Serum levels of sICAM-1 and sE-selectin in patients with dengue virus infection.

The purpose of this study was to measure the serum level of sICAM-1 and sE-selectin as markers for endothelial damage in patients with dengue fever (DF) and dengue hemorrhagic fever (DHF). Twenty-nine patients with serologically-proven dengue virus infection (age 10.6 +/- 2.4 years, 55% male, DF = 13 and DHF = 16) were enrolled. Serum samples were collected from 25 healthy children (age 10.6 +/- 2.3 years, 40% male) as the control group. A follow-up was done at a mean interval of 15.9 +/- 1.6 days. The level of sICAM-1 at the toxic stage was significantly elevated compared to its level at the follow-up (494.1 +/- 107.4 versus 358.2 +/- 67.6 ng/ml, P = 0.001), but no difference was found between patients with DF and patients with DHF (444.1 +/- 158.0 versus 465.1 +/- 154.6 ng/ml, P = 0.74). The sICAM-1 level at the follow-up was similar to that of the control group (396.9 +/- 113.0 ng/ml, P = 0.56). The level of sE-selectin at the toxic stage was not different from its level at the follow-up (75.9 +/- 33.0 versus 75.5 +/- 31.7 ng/ml, P = 0.96), and no difference was found between the DF group and the DHF group (64.1 +/- 25.7 versus 78.8 +/- 39.9 ng/ml, P = 0.30). These levels were not elevated compared to the sE-selectin level that was determined in 8 patients in the control group (94.7 +/- 20.5 ng/ml, P = 0.12). In conclusion, there is evidence of endothelial activation by an increased sICAM-1 level in patients with dengue virus infection. However, the degree of endothelial activation alone may be similar for patients with DF and patients with DHF, and this fact by itself cannot explain the difference between the two clinical syndromes of dengue virus infection. The sE-selectin level was not elevated for patients included in this study.

Hepatosplanchnic circulatory dysfunction in acute hepatic infection: the case of dengue hemorrhagic fever.

The mechanism of shock in patients with dengue hemorrhagic fever (DHF) has not yet been fully understood. In this study, we investigated the possibility of splanchnic venous pooling as a contributor for circulatory dysfunction in these patients. Ultrasonographic studies of portal vein and inferior vena cava were done in 45 patients with serologically or PCR-confirmed diagnosis of dengue virus infection. The size of portal vein and inferior vena cava, mean blood flow velocity in the right portal vein, and modified portal vein congestion index were compared between patients with dengue fever (DF, n = 20), DHF without shock (n = 14), and dengue shock syndrome (DSS, n = 11) during the toxic stage, convalescent stage, and at follow-up. The portal vein was significantly more dilated in patients with shock (DSS) than DHF without shock and than DF during the toxic and convalescent stages (P < 0.05), but not at follow-up. The change in the size of inferior vena cava followed the opposite trend (not statistically significant). Portal vein blood flow velocity was lower and congestion index was higher in shock cases (DSS) than DHF without shock and than DF at toxic and convalescent stages (P < 0.01). The differences disappeared at follow-up. Hepatosplanchnic venous pooling and/or dysfunction occur and correlate with the severity of circulatory derangement and shock in patients with DHF. The cause(s) and significance of hepatosplanchnic circulatory dysfunction in DHF and possibly other viral hepatic diseases deserve further study.

Transcatheter closure of atrial septal defect in a patient with cor triatriatum sinister and atrial septal defect.

Cor triatriatum sinister is a rare congenital heart disease and rarely found in adults. The authors describe an asymptomatic 20-year old man presenting with heart murmur by check up. Transthoracic and transesophageal echocardiogram demonstrate atrial septal defect (ASD) secundum 26 mm and cor triatriatum sinister with 20 mm of fenestration. Transcatheter closure of ASD using Occlutech Figulla(R) device was successfully performed without complications. Echocardiogram post procedure demonstrate good position of device without obstruction of blood flow, no residual shunt and residual 12 mm of fenestration of cor triatriatum.