Dengue Shock Syndrome Cases Research Articles

A simple nomogram to predict dengue shock syndrome: A study of 4522 south east Asian children.

Dengue shock syndrome (DSS) substantially worsens the prognosis of children with dengue infection. This study aimed to develop a simple clinical tool to predict the risk of DSS. A cohort of 2221 Thai children with a confirmed dengue infection who were admitted to King Chulalongkorn Memorial Hospital between 1987 and 2007 was conducted. Another data set from a previous publication comprising 2,301 Vietnamese children with dengue infection was employed to create a pooled data set, which was randomly split into training (n = 3182), testing (n = 697) and validating (n = 643) datasets. Logistic regression was compared to alternative machine learning algorithms to derive the most predictive model for DSS. 4522 children, including 899 DSS cases (758 Thai and 143 Vietnamese children) with a mean age of 9.8 ± 3.4 years, were analyzed. Among the 12 candidate clinical parameters, the Bayesian Model Averaging algorithm retained the most predictive subset of five covariates, including body weight, history of vomiting, liver size, hematocrit levels, and platelet counts. At an Area Under the Curve (AUC) value of 0.85 (95% CI: 0.81-0.90) in testing data set, logistic regression outperformed random forest, XGBoost and support vector machine algorithms, with AUC values being 0.82 (0.77-0.88), 0.82 (0.76-0.88), and 0.848 (0.81-0.89), respectively. At its optimal threshold, this model had a sensitivity of 0.71 (0.62-0.80), a specificity of 0.84 (0.81-0.88), and an accuracy of 0.82 (0.78-0.85) on validating data set with consistent performance across subgroup analyses by age and gender. A logistic regression-based nomogram was developed to facilitate the application of this model. This work introduces a simple and robust clinical model for DSS prediction that is well-tailored for children in resource-limited settings.

Management of a Case of Dengue Shock Syndrome with Liver Failure: A Case Report

This case report details the management and treatment of a 38-year-old male cook from Dhaka, diagnosed with dengue fever, which progressed to Dengue Shock Syndrome (DSS) accompanied by acute liver failure. Despite initial stabilization with fluid resuscitation, patient’s condition worsened, prompting a fresh whole blood transfusion and comprehensive care. This report underscores the necessity of prompt recognition and effective management of severe dengue cases to improve patient outcomes J Bangladesh Coll Phys Surg 2023; 41: 114-117

Calamity Of Secondary Dengue Virus Followed By Climatic Changes.

Madam, This is to bring your attention to a long-standing issue despite several activities devised to curb it. Being aware of the effect of drastic climatic changes, developing countries like Pakistan should remain alert about the emergence of infectious outbreaks. The stagnant water after heavy rainfall and flood is a ground for the breeding of dengue vector called Aedes aegypti mosquitoes. The virus is transmitted from one person to another through these mosquitoes. Lately, the surge in the cases of dengue virus was due to massive flooding in Pakistan in 2022. A total of 25932 cases were reported and 62 deaths were recorded during the dengue outbreak during the flood crisis of 2022[1]. Dengue virus comprises of four serotypes 1, 2, 3, and 4. A person infected by a distinct serotype of the virus gains immunity against it and future infection by the same DENV will not affect the person’s health but infection by a heterogenous serotype causes secondary infection in the form of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Expansive capillary leakage in DHF due to an increase in the permeability of blood vessels can turn on a shock state called DSS. This deprivation of blood to highly functional organs like the brain, kidney, and heart puts them at risk of multi-organ failure [2]. The seasonal surge of secondary infection puts a burden on hospitals as the patient requires vigilant inpatient hospital care. The patient's health deteriorates further because of self-treatment at home with local herbs and over-the-counter (OTC) drugs [3]. As modern medicine is focused more on prevention than treatment, the need for the approval of the use of the dengue vaccine on high-risk individuals in an endemic country like Pakistan should be considered. The DENGVAXIA is a well-tolerated vaccine protecting against all the serotypes and is approved for use in individuals 9 to 45 years who are previously infected by the dengue virus in the past. [4] The vaccine will restrain the rise in DHF and DSS cases as it is for high-risk individuals who are already infected in the past thus curbing the incidence of secondary infection. Many endemic countries like the Philippines and Brazil have already taken a step against secondary dengue by granting the license of DENGVAXIA [5]. As Pakistan is developing country, approving the license for DENGVAXIA should be considered.

