Síndrome de Takotsubo en paciente con dengue / Takotsubo syndrome in dengue patient

Resumen El síndrome de Takotsubo, fue descripto en Japón en 1990, se trata de una miocardiopatía por estrés, predo minante en mujeres, generalmente postmenopáusicas. Se produce una hipoquinesia cardiaca, con compromiso de múltiples territorios coronarios. En las unidades de terapia intensiva (UTI), se considera subdiagnosticada. En las manifestaciones del dengue grave, se encuen tra el compromiso cardiovascular, principalmente arrit mias y disfunción sistólica. Se presenta el caso de un hombre de 72 años, inter nado en UTI por dengue, con plaquetopenia (15 000 cé lulas/mm3) y deshidratación. Luego de la administración de fluidos refirió disconfort respiratorio, auscultándose estertores pulmonares. Se realizó ecografía pulmonar donde se apreció líneas B bilaterales con patrón B7 compatible con síndrome intersticial y edema pulmonar. En el ecocardiograma transtorácico se objetivó hiperqui nesia basal, hipoquinesia medial y apical con imagen compatible con balonamiento apical. En el electrocardio grama se evidenció bloqueo completo de rama derecha. La serología para Chagas fue negativa y la troponina I cuantitativa se detectó aumentada. Se diagnosticó síndrome de Takotsubo en el contexto de dengue grave. El paciente evolucionó favorablemente. Posterior al alta, se constató normalización de la moti lidad cardíaca, en las imágenes ecográficas. El caso es de importancia clínica por la baja asocia ción de las dos enfermedades y la necesidad de pesqui sar el compromiso cardíaco en el dengue grave.

Abstract Takotsubo syndrome, was described in Japan in 1990, it is a stress cardiomyopathy, predominantly in women, usually postmenopausal. Cardiac hypokinesia occurs, with involvement of multiple coronary territories. In in tensive care unit (ICU), it is considered underdiagnosed. Manifestations of severe dengue fever include cardio vascular involvement, mainly arrhythmias and systolic dysfunction. A case of a 72-year-old man is presented, who was hos pitalized in ICU for dengue fever, with plateletopenia (15 000 cells/mm3) and dehydration. After fluid management the patient reported respiratory discomfort, auscultating crackling rales. A pulmonary ultrasound was made where bilateral B lines were found with B7 pattern compatible with interstitial syndrome and pulmonary edema. Basal hyperkinesia, medial and apical hypokinesia with an im age consistent with apical ballooning were observed in the transthoracic echocardiogram. The electrocardiogram showed complete right bundle branch block. Chagas serol ogy was negative and quantitative troponin I was increased. In the context of severe dengue, a Takotsubo syn drome was diagnosed. The patient evolved favorably. After discharge, a normalization of the cardiac function was stated in ultrasound images. The case is of clinical importance due to the low as sociation of these two diseases and the need to screen for cardiac involvement in severe dengue.

Pattern of changes in hepatic aminotransferases level during dengue infection in children aged 1-12 years

Background: Dengue fever is a pandemic viral disease carried by mosquito-borne flavivirus. Dengue infection is the most common arthropod infection in humans. The study is done with the aim to establish a relation between hepatic dysfunction and outcome in patients with dengue fever. It was found that hepatic transaminases were significantly deranged in dengue with warning signs indicating poor prognosis and need for early initiation of supportive treatment which can reduce mortality and morbidity in these children. Liver function tests can be of profound benefit in indicating the prognosis of children with dengue fever in resource-limited settings.Methods: Cohort prospective observational study in Al-Ameen children hospital over 2 years. Patients aged 1-12 years fulfilling WHO case definition of fever and ?2 of following: nausea/vomiting, rashes, aches and pains, tourniquet test positive, thrombocytopenia or any warning sign and serologically confirmed NS1Ag positive were studied. Once serologically positive, a blood sample was taken while establishing an intravenous line.Results: Dengue with warning signs and dengue without warning signs were the classifications given to the patient. Both AST and ALT were found to be higher in groups having dengue with warning signs, with AST higher than ALT. Conclusions: In dengue infection, hepatic dysfunction was common. Enzymes were significantly deranged in dengue with warning signs indicating prolonged illness and poor prognosis and need for early initiation of supportive treatment for better outcomes.

