Caracterización clínica de dengue con signos de alarma y dengue grave en adultos. Hospital Roosevelt, Guatemala

Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

Estratificación del riesgo de dengue - San José del Guaviare, Guaviare- Colombia, 2022 / Dengue risk stratification - San José del Guaviare, Guaviare- Colombia, 2022

Resumen Introducción: el dengue es una enfermedad endémica en el municipio de San José del Guaviare. En el 2010, el 2014, el 2018 y el 2022 se registraron epidemias. Sin embargo, a pesar de ser endémico, este no cuenta con una focalización que permita priorizar acciones. Objetivo: estratificar el riesgo de dengue en el municipio de San José del Guaviare en 2022, mediante el uso de variables epidemiológicas, entomológicas, socioeconómicas y ambientales para la planificación de acciones de prevención y control. Métodos: se realizó un estudio descriptivo de corte transversal. Se categorizó el nivel de riesgo para dengue de los barrios del municipio, integrando la persistencia e incidencia acumulada de dengue, índice pupal de Aedes aegypti, estrato socioeconómico y acceso de agua potable. La categorización de cada una de las variables se realizó por terciles, se calcularon medidas de tendencia central (promedio, mediana). Para su análisis la información fue procesada y organizadas en tablas y cartografía de riesgo. Resultados: en la variable entomológica, el 43,5% (10/23) de los barrios presentaron un alto índice de pupas Aedes aegypti. En la variable epidemiológica, el 52,3% (23/44) de los barrios se categorizaron en alta transmisión. En la variable ambiental, el 76,2% (32/42) de los barrios se categorizaron en nivel de riesgo medio. Según la variable socioeconómica, el 83,3% (35/42) de los barrios se categorizaron en riesgo alto. Al integrar las variables analizadas, los barrios se categorizaron para la transmisión de dengue en: riesgo muy alto 23,4% (11/47), riesgo alto 31,9% (15/47), riesgo medio 8,5% (4/47) y riesgo bajo 34,0% (16/47). Conclusiones: en la integración final de riesgo aquellos barrios que se clasificaron en muy alto y alto riesgo para la transmisión de dengue, se deben focalizar las acciones de control, promoción y prevención del municipio. Igualmente, se debe continuar con la estratificación en períodos estacionales por cambios en las condiciones ecológicas del vector y dinámicas de transmisión.

Background Dengue is an endemic disease in this municipality, epidemics were recorded in 2010, 2014, 2018 and 2022. Despite being endemic, it does not have a focus that allows prioritizing actions. The objective of this research was to stratify the risk of dengue in the municipality of San José del Guaviare in 2022, through the use of epidemiological, entomological, socioeconomic and environmental variables for the planning of prevention and control actions. Methods: A descriptive cross-sectional study was carried out. The level of risk for dengue in the neighborhoods of the municipality was categorized, integrating the persistence and cumulative incidence of dengue, Aedes aegypti pupal index, socioeconomic stratum, and access to drinking water. The categorization of each of the variables was carried out by tertiles, measures of central tendency (mean, median) were calculated. For its analysis, the information was processed and organized into tables and risk cartography. Results: In the entomological variable, 43.5% (10/23) of the neighborhoods had a high rate of Aedes aegypti pupae. In the epidemiological variable, 52.3% (23/44) of the neighborhoods were categorized as having high transmission. In the environmental variable, 76.2% (32/42) of the neighborhoods were categorized as a medium risk level. According to the socioeconomic variable, 83.3% (35/42) of the neighborhoods were categorized as high risk. By integrating the variables analyzed, the neighborhoods were categorized for dengue transmission as: very high risk 23.4% (11/47), high risk 31.9% (15/47), medium risk 8.5% (4 /47) and low risk 34.0% (16/47). Conclusions: In the final integration of risk, those neighborhoods that were classified as very high and high risk for dengue transmission should focus on the control, promotion and prevention actions of the municipality. Continue with the stratification in seasonal periods due to changes in the ecological conditions of the vector and transmission dynamics.

Telas de proteção em habitações para prevenção de doenças transmitidas por mosquitos: sinopse baseada em evidências / Protective screens in homes to prevent mosquito-borne diseases: evidence-based synopsis