Unforeseen complications: a case of dengue shock syndrome presenting with multi-organ dysfunction in a subtropical region

OverviewDengue fever, a viral illness transmitted by the Aedes mosquito, is capable of causing a range of serious complications, including fulminant hepatic failure, renal dysfunction, encephalitis, encephalopathy, neuromuscular and ophthalmic disorders, seizures, and cardiomyopathy.Case descriptionThis report details the case of a 30-year-old lactating woman with no notable medical history who presented to the emergency department with symptoms of high-grade fever, altered mental status, and seizures. Upon imaging, bilateral infarcts in the thalami and cerebellar hemispheres were observed, consistent with cerebellitis and dengue encephalitis.Patient treatment and outcomeThe patient was admitted to the intensive care unit and received appropriate treatment. Following a critical phase and successful patient stabilization, she was transferred to a high dependency unit for a week before being discharged with recommendations for follow-up care.ConclusionThis case illustrates the broad spectrum of complications that can arise as a result of dengue infection and the importance of timely diagnosis and management in improving patient outcomes. Further investigation is required to better understand the mechanisms underlying these complications and to formulate specific guidelines for the prevention and treatment of dengue shock syndrome.

Variations of dengue shock syndrome cases and their management: report of three cases

Background: Dengue hemorrhagic fever (DHF) occurs due to plasma leakage due to increased vascular permeability, which is also supported by an active complement system, which makes DHF fall into complications such as shock or dengue shock syndrome (DSS). The comprehensive management of DSS could prevent morbidity and mortality in patients. We aimed to report three variations of dengue shock syndrome cases and their management. Case presentation: Three cases of DSS from our hospital. Two case reports with clinical dengue fever patients with shock and one case report with clinical dengue patients with shock and complications of acute liver failure. The first case was a 24 years olds male patient with classic signs of dengue fever plus spontaneous bleeding in the form of nosebleeds accompanied by hemodynamic disturbances. Laboratory examination revealed severe thrombocytopenia. In the second case, a male patient with dengue shock syndrome accompanied acute liver failure. The patient complains of heartburn and nausea accompanied by tea-like urine. Dengue patients with abdominal pain typical of liver disorders, nausea, vomiting and anorexia, and hepatomegaly with or without jaundice are typical of liver disorders. The third case, a male patient with dengue shock syndrome, accompanied the suspicion of ascites. The main treatment is the administration of isotonic crystalloid fluids according to body weight. While in cases of acute liver failure, NAC can be given. Conclusion: We found three cases of DSS with some complications. It is important to know the right treatment immediately so that complications do not occur.

Shapley-Additive-Explanations-Based Factor Analysis for Dengue Severity Prediction using Machine Learning.

Dengue is a viral disease that primarily affects tropical and subtropical regions and is especially prevalent in South-East Asia. This mosquito-borne disease sometimes triggers nationwide epidemics, which results in a large number of fatalities. The development of Dengue Haemorrhagic Fever (DHF) is where most cases occur, and a large portion of them are detected among children under the age of ten, with severe conditions often progressing to a critical state known as Dengue Shock Syndrome (DSS). In this study, we analysed two separate datasets from two different countries– Vietnam and Bangladesh, which we referred as VDengu and BDengue, respectively. For the VDengu dataset, as it was structured, supervised learning models were effective for predictive analysis, among which, the decision tree classifier XGBoost in particular produced the best outcome. Furthermore, Shapley Additive Explanation (SHAP) was used over the XGBoost model to assess the significance of individual attributes of the dataset. Among the significant attributes, we applied the SHAP dependence plot to identify the range for each attribute against the number of DHF or DSS cases. In parallel, the dataset from Bangladesh was unstructured; therefore, we applied an unsupervised learning technique, i.e., hierarchical clustering, to find clusters of vital blood components of the patients according to their complete blood count reports. The clusters were further analysed to find the attributes in the dataset that led to DSS or DHF.