Overlap of dengue fever and HELLP syndrome in pregnancy: a complex clinical encounter

Dengue fever is an arboviral infection caused by the bite of an infected Aedes mosquito, common in tropical areas, especially in India. It is characterized by fever, fatigue, malaise, joint pain, retrobulbar pain, abdominal pain, and thrombocytopenia. It is often complicated by bleeding manifestations like petechiae, bleeding gums, and blood in vomitus. Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is usually a complication of preeclampsia in pregnancy (elevated blood pressure after 20 weeks of gestation) and is characterized by hemolysis, elevated liver enzymes, and low platelet count. This is the case of a primigravida that presented at 32 weeks + 2 days of gestation with dengue fever in the background of HELLP syndrome. Significant overlap in the features of dengue fever and HELLP syndrome can lead to a delay in the diagnosis of HELLP syndrome and its management. This case highlights the importance of early recognition of HELLP syndrome in a dengue positive pregnant patient.

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay / Validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay

Introducción: El dengue es la enfermedad arboviral más común en los seres humanos. Un diagnóstico temprano y preciso del dengue puede respaldar el manejo clínico, la vigilancia y el control de la enfermedad y es fundamental, por ello en el diagnóstico del dengue es importante contar con pautas clínicas y epidemiológicas que permitan la identificación oportuna y una conducta terapéutica adecuada. Objetivos: Evaluar la validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay durante los años de 2012 a 2020. Materiales y métodos: Estudio analítico de tipo observacional, retrospectivo correspondientes a pacientes pediátricos (0 a 18 años) internados en el Hospital de Referencia de Paraguay el periodo enero 2012 a julio 2020 con diagnostico presuntivo de dengue al ingreso. Se realizó́ un análisis bivariado relacionando las frecuencias de 20 grupos de criterios diagnósticos combinados y 3 criterios diagnósticos aislados (OMS 2009, nexo epidemiológico y antigenemia NS1 para dengue) con el gold standard de diagnóstico que fue la conversión serológica. Resultados: Participaron del estudio 342 sujetos. EL 44% tenía edad escolar y 70% tenía 5 años o más. El 52,76% (191) fueron masculinos. Se encontraron desnutrición y sobrepeso en el 13% y 2%, respectivamente. La combinación de proteína C reactiva con plaquetopenia se encontró́ en 0.45% de los pacientes sin dengue y en el 6% de los pacientes con diagnóstico final de dengue (p=0.004). Conclusión: Este resultado aporta la alternativa de uso de una combinación sencilla de exámenes de laboratorio que puede replicarse en salas de urgencias como en salas de internación en un primer contacto con pacientes febriles con sospecha de fiebre dengue.

Introduction: Dengue is the most common arboviral disease in humans. An early and accurate diagnosis of dengue can support the clinical management, surveillance and control of the disease and is essential, therefore in the diagnosis of dengue it is important to have clinical and epidemiological guidelines that allow timely identification and appropriate therapeutic conduct. Objectives: To evaluate the validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay during the years 2012 to 2020. Materials and methods: Analytical study of case and control type, observational, longitudinal, retrospective corresponding to pediatric patients (0 to 18 years) admitted to the Reference Hospital of Paraguay from January 2012 to July 2020 with a presumptive diagnosis of dengue at income. A bivariate analysis was performed relating the frequencies of 20 groups of combined diagnostic criteria and 3 isolated diagnostic criteria (WHO 2009, epidemiological link and NS1 antigenemia for dengue) with the gold standard of diagnosis, which was serological conversion. Results: 342 subjects participated in the study. 44% were school age and 70% were 5 years old or older. 52.76% (191) were male. Malnutrition and overweight were found in 13% and 2%, respectively. The combination of C-reactive protein with thrombocytopenia was found in 0.45% of patients without dengue and in 6% of patients with a final diagnosis of dengue (p=0.004). Conclusion: This result provides the alternative of using a simple combination of laboratory tests that can be replicated in emergency rooms and inpatient wards in a first contact with febrile patients with suspected dengue fever.