Contexto e objetivo: A transmissão de doenças por mosquitos afeta a população e a economia de todo o mundo. Há um número considerável de doenças que podem ser transmitidas por mosquitos, com destaque para a malária e a dengue, endêmica em regiões tropicais. Evidentemente, medidas preventivas são imprescindíveis para a redução da transmissão. Avaliar as evidências de efetividade das telas de proteção com e sem inseticida para prevenção de doenças transmitidas por mosquitos. Métodos: Trata-se de sinopse baseada em evidências. Procedeu-se à busca por estudos que associavam o uso de telas de proteção contra mosquitos à redução do contágio de doenças transmitidas por mosquitos em três bases de dados: PubMed (1966-2024), Portal BVS (1982-2024) e Epistemonikos (2024) e também no metabuscador de evidências TRIP DATABASE (2024). O desfecho de análise envolveu a efetividade das telas de proteção na redução de doenças transmitidas por mosquitos. Resultados: Foram encontradas 307 citações. Seis estudos (1 revisão sistemática e 5 ensaios clínicos) foram incluídos. Discussão: A maioria dos estudos envolveu a colocação de telas de proteção com inseticida, havendo evidência de alta certeza para redução de mortalidade por malária e redução na entrada de mosquitos nas habitações, mesmo com redes sem inseticida. Conclusões: Embora não haja robustez na evidência da efetividade das telas de proteção sem inseticidas contra mosquitos transmissores de doenças, o que demanda a necessidade de realização de novos estudos prospectivos, parece lícita e benéfica a utilização de telas de proteção em regiões endêmicas para doenças transmitidas por esses vetores.

Acute Epstein-Barr virus-related myocarditis: life-threatening complication in immunocompetent patient

Acute Epstein-Barr virus (EBV) related myocarditis is an uncommon but potentially life-threatening condition, particularly in immunocompetent individuals. We present a case of a 14-year-old male with no prior medical history who presented with high-grade fever, sore throat, and dyspnea on exertion. Laboratory tests and echocardiography confirmed the diagnosis of myocarditis secondary to EBV infection. The patient required conservative treatment. Follow-up at post-discharge revealed complete recovery, with normal echocardiographic findings and no residual symptoms. This case underscores the importance of early recognition and intervention in EBV-related myocarditis. Despite its rarity, clinicians should consider viral myocarditis in patients with systemic EBV infection and cardiac symptoms. Aggressive supportive care can lead to full recovery, as demonstrated by this case. It can present as a dengue-mimic.

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.

Efectividad y seguridad de la vacuna tetravalente TAK-003 contra el dengue: una revisión sistemática / Effectiveness and safety of the tetravalent TAK-003 dengue vaccine: a systematic review

Resumen En Argentina, el virus del dengue ha experimentado un aumento en los últimos años. Este estudio se propone realizar una revisión sistemática para evaluar la efec tividad y seguridad de la vacuna TAK-003 tetravalente contra el dengue en este contexto. Se llevó a cabo una revisión sistemática de ensayos clínicos controlados aleatorizados que comparaban la efectividad y seguridad de la vacuna con placebo en la población general. La búsqueda se efectuó en Episte monikos y dos investigadores evaluaron los estudios de manera independiente. El riesgo de sesgo se evaluó con la herramienta Rob 2 de Cochrane. Se realizó un metaa nálisis de los resultados y la certeza en la evidencia se evaluó mediante la metodología GRADE. Concluimos, con alta certeza de evidencia, que la vacuna tetravalente contra el dengue reduce las infec ciones graves (RR 0.17, IC 95% 0.12 a 0.24) e infecciones por el virus del dengue (RR 0.40, IC 95% 0.36 a 0.45) en una población de ≤17 años. La vacuna podría no incre mentar el riesgo de eventos adversos serios, aunque es importante destacar la baja certeza de evidencia (RR 1.04, IC 95%: 0.69-1.55). La aplicación de la vacuna tetravalente contra el dengue disminuye el riesgo de infecciones graves y no graves por el dengue en esa población. No obstante, existe baja certeza en la evidencia en relación a la se guridad de la vacuna. La decisión de la vacunación debe considerar la magnitud de los beneficios en función del riesgo de infección.

Abstract In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to assess the effectiveness and safety of the tetravalent dengue vaccine TAK-003 in this context. A systematic review of randomized controlled clini cal trials comparing the effectiveness and safety of the vaccine with a placebo in the general population was conducted. The search was carried out on Epistemoni kos, and two investigators independently evaluated the studies. Bias risk was assessed using Cochrane's Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was evaluated using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the den gue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population aged ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine's safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.

Consideraciones para el manejo agudo del accidente cerebrovascular durante la epidemia de dengue / Considerations for the acute management of stroke dur ing the dengue epidemic

Resumen El accidente cerebrovascular (ACV) es la principal causa de discapacidad y la tercera causa de mortalidad en nuestro país. Argentina y la región de las Américas se encuentran atravesando el peor brote epidémico de dengue del que se tenga registro, con una importan te demanda en el sistema de salud. El dengue podría aumentar el riesgo de ACV y dada la naturaleza tiem po dependiente del manejo de esta enfermedad para reducir la morbilidad y mortalidad, y las potenciales consideraciones a tener en cuenta en los pacientes con dengue, se presenta una revisión breve de la literatura con puntos de incertidumbre y aspectos a considerar en el protocolo o código de ACV, considerando las ca racterísticas clínicas y alta demanda del sistema de salud provocada por el dengue. Se realiza también un llamado a generar evidencia sobre el manejo del ACV en pacientes con dengue.