Clinically suspected myocarditis complicating dengue shock syndrome: a case report and literature review of cardiac complication in dengue-affected pediatric patient

We report a case of dengue shock syndrome complicated by clinically suspected acute myocarditis in pediatric patient at a limited-resources hospital in a rural area and review the literature. A 12-year-old boy who experienced dengue shock syndrome developed bradycardia on day 7th of illness. His electrocardiogram during the bradycardia showed sinus bradycardia with a rate of 50 beats per minute. Atropine sulfate and dobutamine, alongside supportive management, were administered. The patient recovered 4 days later. We found a total of seven articles involving pediatric patient with dengue illness and cardiac complications by PubMed search. Clinical manifestations of cardiac involvement in pediatric patient with dengue varied and were mostly transient from tachy-bradyarrhythmia, sinus node dysfunction, low blood pressure, decreased ejection fraction, lower cardiac output, and increased cardiac enzyme. Transient cardiac abnormality can be an important presentation, and physician should have high awareness of cardiac complication in dengue-affected pediatric patients to manage them accordingly.

Clinical profile of dengue and its effect of on biochemical parameters

Background: Dengue affects the overall biochemical parameters and these characteristics can be utilized to monitor the progress of the patients. Hence, more and more studies are required to throw light on how these parameters differ in three different forms of dengue, i.e., dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Hence, the present study was carried out. Objective: The objective of the study was to study the clinical profile of patients with dengue and to study the biochemical parameters in these three forms of the dengue. Methods: Hospital-based cross-sectional study was carried out among forty cases of dengue. In all these cases, various biochemical tests were carried out and correlated with three forms of dengue. These parameters were compared in three groups of patients, i.e. DF, DHF, and DSS. Results: Majority (70%) were having classical DF. The most common clinical feature in all three types of dengue was fever. Creatinine, blood urea, total bilirubin, and direct bilirubin mean values were significantly higher in DSS cases compared to DF cases (P < 0.05). Alkaline phosphate was significantly increased, and total proteins were significantly reduced in DSS cases (P < 0.05). Packed cell volume, total white blood cell, and erythrocyte sedimentation rate were significantly more in DHF cases compared to other two groups. The mean platelet values were significantly reduced in DSS group compared to other two groups (P < 0.05). Conclusion: DF is the most common presentation of dengue. DSS and DHF affect the biochemical parameters significantly and can be used to monitor the progress during the management of cases.

Total serum cortisol level is low in children with severe dengue shock syndrome.

Dengue shock syndrome (DSS) is a potentially critical and life-threatening concern, especially in children of tropical countries. The serum cortisol levels in severe DSS or later stages of DSS are limited references. We prospectively studied an association between of serum cortisol as well as interleukin levels and the severity of DSS in pediatric patients. A prospective cross-sectional study of 35 consecutive DSS cases (3 months to 16 years old) admitted to our institution from July 1, 2019, to June 30, 2020 was conducted. Serum cortisol, IL-6, and IL-10 were measured at T0 (shock recognition) and T12 (12 hours after T0); their values were presented as median and interquartile ranges (25%-75%). Severe DSS included patients with impalpable pulses or systolic blood pressure < 70 mmHg, recurrent shock, and prolonged shock. In contrast, non-severe DSS presented circulatory failure without any features of severe DSS. A total of 8 (22.8%) severe DSS patients expressed the cortisol (T0) significantly lower compared to the non-severe DSS group (7.3 μg/dl versus 14.3 μg/dl, p=0.008). In severe DSS, there was a minimal change in cortisol levels between T0 and T12 (7.3 μg/dl and 4.7 μg/dl p>0.05), whereas the decrease is significant in their counterparts (14.3 μg/dl to 5.6 μg/dl, p<0.005). Additionally, there were moderate correlations between IL-6 (T0), IL-10 (T0), IL-10 (T12) and total fluid requirement (Spearman's rho = 0.47, 0.4, and 0.36, respectively; p<0.05). Our study demonstrated that adrenal dysfunction was present in patients with severe and non-severe DSS, as noted by cortisol level at T12. In addition, IL-6 and IL-10 levels are correlated with the total fluid requirement, which is a marker of DSS severity. Further studies could reveal how adrenal dysfunction in pediatric patients with DSS can affect outcomes and the potential roles of interleukin levels in fluid management strategy.