An interesting case of dengue masquerading a splenic brucellosis

Mixed infections or co-infections are not uncommon in dengue fever which can occur as a result of transient suppression of host immunity by unknown mechanisms or as a part of its complication. Brucellosis co infection or post dengue complication can occur due to the indigenous practice of consumption of raw unpasteurized cattle milk. Here is a case report of a 14-year-old girl who presented with dengue fever but then continued to have persistence of fever spikes with abdominal pain requiring administration of antibiotics as well as upgradation, on evaluation was found to have splenic abscess with prior history of ingestion of raw goat抯 milk with serology suggestive of Brucellosis. This case report was done to elucidate the likelihood of co infection of zoonoses like dengue and brucellosis and the importance of consideration of brucellosis as a differential in cases of unresolving pyrexia post dengue fever especially in countries with wide prevalence of this practice of consumption of unpasteurized cattle milk.

Derangement of liver function tests in dengue patients

Background: Changes in the liver function test may serve as an early marker for timely diagnosis and identification of patients who may develop severe dengue. The purpose of this study was to examine the link between dengue fever severity and liver function test. Methods: This prospective observational study was conducted in the Department of General Medicine, Madhesh Institute of health sciences, provincial hospital, Janakpurdham in which we included dengue positive patients (aged 18 years or more) based on NS1 antigen or high titer on IgM/IgG testing from July 2023 till August 2023. We excluded patients with diseases like malaria, cirrhosis of liver, enteric fever, viral hepatitis or any other disease or taking any medication which can derange LFT. Results: We included 96 patients fulfilling the study criteria. Of these, 71% had DF, 22% had DHF and 7% had DSS. Among liver enzymes, mean AST of the patients was significantly higher in DSS group of patients (775.19�.65 U/l), as compared to those in the DF and DHF group of patients, p value <0.01. Similarly, mean ALT of the patients was significantly higher in DSS group of patients (387.8�.6 U/l), as compared to those in the DF and DHF group of patients, p value<0.01. On the contrary, mean alkaline phosphatase levels were similar between the three patient groups. Conclusions: Based on the results our study, we conclude that raised AST and ALT levels were significantly associated with severity of DSS and DHF. Patients with dengue infection should have a baseline liver function test and subsequent LFT monitoring to detect early hepatic impairment.

Percepções da dengue na perspectiva de uma comunidade rural da costa caribenha na Colômbia / Perceptions of dengue fever from the perspective of a rural community on the Caribbean coast in Colombia / Percepciones del dengue desde la perspectiva de una comunidad rural de la costa Caribe en Colombia

O estudo buscou compreender as percepções sobre a dengue em uma comunidade rural de Córdoba, Colômbia, com o objetivo de orientar ações específicas de enfermagem comunitária voltadas para o cuidado e a educação em saúde de pessoas, famílias e comunidades rurais. Foram realizadas 20 entrevistas semiestruturadas com chefes de família (13 homens e 7 mulheres), selecionados com base nos critérios de serem membros da comunidade há mais de 20 anos, se autoidentificarem como camponeses e terem no mínimo 18 anos de idade. O número de participantes foi determinado após alcançar a saturação teórica. As entrevistas foram transcritas e organizadas em uma matriz de análise para codificação, categorização e análise dos dados. Os achados revelaram três categorias analíticas: busca pelo conhecimento sobre a doença, práticas in situ e cuidados do passado e do presente. As famílias entrevistadas possuem conhecimento básico sobre a doença e o vetor causador, mantendo práticas familiares relacionadas ao uso de plantas medicinais para cuidados familiares e automedicação nas fases iniciais, devido à baixa percepção do risco. As famílias camponesas constroem representações socioculturais baseadas em solidariedade, apoio familiar e respeito pelo conhecimento dos idosos. A enfermagem é apresentada como ator essencial na coleta de práticas de cuidado para a elaboração e aplicação de planos de cuidado contextualizados de acordo com as necessidades do território. A pesquisa foi aprovada com o código SI-FCS-02-22, autorizando sua implementação.