Abstract Stroke is the leading cause of disability and the third leading cause of mortality in our country. Argentina and the Region of the Americas are going through the worst epidemic outbreak of dengue on record with significant demand on the health system. Dengue could increase the risk of stroke and given the time-dependent nature of the management of this disease to reduce morbidity and mortality and the potential considerations to be taken into account in patients with dengue, we present a focused review of the literature with points of uncer tainty and aspects to be considered in the stroke code considering the clinical characteristics and high demand of the health system caused by the dengue fever. A call is also made to generate evidence on the management of stroke in patients with dengue.

Observaciones sobre la estrategia de vacunación contra el dengue en Argentina / Observations on the dengue vaccination strategy in Argentina

Resumen Una nueva vacuna contra el dengue ha sido reciente mente aprobada en Argentina, y el gobierno argentino se encuentra planificando su adquisición para desarrollar una estrategia de vacunación. Mientras la enfermedad se está dirigiendo gradualmente hacia la endemicidad en algunas regiones del país, la incorporación de estas vacunas tendrá el potencial de atacar la creciente inci dencia de la enfermedad y de reducir su carga. Sin em bargo, el establecimiento de un programa de vacunación puede también ser susceptible de amenazas relaciona das con el cambio epidemiológico de la enfermedad. La selección de un grupo de edad específico para la vacunación puede resultar en un cambio en el pico de la incidencia hacia otros grupos de edad más vulnerables a las formas graves de la enfermedad, como los niños o los ancianos. Además, la percepción de protección lue go de la introducción de la vacuna en una jurisdicción puede reducir la adherencia a las actividades de control del vector, incrementando el riesgo de introducción y transmisión del virus en otras áreas no priorizadas por la estrategia de vacunación, y aumentando el riesgo de otras arbovirosis como las fiebres Zika y chikungunya. Estas y otras potenciales limitaciones para ser conside radas antes de la implementación de los programas de vacunación son discutidas en este artículo, en conjunto con una serie de recomendaciones sobre cómo abordar estas preocupaciones. Estas recomendaciones pueden resultar de utilidad para los tomadores de decisión y actores sanitarios, en esta etapa temprana del desarrollo de un programa de vacunación.

Abstract A new dengue vaccine has recently been licensed in Argentina, with the Argentine government planning to acquire it in order to develop a vaccination strategy. As the disease is gradually following a path to endemicity in some regions of the country, the incorporation of these vaccines will have the potential to tackle the grow ing incidence of the disease and to reduce the disease burden. However, the establishment of the vaccination programme may also be susceptible of threats related to the epidemiological shift of the disease. Selecting a specific age group for the vaccine may result in a change in the peak incidence to other age groups more suscep tible to severe forms of the disease, such as children or the elderly. Furthermore, the perception of protection following vaccine introduction in one jurisdiction may reduce adherence to vector control activities, increasing the risk of virus introduction and transmission in other areas not prioritised by the vaccination strategy, and the risk of other arboviral diseases such as Zika and chikun gunya fever. These and other potential limitations to be considered prior to the implementation of vaccination programmes are discussed in this article, with a series of recommendations on how to address these concerns. These recommendations can help decision makers and public health practitioners at this early stage of the vac cination programme development.

Encefalitis por dengue en Argentina / Dengue encephalitis in Argentina

Resumen El virus dengue es un virus endémico en Argentina que, si bien inicialmente se consideró que no era neu rotrópico, actualmente se reconoce que tiene neuroinva sión, condicionando así una prevalencia de manifesta ciones neurológicas de hasta el 15% entre los enfermos. Aun siendo considerados síntomas de gravedad, existe subdiagnóstico de encefalitis por dengue debido a su variada forma de presentación clínica. Las manifesta ciones neurológicas de la encefalitis por dengue pueden abarcar desde fiebre y cefalea hasta alteraciones del nivel de conciencia y convulsiones. Si bien el líquido cefalorraquídeo (LCR) puede hallarse normal en hasta un tercio de los casos, lo habitual es que presente aumento de concentración de proteínas y pleocitosis. En cuanto a los métodos de neuroimagen, los hallazgos suelen ser variados e inespecíficos, e incluso pueden ser normales hasta en 40-50% de los casos. Se presentan 3 casos de encefalitis por dengue diag nosticados en un hospital universitario de Buenos Ai res, Argentina, en donde la presentación clínica varió desde desorientación témporo-espacial hasta estatus convulsivo refractario con diferentes presentaciones en el LCR pero todos con PCR positivo para dengue y con neuroimágenes sin alteraciones.