Clinical profile and outcome of dengue fever among children in tertiary care hospital

Background: Dengue viral infection is the most common mosquito-borne disease in the world with varied presentations, high morbidity, and high mortality patterns. To study the clinical profile and outcome of dengue fever in children. Methods: This analytical study was conducted in children less than 12 years of age with clinical features of dengue (any acute febrile illness with one of the following: myalgia, headache, retro-orbital pain, bleeding, altered sensorium, shock, or low platelet count) presented at Mahavir institute of medical sciences between February 2019 to January 2020 (12) months were included in the study. Children positive for IgM alone or both IgM and IgG were followed up for a clinical profile.Results: Seizures (9.5%), loose stools (8.5%), lymphadenopathy (15.2%), relative bradycardia (8.5%) were less common manifestations. Rashes were seen in 64.7% of children. Many children in this study were mildly anemic. Mean hemoglobin was slightly higher in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Mean Hb in DSS was 11.28 g%. It was 10.02, 10.1, and 10.45 in DF, DFB, DHF respectively. But it was statistically not significant (P=0.27).Conclusions: Seizure was significant in DSS cases. Any dengue child throwing convulsions should hence be promptly evaluated for an unrecognized shock. The bleeding in dengue is not purely due to thrombocytopenia. There is no role for prophylactic platelet transfusion.

Hyponatremic encephalopathy: An uncommon presentation associated with dengue shock syndrome: Two case reports

Hyponatremia of mild-to-moderate degree is commonly seen in dengue infection. Severe hyponatremia with encephalopathy in dengue infection is rarely seen. Two cases of dengue shock syndrome presented with severe hyponatremia and hyponatremic encephalopathy. Following correction of hyponatremia, sensorium normalized in both cases. Serum sodium levels should be checked and monitored in patients of dengue fever, especially with altered sensorium, as early recognition and management of such hyponatremia can prevent serious morbidity and even mortality.

Study of Clinical and Laboratory Profile in Patients With Dengue Fever at A Tertiary Care Center in Central Nepal

Introduction: Dengue is a mosquito-borne viral disease transmitted from person to person by Aedes mosquitoes which result in a wide spectrum of disease severity ranging from influenza-like illness (dengue fever; DF) to the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Terai regions of Nepal were focal epidemics of Dengue infections during the outbreak in 2010, 2013, and 2016. Dengue infections have been reported in the valleys of upland Hill regions at an altitude of 2500 m above sea level in Nepal. Methods: A cross-sectional study was carried out among febrile patients in Nepal Police Hospital (NPH), from 1st Baisakh 2076 to 30th Chaitra 2076. Blood samples were collected from dengue presumed cases and tested against dengue specific IgM antibody and/or NS1antigen. Clinical examination findings were recorded, hematological and biochemical parameters tests were done among the patients who fulfilled the inclusion criteria. Results: A total of 87 dengue cases were included in the study during the study period. Out of these, the majority were males ( 85.05%) from Kathmandu (38/87; 43.67%) seen in the month of Asoj (40/87; 45.98%). Fever was the major symptom (100%) followed by myalgia (52.87%), headache (45.97%), retro-orbital pain (12.64%), bleeding manifestations (9.19%). Common hematological abnormalities were thrombocytopenia and leucopenia in the critical phase. There was no case of dengue shock syndrome. Conclusion: This study highlights the utilization of most common clinical and easily available laboratory profiles of dengue viral infections in particular season and place that could alert physicians to diagnose early to reduce morbidity and mortality due to dengue hemorrhagic fever and dengue shock syndrome.

