Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection.

BACKGROUND: Dengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases. CASE PRESENTATION: A 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay. CONCLUSIONS: Dengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.

Clinical Features, Bacteriology, and Antibiotic Treatment Among Patients with Presumed Naja Bites in Vietnam.

INTRODUCTION: Clinical and bacteriological features of cobra (Naja) bites are still relatively unknown in Vietnam. This study aimed to characterize the clinical and bacteriological characteristics of local wounds in patients with presumed Naja spp bite, as well as their antibiotic treatment. METHODS: A cross-sectional study was performed on presumed Naja bite patients who were admitted to Bach Mai Hospital in Hanoi, Vietnam. In vitro bacterial isolation, blood tests, and lesion measure were conducted, and antibiotic susceptibilities of localized bite wounds were assessed. The Mann-Whitney test was used to examine the difference in clinical characteristics between patients experiencing presumed Naja atra bites and Naja kaouthia bites. Data are presented as percentages or median with interquartile range, as appropriate. Statistical significance was accepted at P<0.05. RESULTS: Among 46 patients, all had typical clinical features of Naja bite. The median bite-to-hospital time was 6 h (interquartile range 4.0-11.3). The dominant organisms isolated from local wounds were Morganella morganii (11/36) and Enterococcus faecalis (25/36). All cultures were susceptible to ciprofloxacin. No difference was found with regard to pain, swelling circumference, swelling spread, or necrotic area between patients bitten by presumed Naja atra and Naja kaouthia (P>0.05). CONCLUSIONS: Wound necrosis and infection were important clinical issues in presumed Naja spp snake bites. Morganella morganii and Enterococcus faecalis were dominant in local wound swabs of such cases. Ciprofloxacin should be an effective first-line antibiotic for patients with presumed Naja bite.