Abstract Dengue virus is an endemic virus in Argentina that, although it was initially considered to be non-neuro tropic, it is currently recognized to be neuroinvasive; thus conditioning a prevalence of neurological mani festations of up to 15% among patients. Even being considered severe symptoms, there is underdiagnoses of dengue encephalitis due to its varied clinical presenta tion. Neurological manifestations of dengue encephalitis can range from fever and headache to altered levels of consciousness and seizures. Although the cerebrospinal fluid may be normal in up to a third of cases, it usually presents increased protein concentration and pleocyto sis. Regarding neuroimaging methods, the findings are usually varied and nonspecific, and can even be normal in up to 40-50% of cases. We present three cases of dengue encephalitis di agnosed in a university hospital in Buenos Aires, Ar gentina, where the clinical presentation varied from temporal-spatial disorientation to refractory convulsive status with different presentations in the cerebrospinal fluid but all with positive PCR for dengue in it and with normal neuroimaging.

Impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay

Introducción: Los brotes recurrentes de dengue subrayan la necesidad de abordajes más efectivos en la prevención y control de vectores. A menudo, las intervenciones se centran en un enfoque biomédico y de promoción de la salud desde un enfoque individual, sin integrar factores socioambientales ni ser evaluados científicamente Objetivo: Evaluar el impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay durante los años 2017 a 2021. Material y métodos: Estudio cuasiexperimental, longitudinal, donde se encuestaron 350 hogares, como línea de base durante el 2017 y una línea de cierre en 108 hogares en 2021. Se utilizó el método de Diferencia en Diferencia (DID) para comparar la presencia de criaderos antes y después de la intervención en 43 hogares intervenidos y 65 no intervenidos. Resultados: La recolección diferenciada fue utilizada principalmente por aquellos hogares que tenían una gran cantidad de residuos sólidos de gran tamaño, pero no para deshacerse de todos estos objetos, sino sólo de una parte (DID de -52% en el número total de criaderos y DID de 1% en número de hogares con criaderos). Encontramos una reducción significativa en el número de total de criaderos de gran tamaño, pero no observamos diferencias en el número total de hogares con criaderos. Factores subjetivos, como la creencia de que los objetos en desuso podrían llegar a ser útiles en el futuro explicaban en gran medida su presencia en los hogares, incluso con el servicio disponible. Conclusiones: El enfoque de la gestión municipal en los residuos voluminosos puede contribuir a la prevención del dengue por el hecho de que no constituyen residuos de generación rápida en los hogares, y su eliminación puede tener un impacto relativamente duradero. El factor subjetivo relacionado con la presencia de estos criaderos en los hogares debe ser objeto de mayores estudios.

Introduction: Recurrent dengue outbreaks underscore the need for more effective approaches to vector prevention and control. Often, interventions focus on a biomedical and health promotion approach from an individual approach, without integrating socio-environmental factors or being scientifically evaluated. Objetive: To evaluate the impact of large household waste collection on potential breeding sites of dengue-transmitting mosquitoes in Asuncion, Paraguay during the years 2017 to 2021. Material and methods: Quasi-experimental, longitudinal study, where 350 households were surveyed, as a baseline during 2017 and a closing line in 108 households in 2021. The Difference-in-Difference (DID) method was used to compare the presence of breeding sites before and after the intervention in 43 intervened and 65 non-intervened households. Results: Differentiated collection was mainly used by those households that had a large amount of large solid waste, but not to dispose of all these objects, but only part of them (DID of -52% in the total number of breeding sites and DID of 1% in the number of households with breeding sites). We found a significant reduction in the total number of large breeding sites but did not observe differences in the total number of households with breeding sites. Subjective factors, such as the belief that disused objects could become useful in the future, were largely responsible for the reduction in the number of large breeding sites. Conclusions: The municipal management approach to bulky waste can contribute to dengue prevention because it does not constitute rapidly generated waste in households, and its disposal can have a relatively long-lasting impact. The subjective factors related to the presence of these breeding sites in households warrant further study.

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.

Fatores de risco de morte por dengue no Brasil: um estudo ecológico / Dengue death risk factors in Brazil: an ecological study / Factores de riesgo de muerte por dengue en Brasil: un estudio ecológico