Microvascular Fluid Exchange: Implications of the Revised Starling Model for Resuscitation of Dengue Shock Syndrome.

Dengue is the most common mosquito-borne viral infection in the world. The most feared complication is a poorly understood vasculopathy that occurs in only a small minority of symptomatic individuals, especially children and young adults, but can result in potentially fatal dengue shock syndrome (DSS). Based mainly on expert opinion, WHO management guidelines for DSS recommend prompt infusion of a crystalloid fluid bolus followed by a tapering crystalloid fluid regimen, supplemented if necessary by boluses of synthetic colloid solutions. However, following publication of a number of major trials undertaken in other, primarily adult, critical care scenarios, use of both synthetic colloid solutions and of fluid boluses for volume expansion have become controversial. Synthetic colloids tend to be used for severe DSS cases in order to boost intravascular oncotic pressure, based on the classic Starling hypothesis in which opposing hydrostatic and oncotic forces determine fluid flow across the microvascular barrier. However, the revised Starling model emphasizes the critical contribution of the endothelial glycocalyx layer (EGL), indicating that it is the effective oncotic pressure gradient across the EGL not endothelial cells per se that opposes filtration. Based on several novel concepts that are integral to the revised Starling model, we review the clinical features of DSS and discuss a number of implications that are relevant for fluid management. We also highlight the need for context-specific clinical trials that address crucially important questions around the management of DSS.

Dengue Fever, Expanded Dengue Syndrome and Dengue Shock Syndrome: Clinical Profile, Management and Outcome of Patients at a Tertiary Hospital, Dhaka, Bangladesh

Background: Dengue fever is endemic in Bangladesh. Its incidence has been increasing and spreadingfrom urban Dhaka to rural areas. In 2019, over 100,000 cases reported with deaths over 250.Clinical profiles varied from classical signs and symptoms to alarming severity and complications,such as, Expanded Dengue Syndrome (EDS), Dengue Shock Syndrome (DSS) along with coinfectionsand comorbidities. No detail study on EDS &amp; DSS carried out yet over 2019 outbreak. This reporthighlights the features, management and the outcome of EDS &amp; DSS cases of 2018-19 admitted in aspecialized tertiary private hospital in Dhaka, Bangladesh.&#x0D; Methods: This cross sectional observational study was performed at Square Hospital, Dhaka,exclusively over 62 adult dengue patients with complications who fulfilled the admission criteria inICU and HDU and managed as per national guidelines and diagnosed by positive NS1 Ag, DengueRT PCR , Anti-dengue IgM, hematological and biochemical tests.&#x0D; Results: Of 343 cases, 62 (18.1%) patients had complications; 17 (27.4%) admitted in ICU and 45(72.6%) patients in HDU. Among 62 patients, 25 patients had EDS (40.3%) and 17 had DSS (27.4%).Of the EDS patients, majority were 40-50 years old with male predominance. Of 62 patients, 42 hadatypical presentations (67.74%), 25 (40.3%) had EDS and 17 (27.4%) had DSS, 16 (25.8%) had coinfection,45 (72.58%) had co-morbidities. Most patients presented with gastrointestinal symptoms(80%). Twenty one cases (84%) of EDS survive; 4 (16%), died after developing rhabdomyolysis, multiorgandysfunction and acute renal failure.&#x0D; Conclusion: Early diagnosis of complicated cases by clinical features, lab predictors and early fluidtherapy are the key to successful management with positive outcome. Death could be averted byrecognizing the stage of plasma leakage indicated by raised CRP, reduced serum Albumin, andultrasonography for detecting ascites, pleural effusion, mucosal thickening and edema of gall bladderand appropriate replacement of fluid loss and maintenance of nutrition.&#x0D; Bangladesh J Medicine July 2020; 31(2) :58-63

Phylogenetic and recombinant analyses of complete coding sequences of DENV-1 from field-caught mosquitoes in Thailand

