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1.
Rev. inf. cient ; 97(3): i:584-f:595, 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-1000297

RESUMO

Introducción: el dengue constituye un importante problema de salud pública para las regiones endémicas. Objetivo: identificar variables clínicas, biológicas e imaginológicas asociadas a la probabilidad de morir en pacientes con dengue grave ingresados en la unidad de cuidados intensivos del Hospital General Docente "Dr. Agostinho Neto" entre enero y noviembre de 2014. Método: se realizó un estudio epidemiológico, caso-control, retrospectivo en el que se incluyen todos los pacientes ingresados en el escenario investigacional con diagnóstico de dengue grave y que fueron confirmados serológicamente, en dicho período de estudio. Se emplearon estadígrafos descriptivos y análisis univariado, bivariado y de regresión logística para determinar la asociación de las variables seleccionadas con la mortalidad. Se analizaron 90 casos, 10 fallecidos y 80 egresados vivos. Resultados: En el análisis univariado resultaron tener diferencias significativas la presión arterial media, el gasto urinario y el conteo plaquetario, la glicemia, la acidosis metabólica y el derrame pericárdico. En el análisis multivariado, mostraron asociación con la mortalidad el gasto urinario y la presión arterial media, la glicemia, la acidosis metabólica y el derrame pericárdico. El derrame pericárdico y la acidosis metabólica tienen aceptables medidas de validez y seguridad diagnósticas de la probabilidad de morir. Conclusiones: La presión arterial media y el gasto urinario 3, la glicemia 2 y 3, la acidosis metabólica con DB? -8 mmol/l en el momento 1 y 2, y el derrame pericárdico en el momento 3 resultaron ser variables con capacidad predictiva de mortalidad en pacientes con dengue grave(AU)


Introduction: dengue is an important public health problem for endemic regions. Objective: to identify clinical, biological and imaging variables associated with the probability of dying in patients with severe dengue admitted to the intensive care unit of the General Teaching Hospital "Dr. Agostinho Neto" between January and November 2014. Method: a study was conducted epidemiological, case-control, retrospective study in which all patients were admitted to the research scenario with a diagnosis of severe dengue and whom were confirmed serologically in this studied period. Descriptive statistics and univariate, bivariate and logistic regression were used to determine the association of the selected variables with mortality. It were analyzed 90 cases, 10 deaths and 80 alive. Results: In the univariate analysis, mean blood pressure, urinary output and platelet count, glycaemia, metabolic acidosis and pericardial effusion were found to have significant differences. In the multivariate analysis, that shown an association with mortality, urinary output and mean arterial pressure, glycemia, metabolic acidosis and pericardial effusion. Pericardial effusion and metabolic acidosis have acceptable measures of diagnostic validity and safety of the probability of dying. Conclusions: Mean arterial pressure and urinary output 3, glycemia 2 and 3, metabolic acidosis with DB?8 mmol / l at time 1 and 2 and pericardial effusion at time 3 were found to be variables with predictive capacity of mortality in patients with severe dengue(AU)


Assuntos
Humanos , Dengue Grave/diagnóstico , Dengue Grave/mortalidade , Previsões , Estudos de Casos e Controles , Epidemiologia Descritiva , Estudos Retrospectivos , Cuidados Críticos
2.
Rev. cuba. med. trop ; 69(3): 1-15, set.-dic. 2017.
Artigo em Espanhol | LILACS | ID: biblio-901256

RESUMO

El dengue es una enfermedad viral transmitida por mosquitos que puede ser causa de gravedad y muerte. No existe droga antiviral reconocida como eficaz. Sin embargo, las regularidades de esta enfermedad han permitido la identificación de signos de alarma que anuncian extravasación de plasma e inminencia del choque. El inicio precoz del tratamiento de los pacientes mediante la reposición de líquidos cristaloides por vía intravenosa ha demostrado ser una medida efectiva y salvadora. Se necesita capacitación sistemática y acciones de reorganización de la atención médica en función de la epidemia. Se expone la contribución de los profesionales del Instituto de Medicina Tropical Pedro Kourí y otras instituciones cubanas a ese empeño(AU)