Este artigo tem por objetivo identificar os fatores de risco de morte por dengue no Brasil. Para isso, por meio do Sistema de Informação de Agravos de Notificação (SINAN) e do Morbidade Hospitalar do Sistema Único de Saúde (SIH/SUS), foram levantados os dados referentes às mortes por dengue ocorridas no Brasil entre 1 de janeiro de 2014 a 11 de março de 2024. A partir desses dados, foram calculados os riscos relativos para as seguintes variáveis: sexo, raça, faixa etária, escolaridade e sorotipo, adotando-se o nível de significância de 5% e o intervalo de confiança de 95%. Em relação ao sexo, os homens apresentaram maior risco de morte (RR: 1,24; IC95%: 0,76­0,84) em comparação às mulheres. Quanto à raça, brancos (RR: 1,18; IC 95%: 1,12­1,25) e amarelos (RR: 1,33; IC95%: 1,07­1,66) exibiram um risco significativamente maior do que as demais. Pessoas com 60 anos ou mais apresentaram risco de morte 7,74 vezes maior (RR: 7,74; IC95%: 7,38­8,11) em comparação às outras faixas etárias. Pessoas analfabetas ou que estudaram só até a 4a série do ensino fundamental tiveram um risco três vezes maior (RR: 3,00; IC95%: 2,79­3,23) do que aquelas com mais anos de estudo. O sorotipo DENV-2, por sua vez, aumentou 1,61 vezes o risco de morte (RR: 1,61; IC95%: 1,43­1,80) em relação aos demais sorotipos, enquanto o DENV-3 aumentou 2,94 vezes (RR: 2,94; IC95%: 1,68­5,15). Foi possível deduzir que sexo, raça, faixa etária, escolaridade e sorotipo são fatores de risco de morte por dengue, devendo, portanto, ser considerados na elaboração de políticas públicas de combate à dengue.

This study investigated the dengue risk death factors in Brazil by analyzing data on dengue deaths between January 1st, 2014 to March 11, 2024, registered in the SINAN and SIH/SUS databases. Relative risks were calculated for the following variables: gender, race, age group, schooling level and serotype, adopting a 5% level of significance and 95% confidence interval. Regarding gender, men had a higher death risk (RR: 1.24; 95% CI: 0.76­0.84) than women. Whites (RR: 1.18; 95% CI: 1.12­1.25) and Asians (RR: 1.33; 95% CI: 1.07­1.66) showed a significantly higher risk than other ethnicities. People with 60 years of age or over presented death risk 7.74 times higher (RR: 7.74; IC 95%: 7.38­8.11) compared with other age groups. Illiterates or people with complete primary education had a 3 times higher risk (RR: 3.00; 95% CI: 2.79­3.23) than those with more years of study. The serotype DENV-2 increased in 1.61 times the risk of death (RR: 1.61; 95% CI: 1.43­1.80) compared with other serotypes, whereas DENV-3 serotype increased the risk by 2.94 times (RR: 2.94; 95% CI: 1.68­5.15). Gender, race, age group, schooling level and serotype are dengue death risk factors, thus they should be considered when elaborating public policies to fight the disease.

Este estudio tuvo por objetivo identificar los factores de riesgo de muerte por dengue en Brasil. Para ello, se recogieron datos de muertes por dengue en Brasil entre el 1 de enero de 2014 y el 11 de marzo de 2024 del Sistema de Información de Agravios de Notificación (SINAN) y del Sistema de Morbilidad Hospitalaria del Sistema Único de Salud (SIH/SUS). A partir de estos datos, se calcularon los riesgos relativos para las siguientes variables: sexo, raza, grupo de edad, nivel de estudios y serotipo, adoptando un nivel de significación del 5% y un intervalo de confianza del 95%. Con relación al sexo, los hombres presentaron un mayor riesgo de muerte (RR: 1,24; IC 95%: 0,76-0,84) en comparación con las mujeres. En cuanto a la raza, los blancos (RR: 1,18; IC 95%: 1,12-1,25) y los pardos (RR: 1,33; IC 95%: 1,07-1,66) tenían un riesgo significativamente mayor que los demás. Las personas de 60 años o más tenían un riesgo de muerte 7,74 veces mayor (RR: 7,74; IC 95%: 7,38-8,11) que otros grupos de edad. Las personas analfabetas o con hasta 4.º grado de la primaria tenían un riesgo 3 veces mayor (RR: 3,00; IC 95%: 2,79-3,23) que las que tenían más años de escolaridad. El serotipo DENV-2 aumentó el riesgo de muerte en 1,61 veces (RR: 1,61; IC 95%: 1,43-1,80) en comparación con los demás serotipos, mientras que el DENV-3 lo aumentó 2,94 veces (RR: 2,94; IC 95%: 1,68-5,15). El sexo, la raza, el grupo de edad, el nivel de estudios y el serotipo son factores de riesgo de muerte por dengue, por lo tanto, deben tenerse en cuenta en la elaboración de políticas públicas de lucha contra el dengue.

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.