The study sought to understand perceptions about dengue fever in a rural community in Córdoba, Colombia, with the aim of guiding specific community nursing actions aimed at health care and education for people, families and rural communities. 20 semi-structured interviews were carried out with heads of families (13 men and 7 women), selected based on the criteria of being members of the community for more than 20 years, self-identifying as peasants and being at least 18 years of age. The number of participants was determined after reaching theoretical saturation. The interviews were transcribed and organized into an analysis matrix for coding, categorization and data analysis. The findings revealed three analytical categories: search for knowledge about the disease, in situ practices and past and present care. The families interviewed have basic knowledge about the disease and the causative vector, maintaining family practices related to the use of medicinal plants for family care and self-medication in the early stages, due to low risk perception. Peasant families build sociocultural representations based on solidarity, family support and respect for the knowledge of the elderly. Nursing is presented as an essential actor in the collection of care practices for the elaboration and application of care plans contextualized according to the needs of the territory. The research was approved with code SI-FCS-02-22, authorizing its implementation.

El estudio buscó comprender las percepciones sobre el dengue en una comunidad rural de Córdoba, Colombia, para orientar acciones específicas de Enfermería comunitaria sobre cuidado y educación en salud para personas, familias y comunidades rurales, mediante la realización de 20 entrevistas semiestructuradas a los jefes de familia (13 hombres y 7 mujeres), seleccionados a partir de los siguientes criterios: miembros de la comunidad con permanencia de más de 20 años, autorreconocerse como campesinos y tener mínimo 18 años. El número de participantes se obtuvo una vez se alcanzó el punto de saturación teórica. Las entrevistas fueron transcritas y organizadas en una matriz de análisis para su codificación, categorización y análisis. Los hallazgos arrojaron tres categorías analíticas: en búsqueda del conocimiento acerca de la enfermedad, las praxis in situ y cuidados del ayer y del hoy. Las familias entrevistadas poseen conocimiento básico sobre la enfermedad y el vector que la causa, conservan prácticas familiares relacionadas con el uso de plantas medicinales para el cuidado familiar y la automedicación en las fases iniciales ante la baja percepción del riesgo. Las familias campesinas construyen representaciones socioculturales a partir de la solidaridad, apoyo familiar y respeto por el conocimiento de los adultos mayores. Se presenta a Enfermería como actor esencial en la recopilación de prácticas de cuidado para la elaboración y aplicación de los planes de cuidado contextualizados y de cara a las necesidades del territorio. La investigación fue aprobada con el código SI-FCS-02-22, a partir del cual se autoriza su implementación.

Dengue encephalitis as a sole presentation of dengue fever in a child, is it a separate clinical entity?

Dengue fever is one of the common viral infections in tropical areas, especially in India. Though classically non-neurotropic in nature, recent literature has documented dengue viral neurotropism, suggesting possible elements of direct encephalitis. However, limited reports are available in paediatric age groups. Here we report a case of dengue encephalitis in a 3-year 6 months-old male child from Imphal, Manipur, India who presented with a history of fever, altered sensorium, and seizures. The anti-dengue immunoglobulin M antibodies were positive in serum. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with elevated proteins and normal glucose. Neuroimaging was unremarkable. We also ruled out other causes of encephalitis by appropriate investigations. Our case did not have the typical salient features of dengue fever and recovered fully with the supportive treatment on time. The case highlights that dengue encephalitis may present even in the absence of neuroimaging findings and classical clinical signs of dengue fever. Hence, dengue encephalitis should be suspected in a child with fever with altered sensorium and seizures, especially in areas where dengue fever is endemic.

