm.nih.gov/10933688/
De Azeredo EL, Monteiro RQ, De-Oliveira Pinto LM. Thrombocytopenia in dengue: Interrelationship between virus and the imbalance between coagulation and fibrinolysis and inflammatory mediators (Internet). Vol. 2015,
Mediators of Inflammation. Hindawi Publishing Corporation; 2015. Available from: https://pubmed.ncbi.nlm.nih.gov/25999666/
Pardo D, Oheda B, Alonso A. Dinámica de la respuesta inmune en la infección por virus del dengue (Internet). 2018. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1727-897X2018000100011
Hannaoui E, Sulbarán M, Campos M. Características clínicas y parámetros hematológicos de pacientes con fiebre dengue y mononucleosis infecciosa. Kasmera (Internet). 2005;33(2):93–101. Available from: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0075-52222005000200002&lng=es.
Araya L, Wilson E. Dengue Hallazgos Hematológicos y de Imagen. Revista Médica de Costa Rica y Centroamerica LXXIII (Internet). 2016;665–8. Available from: https://www.medigraphic.com/pdfs/revmedcoscen/rmc-2016/rmc163at.pdf
Sung JM, Lee CK, Wu-Hsieh BA. Intrahepatic Infiltrating NK and CD8 T Cells Cause Liver Cell Death in Different Phases of Dengue Virus Infection. PLoS One (Internet). 2012 Sep 26;7(9). (cited 2024 Mar 4). Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458800/
Lin JC, Lin SC, Chen WY, Yen YT, Lai CW, Tao MH, et al. Dengue Viral Protease Interaction with NF-κB Inhibitor α/β Results in Endothelial Cell Apoptosis and Hemorrhage Development. The Journal of Immunology
(Internet). 2014 Aug 1;193(3):1258–67. Available from: https://pubmed.ncbi.nlm.nih.gov/24973451/
Srikiatkhachorn A, Kelley JF. Endothelial cells in dengue hemorrhagic fever (Internet). Antiviral Research. Elsevier. 2014;109. p. 160–70. Available from: https://pubmed.ncbi.nlm.nih.gov/25025934/
Ministerio de Salud Pública y Bienestar Social (MSBS). Dengue Guía de Manejo Clínico (Internet). MSBS: Asunción-Paraguay; 2012. Available from: https://iris.paho.org/bitstream/handle/10665.2/10101/9789996768422_esp.pdf?sequence=1&isAllowed=y
Chediack V, Blanco M, Balasini C, Juárez P, José Eusebio M, aleJandra Morales M, et al. Dengue grave. Revista Argentina de Terapia Intensiva (Internet). 2021;38(707):1–11. Available from: https://revista.sati.org.ar/index.
php/MI/article/download/707/856/4509
MSPAS. Noticias. Ministerio de Salud actualiza casos de dengue y reitera llamado a unir esfuerzos de prevención. MSPAS;2023 Available from: https://www.mspas.gob.gt/component/k2/item/488-ministerio-de-salud-actualizacasos-de-dengue-y-reitera-llamado-a-unir-a-esfuerzos-de-prevencion?tmpl=component&print=1
Ooi EE, Gubler DJ. Global spread of epidemic dengue: The influence of environmental change (Internet). Future Virology. 2009;4. p. 571–80. Available from: https://sci-hub.ru/10.2217/fvl.09.55
Copyright (c) 2024 Sabrina Navas, Mariana Guzmán Torres , Diana Karina Baldizón Pernillo, Deemi Fernanda Orellana Pinto , Ana Johanna Samayoa Bran

This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain their copyright and assign to the journal the right of first publication of their work, which will be simultaneously subject to the Creative Commons Attribution 4.0 International License. that allows sharing the work as long as the initial publication in this magazine is indicated.