Temporal patterns of probable dengue cases before and during the COVID-19 pandemic, Jaboatão dos Guararapes-PE / Padrões temporais dos casos prováveis de dengue antes e durante a pandemia de COVID-19, Jaboatão dos Guararapes-PE / Patrones temporales de casos probables de dengue antes y durante la pandemia de COVID-19, Jaboatão dos Guararapes-PE

Justification and Objectives: dengue is one of the serious public health concerns in the world, due to the severity of its infection, which can lead to serious cases and death. The study aimed to analyze the epidemiological profile of dengue cases as well as their temporal distribution in the municipality of Jaboatão dos Guararapes-PE before and during the COVID-19 pandemic. Methods: this is an ecological time series study, with a descriptive character of suspected cases of dengue in the Notifiable Diseases Information System, from 2018 to 2021. Results: it should be noted that 2018 had the lowest dengue incidence rate of the years analyzed. The other years had high incidence rates, however 2020 had a decline in cases when compared to 2019. The year 2021 was marked by the highest number of cases in the study period. Conclusion: it was possible to observe a seasonal pattern of dengue in 2020 that was different from other years, with a more pronounced decrease in dengue cases following the arrival of COVID-19 in the municipality.(AU)

Justificativa e Objetivos: a dengue é um dos graves problemas de saúde pública no mundo, devido à gravidade de sua infecção, podendo evoluir para casos graves e a óbito. O estudo teve como objetivo analisar o perfil epidemiológico dos casos de dengue, bem como sua distribuição temporal no município do Jaboatão dos Guararapes-PE antes e durante a pandemia de COVID-19. Métodos: trata-se de estudo ecológico de série temporal, com caráter descritivo dos casos suspeitos de dengue no Sistema de Informação de Agravos de Notificação, de 2018 a 2021. Resultados: observou-se que o ano de 2018 apresentou a menor taxa de incidência de dengue dos anos analisados. Os demais anos tiveram altas taxas de incidência, no entanto 2020 teve um decréscimo dos casos quando comparado com o ano de 2019. Já o ano de 2021 foi marcado pela maior quantidade de casos do período temporal de estudo. Conclusão: foi possível observar um padrão de sazonalidade da dengue em 2020 diferente dos demais anos, com um decréscimo mais acentuado dos casos de dengue a partir da chegada da COVID-19 no município.(AU)

Justificación y Objetivos: el dengue se presenta como uno de los graves problemas de salud pública en el mundo, debido a la gravedad de su infección, que puede provocar casos graves y la muerte. El estudio tuvo como objetivo analizar el perfil epidemiológico de los casos de dengue, así como su distribución temporal en el municipio de Jaboatão dos Guararapes-PE antes y durante la pandemia de COVID-19. Métodos: un estudio de serie temporal ecológica, con carácter descriptivo de casos sospechosos de dengue en el Sistema de Información de Enfermedades de Declaración Obligatoria, del 2018 al 2021. Resultados: cabe señalar que el año 2018 tuvo la tasa de incidencia de dengue más baja de los años analizados. Los demás años tuvieron altas tasas de incidencia, sin embargo el 2020 tuvo una disminución de casos en comparación con el 2019. El año 2021 estuvo marcado por el mayor número de casos en el período de estudio. Conclusión: se pudo observar un patrón estacional del dengue en el año 2020 diferente a otros años, con una disminución más pronunciada de los casos de dengue tras la llegada del COVID-19 al municipio.(AU)

Colonización del Aedes aegypti en la región Metropolitana de Cochabamba / Colonization of Aedes aegypti in the Metropolitan Region of Cochabamba / Colonização do Aedes aegypti na Região Metropolitana de Cochabamba

El Aedes aegypti transmite enfermedades graves como dengue, zika, chikungunya y fiebre amarilla, representando una amenaza para la salud pública. En Cochabamba, Bolivia, su proliferación es favorecida por el clima y la urbanización. Estudiar su colonización es crucial para desarrollar estrategias efectivas de control y prevención. Metodología: para revisar la colonización del Aedes aegypti en Cochabamba, se usaron bases de datos como Scielo, PubMed y Google Scholar. Se seleccionaron estudios relevantes con palabras clave como Aedes aegypti, Cochabamba y salud pública. Zotero se utilizó para organizar las referencias. Se llevó a cabo un análisis cualitativo y sistemático de los hallazgos. Desarrollo: el Aedes aegypti es un mosquito pequeño, identificado por sus marcas blancas en las patas y una marca en forma de lira en el tórax. Prefiere áreas urbanas con agua estancada para depositar sus huevos. Su ciclo de vida incluye etapas de huevo, larva, pupa y adulto, completándose en 8 a 10 días. La presencia del mosquito en Cochabamba ha sido documentada desde los años 80, con una expansión asociada a la densidad poblacional y la disponibilidad de hábitats adecuados. Estrategias de control incluyen campañas de educación pública, uso de insecticidas y vigilancia entomológica. Discusión: los estudios sobre la colonización del Aedes aegypti en Cochabamba muestran su adaptación a nuevas altitudes y áreas urbanas, influenciada por variaciones climáticas y urbanización desordenada. Factores como la escasez de agua y el almacenamiento inadecuado facilitan su proliferación. Se recomienda intensificar la educación pública y la participación comunitaria para eliminar criaderos.

