Abstract
Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13–84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients’ selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients’ electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.
Highlights
Seventy-two (37.9%) patients were later excluded after systematic testing showed concomitant infections, due to lack of dengue infection confirmation, no identification of gallbladder during abdominal ultrasound, or inability to obtain ultrasound
The remaining 118 subjects were considered for analysis: 54 with confirmed dengue infection and 64 with presumptive dengue infection
This study shows the correlation between Gallbladder wall thickening (GBWT) and dengue severity
Summary
Recent studies estimate that there are 3.5 billion people living in areas of risk, contributing to over 390 million infections Of these infections, 96 million manifest in dengue fever, 2 million in the severe disease, and 21,000 in death [2] [3]. Since the 1960s, there has been an increasing share of the disease burden in the Americas, especially Latin America, where a re-infestation of the dengue vector Aedes aegypti has brought infections up to 14% of the global rate in this region [3]. This re-emergence of infection, following a period of elimination in the Americas, reflects the limited success in primary prevention of dengue by vector control despite worldwide efforts (3). To determine which patients should be closely monitored, there is a case for refining criteria for early identification of patients at risk for developing severe dengue
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