Dengue diseases are a group of infectious diseases that have been widespread throughout the world for several decades. Dengue outbreaks have occurred in many parts of the world, including Southeast Asia. The outbreak and the severity of the diseases depend on many factors including dengue genotype. Data on the genetic variation of dengue virus is highly informative for dengue protection plans and vaccine development. In this study, we focused on the analyses of genetic variation and amino acid changes of the whole coding sequences in two dengue strains isolated from Aedes mosquitoes in Bangkok, Thailand, an endemic area. The strains were identified as belonging to dengue virus serotype 1 (DENV-1) genotype I, and have unique nucleotide sequences. In the recombinant analysis, these strains were identified as recombinants derived from Chinese counterparts for both the major (DENV-1 genotype I) and the minor (DENV-1 genotype IV) parental strains. The recombination event occurred within the prM and E genes. This corresponded with the result of multiple alignments where several amino acid residues between the recombination breakpoints in the strains were identical to those in DENV-1 genotype IV. Several of the amino acid substitutions also have changed the amino acid properties, which might affect viral infection and antigenicity. These results provide insight into the genetic variation of DENV in this endemic area, which might have been involved in the dengue outbreak and high numbers of dengue haemorrhagic fever and dengue shock syndrome cases in Thailand in 2015.

An unusual case of dengue shock syndrome complicated by ilio-femoral deep vein thrombosis; a case report

BackgroundDengue fever is a hemorrhagic fever caused by flaviviruses. Hemorrhagic manifestations are well known to be associated with dengue fever, though the thrombotic events are only seldom reported. Underlying pathophysiology of thrombotic events is multifactorial and the management is challenging due to associated thrombocytopenia and bleeding tendency. We report a case of dengue shock syndrome with severe thrombocytopenia complicated by ilio-femoral deep vein thrombosis.Case presentationA 16 year old boy presented with dengue fever. He had dengue shock syndrome after entering the critical phase on the fifth day of the illness. With the recovery from the critical phase he developed deep vein thrombosis involving right external iliac, common femoral and superficial femoral veins. There were no provocative factors other than dengue fever itself. His platelet count was 12,000/μl at the time of diagnosis with deep vein thrombosis. Anticoagulation was started with intravenous unfractionated heparin 500 IU/hour while closely being observed for bleeding complications. 1000 IU/hour dose was commenced with the recovery of the platelet count above 50,000/μl. Thrombophilia screening was negative and he was discharged on warfarin. Venous duplex done after 6 weeks showed normal lower limb venous flow and warfarin was omitted after three months.ConclusionsWith dengue fever, complications like deep vein thrombosis can be easily missed given its rarity and that the major concern is on hemorrhagic complications. Management is challenging due to associated thrombocytopenia and hemorrhagic complications.

Dengue Fever in the Darfur Area, Western Sudan

Abstract We report an outbreak of dengue in Darfur, western Sudan, during September 2014–April 2015. Dengue virus–specific PCR testing of 50 samples from nonmalaria febrile illness case-patients confirmed 35 dengue cases. We detected 7 cases of dengue shock syndrome and 24 cases of dengue hemorrhagic fever.

Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings

Background: Fluid therapy for dengue shock syndrome (DSS) requires a dynamic approach that involves monitoring of the pathophysiological processes as well as the preload, contractility, and afterload assessment during the course dengue infection. Hemodynamically unstable DSS patients received in referral setting often complicated by fluid overload and secondary infection. Objective: This study aims to provide hemodynamic profiles and fluid responsiveness of pediatric patients admitted to the PICU with DSS. Methods: Hemodynamic profiles, laboratories, and demographic data were collected from patients aged 1 month to 18 years old with DSS who were admitted to the Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January to December 2016. Hemodynamic profiles were assessed in clinically shock and not clinically shock group at PICU admission using the non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Fluid responsiveness in clinically shock group was evaluated after fluid challenge with 10 ml/kgBW crystalloid or colloid. Results: Eighty six subjects were included in this study. Sixty six subjects were admitted to PICU with clinically shock condition. This group received less intravenous fluid than hemodynamically stable group (6.9 vs 7.52 ml/kgBW/hour respectively), had higher mean hematocrit level (42.09% vs 40.32% respectively), had higher hematocrit level during PICU stay (43.37% vs 42.06% respectively), significantly higher percentage to receive inotropes agent (62,1% vs 5%, p 0,000) and longer duration of inotropes usage (23,5 vs 0 hours, p 0.72). From the clinically shock patients admitted to PICU, only 19,69% were fluid responsive. Other subjects in this group with fluid non responsive state, 90,38% had low inotropic index and high systemic vascular resistance index. Among 8 patients in clinically shock group who died during PICU stay, 6 of them had low cardiac Index, fluid non responsive condition, low inotropic index and high systemic vascular resistance index. Conclusion: Only a small percentage of DSS patients with clinically shock admitted to the PICU were fluid responsive. Majority of DSS cases in children had low inotropy index and high systemic vascular resistance index.