Introduction: aedes aegypti transmits severe diseases such as dengue, Zika, chikungunya, and yellow fever, representing a significant public health threat. In Cochabamba, Bolivia, its proliferation is favored by the climate and urbanization. Studying its colonization is crucial for developing effective control and prevention strategies. Methodology: to review the colonization of Aedes aegypti in Cochabamba, databases such as Scielo, PubMed, and Google Scholar were used. Relevant studies were selected using keywords like Aedes aegypti, Cochabamba, and public health. Zotero was used to organize the references. A qualitative and systematic analysis of the findings was conducted. Development: Aedes aegypti is a small mosquito, identified by its white markings on the legs and a lyre-shaped marking on the thorax. It prefers urban areas with stagnant water to lay its eggs. Its life cycle includes the egg, larva, pupa, and adult stages, which it completes in 8 to 10 days. The presence of the mosquito in Cochabamba has been documented since the 1980s, with expansion associated with population density and the availability of suitable habitats. Control strategies include public education campaigns, insecticide use, and entomological surveillance. Discussion: studies on the colonization of Aedes aegypti in Cochabamba show its adaptation to new altitudes and urban areas, influenced by climate variations and unplanned urbanization. Factors such as water scarcity and inadequate storage facilitate its proliferation. It is recommended to intensify public education and community participation to eliminate breeding sites

Introdução: o Aedes aegypti transmite doenças graves como dengue, zika, chikungunya e febre-amarela, representando uma ameaça significativa à saúde pública. Em Cochabamba, Bolívia, sua proliferação é favorecida pelo clima e pela urbanização. Estudar sua colonização é crucial para desenvolver estratégias eficazes de controle e prevenção. Metodologia: para revisar a colonização do Aedes aegypti em Cochabamba, foram utilizadas bases de dados como Scielo, PubMed e Google Scholar. Estudos relevantes foram selecionados usando palavras-chave como Aedes aegypti, Cochabamba e saúde pública. O Zotero foi utilizado para organizar as referências. Foi realizada uma análise qualitativa e sistemática dos achados. Desenvolvimento: o Aedes aegypti é um mosquito pequeno, identificado por suas marcas brancas nas patas e uma marca em forma de lira no tórax. Prefere áreas urbanas com água estagnada para depositar seus ovos. Seu ciclo de vida inclui as fases de ovo, larva, pupa e adulto, completando-se em 8 a 10 dias. A presença do mosquito em Cochabamba é documentada desde a década de 1980, com uma expansão associada à densidade populacional e à disponibilidade de habitats adequados. As estratégias de controle incluem campanhas de educação pública, uso de inseticidas e vigilância entomológica. Discussão: os estudos sobre a colonização do Aedes aegypti em Cochabamba mostram sua adaptação a novas altitudes e áreas urbanas, influenciada por variações climáticas e urbanização desordenada. Fatores como a escassez de água e o armazenamento inadequado facilitam sua proliferação. Recomenda-se intensificar a educação pública e a participação comunitária para eliminar criadouros

Dengue, chikungunya y el mosquito vector en el límite Sur de distribución durante la epidemia 2023, Argentina / Dengue, chikungunya and the mosquito vector at the Southern limit of distribution during the 2023 epidemic, Argentina

Resumen Objetivos : Monitorear la actividad de oviposición del mosquito Aedes aegypti y de casos de dengue y chikun gunya en cuatro localidades de Argentina templada, durante la epidemia del 2023. Métodos : Durante el verano y otoño del 2023, se mo nitoreó semanalmente mediante ovitrampas la actividad de oviposición del mosquito vector, y se registró el arribo de casos con dengue o chikungunya a Tandil, Olavarría, Bahía Blanca y Laprida. Resultados : La variación mensual del porcentaje de trampas positivas fue similar en las tres primeras localidades; en Laprida no se detectó el mosquito. Por el contrario, se observó una diferencia significativa del porcentaje de trampas que alguna vez resultó positiva en cada localidad, siendo mayor en Olavarría (83%), que en Bahía Blanca (67%) y Tandil (49%). Respecto a las enfermedades, se registraron 18 casos importados de dengue y 3 de chikungunya. Además, se registró el primer caso autóctono de dengue en la región, siendo el más austral hasta el momento. Conclusión : Es imprescindible sensibilizar y capacitar a los integrantes de los sistemas de salud de las nue vas regiones expuestas al Ae. aegypti para la detección temprana de casos, y a la población en general para potenciar las acciones de prevención.

