Abstract
BackgroundDengue is the most important arboviral infection of humans. Following an initial febrile period, a small proportion of infected patients develop a vasculopathy, with children at particular risk for severe vascular leakage and shock. Differentiation between dengue and other common childhood illnesses is difficult during the early febrile phase, and risk prediction for development of shock is poor. The presence of microalbuminuria is recognized as a useful early predictor for subsequent complications in a number of other disorders with vascular involvement. Significant proteinuria occurs in association with dengue shock syndrome and it is possible that early-phase microalbuminuria may be helpful both for diagnosis of dengue and for identification of patients likely to develop severe disease.Methodology/Principal FindingsWe measured formal urine albumin to creatinine ratios (UACRs) in daily samples obtained from a large cohort of children with suspected dengue recruited at two outpatient clinics in Ho Chi Minh City, Vietnam. Although UACRs were increased in the 465 confirmed dengue patients, with a significant time trend showing peak values around the critical period for dengue-associated plasma leakage, urine albumin excretion was also increased in the comparison group of 391 patients with other febrile illnesses (OFI). The dengue patients generally had higher UACRs than the OFI patients, but microalbuminuria, using the conventional cutoff of 30 mg albumin/g creatinine discriminated poorly between the two diagnostic groups in the early febrile phase. Secondly UACRs did not prove useful in predicting either development of warning signs for severe dengue or need for hospitalization.Conclusion/SignificanceLow-level albuminuria is common, even in relatively mild dengue infections, but is also present in many OFIs. Simple point-of-care UACR tests are unlikely to be useful for early diagnosis or risk prediction in dengue endemic areas.
Highlights
Dengue is the most important arboviral infection affecting humans and represents a major global public health problem
Characteristics of the Study Population Between October 2005 and December 2008, 1165 children were recruited at the two study sites, of whom 465 (40%) patients had confirmed dengue (353 patients from Clinic A and 112 patients from Clinic B), and 391 (34%) patients were diagnosed with other febrile illnesses (OFI) (86 patients from Clinic A and 305 patients from Clinic B)
urine albumin to creatinine ratios (UACRs) were increased in the confirmed dengue patients, with a significant time trend showing peak values around the critical period for dengue-associated plasma leakage, urine albumin excretion was increased in the OFI comparison group
Summary
Dengue is the most important arboviral infection affecting humans and represents a major global public health problem. Clinical presentation of dengue infection varies widely, ranging from mild febrile illness to severe and fatal disease. Vascular leakage may be severe, especially in children, resulting in circulatory compromise and the potentially life-threatening dengue shock syndrome (DSS). Following an initial febrile period, a small proportion of infected patients develop a vasculopathy, with children at particular risk for severe vascular leakage and shock. Differentiation between dengue and other common childhood illnesses is difficult during the early febrile phase, and risk prediction for development of shock is poor. Significant proteinuria occurs in association with dengue shock syndrome and it is possible that early-phase microalbuminuria may be helpful both for diagnosis of dengue and for identification of patients likely to develop severe disease
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