Level of Vitamin D, TNF-Alpha and Calcium in Patients with Dengue Fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome

Background: Vitamin D has been widely studied for its beneficial role in treating different diseases. Dengue epidemic has affected many house hold since last decade. Vitamin D seems a gate through in its treatment as it inhibits Th1 cytokine activities, responsible for the development of dengue complications.Objective: To determine the levels of vitamin D, TNF- ? and calcium in patients with variation of dengue fever stages.Methods: A cross sectional analytical study conducted on dengue confirmed patients (fever, hemorrhagic, shock) admitted in tertiary care hospitals of Lahore (IRBNo.1165). After obtaining informed consent the study objectives were explained to the patients and data collected. Patients were classified into three groups (a) dengue fever (DF) (b) dengue hemorrhagic fever(DHF) and (c) dengue shock syndrome (DSS) (40+30+10 cases). Serum from 5cc blood was stored at –20? C until analysis. The data was analyzed using SPSS version 21.Results: The study was conducted in 4 hospitals of Lahore on 80 NS1confirmed cases (age: 5-70 years). The age difference, vitamin D and calcium levels were significant (p-values 0.030, 0.047 and 0.003 respectively). Calcium levels were lowest in DSS and significantly lower than DHF patients. Vitamin D levels were higher among those with higher severity of disease with p-value 0.031. The patients did not have significantly different TNF ? levels. There were 90.0% of DSS cases that had TNF ? levels &gt; 100, (p-value 0.109).Conclusion: High levels of TNF-alpha are associated with dengue complications regardless of vitamin D levels and severity of disease.

Level of Vitamin D, TNF-Alpha and Calcium in Patients with Dengue Fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome

Background: Vitamin D has been widely studied for its beneficial role in treating different diseases. Dengue epidemic has affected many house hold since last decade. Vitamin D seems a gate through in its treatment as it inhibits Th1 cytokine activities, responsible for the development of dengue complications.Objective: To determine the levels of vitamin D, TNF- α and calcium in patients with variation of dengue fever stages.Methods: A cross sectional analytical study conducted on dengue confirmed patients (fever, hemorrhagic, shock) admitted in tertiary care hospitals of Lahore (IRBNo.1165). After obtaining informed consent the study objectives were explained to the patients and data collected. Patients were classified into three groups (a) dengue fever (DF) (b) dengue hemorrhagic fever(DHF) and (c) dengue shock syndrome (DSS) (40+30+10 cases). Serum from 5cc blood was stored at –20⁰ C until analysis. The data was analyzed using SPSS version 21.Results: The study was conducted in 4 hospitals of Lahore on 80 NS1confirmed cases (age: 5-70 years). The age difference, vitamin D and calcium levels were significant (p-values 0.030, 0.047 and 0.003 respectively). Calcium levels were lowest in DSS and significantly lower than DHF patients. Vitamin D levels were higher among those with higher severity of disease with p-value 0.031. The patients did not have significantly different TNF α levels. There were 90.0% of DSS cases that had TNF α levels &gt; 100, (p-value 0.109).Conclusion: High levels of TNF-alpha are associated with dengue complications regardless of vitamin D levels and severity of disease.