Abstract Objectives : To monitor the oviposition activity of the mosquito Aedes aegypti and of dengue and chikungunya cases in four localities of temperate Argentina, during the 2023 epidemic. Methods : During the summer and autumn of 2023, the oviposition activity of the mosquito vector was monitored weekly using ovitraps, and the arrival of cases with dengue or chikungunya in Tandil, Olavarría, Bahía Blanca and Laprida were registered. Results : Monthly variations of the percentage of positive traps were similar in the first three locations; in Laprida the mosquito was not detected. On the con trary, a significant difference was observed in the per centage of total traps that ever tested positive in each locality, being higher in Olavarría (83.3%) than in Bahía Blanca (68.6%) and Tandil (48.7%). Regarding diseases, 18 imported cases of dengue and 3 of chikungunya were registered. In addition, the first autochthonous case of dengue in the region was recorded, being the southern most until known. Conclusion : It is essential to raise awareness and train the members of the health systems of the new regions exposed to Ae. aegypti for early detection of cases, and to the general population to enhance pre vention actions.

Hematological profile of pediatric patients with dengue in district hospital Samba

Background: Dengue is an acute viral illness spread by vector aedes mosquito and caused by RNA virus of the family Flaviviridae. Dengue presents with high fever, severe headache, vomiting, arthralgia, myalgia. Laboratory findings include thrombocytopenia and leukopenia. Dengue is self-limiting illness. Objectives were to study hematological profile of pediatric patients with dengue in district hospital samba from September to November 2022.Methods: Dengue patients aged 0-18 years detected by ELISA NS1 antigen assay in DH samba were included in the study. CBC of all these patients was analyzed on day of presentation to hospital and day of dengue positivity.Results: There were 50 participants in this study. Out of these 35 (70%) were males and 15 (30%) were females, 11 patients were 1-5-year-old (22%); 16 patients were 6-12-year-old (32%); 23 patients were 13-18-year-old (46%), 21 patients (42%) had thrombocytopenia at presentation. 29 out of 50 (58%) were anemic, 19 out of 50 (38%) patients had leukocytopenia. Statistically significant association were seen between age group and platelet counts; platelet and leukocyte count.Conclusions: Teenagers were most commonly affected. Males were affected 3� more than females. Although thrombocytopenia was not universal at presentation but it was observed in less than half (42%) of study participants. One third of study participants (38%) had leukocytopenia at presentations. Thrombocytopenia was most predominant in adolescent age group. Leukocytopenia and thrombocytopenia were associated with each other.

The study of clinical profile of severe dengue in children

Background: Dengue fever is one of the most important vectors borne viral diseases, causing the significant burden due to high admissions and mortality in southern parts of India. Early detection and early intervention of sickness can reduce this burden for which we should know the clinical features and other parameter in dengue so that mortality rate can be reduced.Methods: It was a retrospective single center study which included patients admitted to department of pediatrics from a period of October 2022 to November 2023. A total of 30 cases of severe dengue admitted in a span of 6 months. A detailed clinical and laboratory data was recorded in a questionnaire format which was analyzed using statistical tool.Results: Among 30 cases of severe dengue the most common clinical feature was shock (53%), hepatitis (36%), clinical fluid accumulation (33%), mucosal bleeding (26%) and ARDS (165). Severe dengue was frequently found in the range of white cell count 1000-4000/ul and platelet count 12000-50000/ul.Conclusions: The key to the management of severe dengue illness lies in the in-depth knowledge of clinical manifestation among children. Thus, it is important to be aware of warning signs and varied presentations of severe dengue so that there will be accurate management of in resource limited setups.

Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Falla hepática aguda fulminante secundaria a dengue severo en un niño: reporte de un caso / Fulminant acute liver failure secondary to severe dengue in a child: case report

RESUMEN El dengue es una enfermedad infecciosa frecuente en áreas tropicales como Perú. Este virus puede producir complicaciones poco reportadas y potencialmente fatales como la falla hepática aguda. Reportamos el caso de un niño de 7 años que presentó fiebre, cefalea y dolor abdominal. En la ecografía se encontró hepatomegalia y en los laboratorios se observó trombocitopenia severa y elevación de transaminasas. Durante la hospitalización fue diagnosticado como dengue severo y desarrolló falla hepática aguda, injuria renal y encefalopatía. A pesar del manejo de soporte y la ventilación asistida, desarrolló disfunción orgánica múltiple con refractariedad a fluidos y fuga capilar. La falla hepática aguda secundaria a dengue severo es una complicación rara con desenlace desfavorable.

ABSTRACT Dengue is a common infectious disease in tropical areas such as Peru. This virus can cause underreported and potentially fatal complications such as acute liver failure. We report the case of a 7-year-old boy who presented with fever, headache, and abdominal pain. On ultrasound, we found hepatomegaly and labs severe thrombocytopenia and elevated transaminases. During hospitalization he was diagnosed with severe dengue and developed acute liver failure, kidney injury, and encephalopathy. Although intensive care management and assisted ventilation, he developed multiple organ dysfunctions with fluid refractoriness and capillary leak. Acute liver failure secondary to severe dengue is a rare complication with an unfavorable outcome.