Enhancing blood safety: the utility of NS-1 antigen capture ELISA for detecting acute dengue infections among blood donors during peak transmission periods and the potential to curtail dengue spread

Background: Dengue fever is a viral disease transmitted by mosquitoes and affects millions of people worldwide. It can also be transmitted through blood transfusions, particularly during peak transmission periods. Methods: This was a cross sectional study which was conducted over a two-month period (June 2022 to July 2022) at a tertiary hospital blood bank. A total of 180 nonrepetitive serum samples were collected from voluntary blood donors and analyzed using the dengue NS-1 Ag Microlisa ELISA kit. Results: Among the 180 samples two samples tested positive for the dengue virus NS-1 antigen using the NS-1 antigen capture ELISA, indicating a prevalence of acute dengue virus infection among blood donors during the peak transmission period of 1.2% (2/180). Conclusions: The use of NS-1 antigen testing was shown to be useful for dengue virus detection. Routine screening of blood donors for dengue virus is not universally implemented in many countries, partly due to the lack of sensitive and specific screening tests. However, the use of serological tests, such as ELISA for dengue antibodies or NS-1 antigen, can effectively detect dengue virus in blood donors. Interventions made during peak transmission periods can help in curtailing the spread of dengue infections.

Pancreatitis with pancytopenia: are we missing a common diagnosis?

Acute pancreatitis with pancytopenia is a rare unreported complication of dengue non-hemorrhagic fever. A 16-year-old girl came to the emergency with complaints of loose stools and vomiting with pain abdomen and mild fever the previous day. She was diagnosed to have acute pancreatitis, which evolved into pancytopenia. She was then diagnosed with dengue fever. She was successfully managed conservatively nil orally, with intravenous fluids therapy as per the dengue protocol, timely investigations and watchful management. Acute pancreatitis with pancytopenic blood picture must point the clinician to underlying causes like dengue in endemic areas.

Demographic and clinical features associated with dengue fever during an outbreak in North India

Background: Dengue is a viral mosquito borne disease that poses high medical burden in many regions of the world. Early diagnosis and prompt treatment are critical in reducing the overall morbidity and mortality associated with dengue fever. So, this study was conducted to study the overview of dengue fever and its clinical manifestations during an outbreak in patients in a tertiary care hospital. Methods: It was a cross sectional study which was conducted at a tertiary care hospital GMC Jammu. Nonprobability convenience sampling technique was used to enroll the study participants. Results: The 222 dengue patients were included in this study with mean age of the patients 33.2±11.32 SD years. Among the dengue patients, 74 (33.3%) tested positive for antigen Ns1Ag. IgM antibodies was positive in 20 (9.0%), IgG antibodies was positive in 10 (4.5%) and 18 (8.1%) of the patients tested positive for both IgG and IgM antibodies. Overall prevalence of antibodies that are specific to dengue was 22%. Conclusions: Dengue specific antigen was present in most of the patients. The major clinical and laboratory outcomes were fever, myalgia, headache/joint pain/body aches, diarrhea and vomiting. An overall prevalence of 22% of dengue specific antibodies was found in the patients.

Assessment of knowledge, attitude and practice regarding dengue among undergraduates of Government Medical College, Western Maharashtra: a cross-sectional study

Background: Dengue fever is one of the most important viral infections transmitted by Aedes mosquitoes and a major cause of morbidity and mortality globally. For its prevention and control need to assess knowledge, attitude and practice (KAP) level of individuals. Methods: This cross-sectional observational study was carried out in Dr. V. M. Government Medical College, Solapur after taking institutional ethical committee (IEC) approval during 01 October to 30 October in all 200 undergraduate students of a batch of MBBS was selected out of 3 batches by lottery method, who were given consent were included in the study, out of which 154 had responded to pre-tested, structured, questionnaire. Results: 78.57% participants had good knowledge regarding dengue fever causative agent, transmission, signs and symptoms, preventive and control measures. 92.2% participants had good attitude towards dengue fever seriousness, preventive and control measures, need of community participation, importance of immediate visit to health care facilities. All participants had good practices regarding dengue fever preventive and control measures and 98% participants had high KAP score >38 (out of 50) regarding dengue fever signs and symptoms, means of transmission and its preventive and control measures. Conclusions: Majority of participants had good knowledge regarding dengue fever causative agent, transmission, signs and symptoms, preventive and control measures. Majority of participants had good attitude towards dengue seriousness, preventive and control measures, need of community participation, and all participants had good practice regarding dengue fever preventive and control measures and majority of participants had high KAP score regarding the same.

