Abstract
BackgroundDengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.MethodsFrom June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays.ResultsA total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4), and 5 of them (4%) died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%), and recorded dengue infection as the final diagnosis in 96 patients (76%). Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality.ConclusionsA number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.
Highlights
Dengue is a common cause of fever in adult patients in tropical countries
There was a trend showing that age!60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality
A number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock
Summary
Dengue is a common cause of fever in adult patients in tropical countries. A prospective study in Laos shows that 9% (112/1215) of adult patients (age>15 years) presenting with non-malarial fever have dengue [1]. A prospective study in Papua Indonesia demonstrates that about 5% of adult patients (age>18 years) presenting with non-malarial fever have dengue [2]. These figures are probably representative of all tropical countries in Asia, Africa and the Americas where dengue is endemic [3, 4]. The hallmark of progression to severe dengue is increased vascular permeability and consequent plasma leakage, leading to circulatory collapse and shock. If shock occurs, it usually takes place after 2 to 6 days of fever [4]. We investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.
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