A study of relationship between various platelet indices and outcome of dengue fever in pediatric patients

Background: The study analyzed clinical characteristics and platelet indices in 200 children (1 month to 15 years) diagnosed with dengue fever, admitted to affiliated hospitals. It aimed to explore the relationship between platelet indices and disease severity in pediatric patients of teaching hospitals affiliated with MRMC College with a confirmed diagnosis of dengue fever.Methods: In this study, the majority of patients were aged (10-15) years, with a small percentage (3.5%) being infants. Females accounted for 50% of the cases. Fever was the most common symptom, followed by headache, abdominal pain, and myalgia. Rash occurred in (14.5%) of cases. Among 200 cases, 80 exhibited warning signs, with varying positivity for NS1 and IgM. All patients required fluid therapy, and (77.5%) needed ICU care. Platelet count and Plateletcrit decreased initially but improved later, while PDW, MPV, and PLCR increased and then decreased. NS1-positive cases had lower platelet count and Plateletcrit but higher PLCR and MPV compared to IgM-positive cases.Results: The study found that lower platelet count and Plateletcrit, as well as higher mean platelet volume, were associated with more severe disease outcomes, including longer hospital stays, increased intensive care unit care, and higher fluid therapy requirements. However, there was no significant correlation between other platelet indices (PLCR and PDW) and disease severity indicators.Conclusions: In conclusion, this study provided valuable insights into the clinical features and platelet indices of patients with dengue fever. Understanding the relationship between these indices and disease severity can help in predicting the progression of the illness and improving patient management strategies.

Clinical profile and prognosis of severe dengue infection in pediatric population admitted to tertiary care hospital

Background: Dengue fever is one of the most important emerging vector-borne viral diseases. Approximately 500,000 out of 100 million cases develop severe dengue infection. Dengue infection is endemic to Bangladesh and presents with varying degrees of severity of illness in Bangladeshi children. Objectives was to assess the common clinical profile, biochemical findings associated with severe dengue fever, and their outcome in children less than 14 years of age.Methods: This was an observational study conducted from April 2022 to October 2022 at the Pediatrics Department of Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.Results: A total of 150 cases were classified as severe dengue. The most common age of presentation was 6-8 years. The most common presenting symptom was fever (97.3%) followed by abdominal pain and vomiting (77.3%) followed by shock in 94 cases (62.7%) of severe dengue. Pleural effusion was the most common physical finding seen in 70 cases (46.6%) followed by ascites in 52 cases (34.7%). Elevation in aspartate transaminase AST (IU/L) was found in 60.0%, low albumin was found in 78.7% of the cases. Hyponatremia was the most common electrolyte abnormality found in 70 cases (46.7%). Regarding coagulation profile raised D-dimer and low fibrinogen were found in 106 cases (70.7%) and 84 cases (56.0%) respectively. Activated partial thromboplastin time (aPTT) was prolonged in 37.3% of cases. The case fatality rate (CFR) was (5.3%).Conclusions: Abdominal pain and vomiting, shock, as-cities and pleural effusion were dominant features of severe disease. Raised AST and D-dimer, low fibrinogen and albumin level as well as hyponatremia are very significant findings in severe disease. Early suspicion and effective management can reduce the severity.

An Unique Case of Dengue and Typhoid Coinfection Resulting in Hemophagocytic Lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis (HLH) is rare, uncommon and life threatening condition characterised by dysfunction of cytotoxic T and natural killer cells and abnormal immune activation, leading to tissue destruction. We report a case of 17 year old with primary diagnosis of Dengue and Typhoid coinfection causing excess immune activity, leading to HLH. Initial management was based on dengue fever. Subsequent blood test revealed a Typhoid coinfection. In spite of treatment for coinfection, patient’s clinical condition deteriorated. On further evaluation, HLH was diagnosed. Evaluation fulfilled the criteria of HLH and steroid therapy was added, to which the patient showed improvement. There are many causes of HLH as primary and secondary. It has noted to occur with dengue and typhoid infection individually, but here we represent an unique case of HLH occurring in a dengue and typhoid coinfection ,which has never been reported.

Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

Clinical Profile of Dengue Fever Infection in Patients seen in OPD & Admitted in Govt Medical College, Doda (J &K) India for the Year 2022

Introduction: Dengue infections can result in a wide spectrum of disease severity ranging from an influenza-like illness (dengue fever; DF) to the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The study was aimed to compare the clinical profile of all patients diagnosed with dengue viral infection at GMC Doda. Material and methods: This retrospective study included 215 patients infected with dengue virus, age 20 years to 81years. Laboratory and haematological data were included. Results: Peak of infection occurred in Nov. 2022 and least number of cases were recorded in September 2022. Common clinical symptoms were fever, headache and myalgia. Common haematological abnormalities were thrombocytopenia and leucopoenia. All patients survived. There was no case of dengue hemorrhagic fever or dengue shock syndrome. Conclusions: Significant differences in the clinical profile is possibly because of infection with different serotypes of dengue virus (DENV), concurrent/sequential infection of more than one serotype, and differences in host immune responses associated with host genetic variations.

A Case Report of Ischemic Stroke in an Adult Patient of Dengue Fever with Thrombocytopenia

Neurological complications in Dengue patients are extremely rare with 0.5-6% incidence including encephalopathy, Guillain Barre Syndrome, Brachial neuritis, Myelitis, Encephalomyelitis. Stroke as a neurological complication is extremely rare with very few cases reported previously. We present the case of a 69-year-old male with Dengue fever where the patient presented with persistent hiccups was found to have pontine infarct.

Características clínicas y epidemiológicas de las muertes por dengue durante un brote en el norte del Perú / Clinical-epidemiological characteristics of dengue deaths during an outbreak in northern Peru

Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con cristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

Objective: To describe the clinical-epidemiological characteristics of patients who died from dengue during 2017. Methods: We conducted a retrospective study of the information related to cases of dengue deaths in the department of Piura. Results: We reviewed 24 medical records. Sixty-seven percent were women and 3 (12.5%) were pregnant. Diabetes (12.5%) and hypertension (16.7%) were the most frequent comorbidities. Previous dengue fever was reported in only 12.5%. The time from health care and death was 4.10 ± 5.34 days. Red blood cell transfusions were performed in 45.8%, plasma in 25%, platelets in 16.8% and cryoprecipitate in 16.8% of cases. Crystalloid therapy (91.7%) and treatment with vasoactive drugs (70.8%) were also frequent. In conclusion, mortality from severe dengue fever was predominantly in adult women, and the time of care from the first health facility to a specialized unit was prolonged.

Epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 / 预防医学

Objective@#To investigate the epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021, so as to provide insights into the prevention and control of overseas imported arthropod-borne infectious diseases.@*Methods@#The data pertaining to imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 were collected from the Chinese Disease Prevention and Control Information System, and the temporal distribution, regional distribution, population distribution, sources, diagnosis and treatment of imported dengue fever and malaria cases were descriptively analyzed.@*Results@#Totally 4 332 overseas imported dengue fever cases and 2 011 overseas imported malaria cases were reported in Yunnan Province form 2015 to 2021, which accounted for 30.09% of all reported dengue fever cases and 98.53% of all reported malaria cases. The number of overseas imported dengue fever and malaria cases peaked from August to November (83.13% of all imported dengue fever cases) and from April to July (59.08% of all imported malaria cases), and the cases were predominantly reported in Dehong Prefecture (50.99% and 58.88%), with farmers as the predominant occupation (40.21% and 67.93%). The dengue fever and malaria cases were mainly imported from Southeast Asia (99.04% and 88.21%), and the proportions of definitive diagnosis of dengue fever and malaria were 88.33% and 97.80% at township hospitals, respectively.@*Conclusions@#The number of overseas imported dengue fever and malaria cases peaked from August to November and from April to July in Yunnan Province from 2015 to 2021, and the cases were predominantly reported in Dehong Prefecture and imported from Southeast Asia, with farmers as the predominant occupation.