Dengue is a viral disease transmitted by mosquitoes which may be severe and cause death. No antiviral drug has been recognized as effective. However, the regularities of this condition have made it possible to identify warning signs announcing plasma leakage and the imminence of shock. Early start of treatment with intravenous crystalloid fluid replacement has proven to be an effective, life-saving measure. Systematic training actions and reorganization of medical care are required during an epidemic. The paper describes the contribution of professionals from Pedro Kouri Tropical Medicine Institute and other Cuban institutions to this effort(AU)


Assuntos
Humanos , Masculino , Feminino , Dengue Grave/prevenção & controle , Dengue/mortalidade , Dengue/terapia , Cuba , Dengue/diagnóstico , Cristais Líquidos/normas
3.
Case reports (Universidad Nacional de Colombia. En línea) ; 3(1): 12-21, Jan.-June 2017. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-989545

RESUMO

ABSTRACT Dengue fever is the biggest public health issue in tropical countries. A significant percentage of patients who suffer from this disease require admission to the intensive care unit (ICU) due to the severity of the clinical picture. This case reports the clinical evolution of an eight-week pregnant woman with dengue fever associated with thrombocytopenia and leukopenia. The patient comes from an endemic area for tropical diseases, fact that led to diagnose dengue fever with hemorrhagic characteristics. During her stay in the ICU, the patient presented with first trimester bleeding and placental hematoma. Therefore, and considering the pregnancy and the risk of loss, the hematological function was monitored through thromboelastography. The transfusion of blood products was decided according to the specific findings. Controlling and reversing the obstetric bleeding process was possible, the patient condition evolved favorably, and she was subsequently discharged from the ICU. This article reports on the usefulness of dynamic monitoring the hematological function using thromboelastography in patients with hemorrhagic dengue fever and special conditions such as pregnancy.


RESUMEN El dengue es una enfermedad considerada como el mayor problema de salud pública en países tropicales. Un importante porcentaje de pacientes que lo padecen requieren ingreso a la unidad de cuidados intensivos (UCI) debido a la severidad del cuadro clínico. El presente caso reporta la evolución clínica de una gestante de ocho semanas con cuadro febril asociado a trombocitopenia y leucopenia. La paciente procede de un área endémica para enfermedades tropicales, lo que lleva a realizar un diagnóstico de dengue con características hemorrágicas. En la UCI, la paciente presenta hemorragia del primer trimestre y hematoma placentario, por lo que, ante el estado de embarazo y el riesgo de pérdida del mismo, se decide monitorizar la función hematológica con tromboelastrografía y transfundir hemoderivados según los hallazgos específicos. Se logra controlar y revertir el proceso de sangrado obstétrico con evolución favorable de la paciente y egreso de UCI. En el presente artículo se reporta la utilidad de la monitorización dinámica de la función hematológica con tromboelastografia en pacientes con dengue hemorrágico y condiciones especiales, tales como el embarazo.


Assuntos
Humanos , Tromboelastografia , Gravidez , Dengue Grave
4.
Rev. Nac. (Itauguá) ; 9(1): 49-60, jun 2017.
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-884677

RESUMO

Introducción: las complicaciones del embarazo y parto constituyen las principales causas de muerte entre las mujeres en edad reproductiva. Las embarazadas o puérperas que ingresan a Unidad de Cuidados Intensivos (UCI) son en su mayoría casos agudos críticos con riesgo de muerte, que necesitan tratamiento especializa do y complejo. Constituyen un grupo significativo de la práctica obstétrica. Objetivo: determinar las características clínicas y demográficas de las pacientes gestantes o puérperas que ingresaron a UCI del Hospital Nacional de Itauguá durante 5 años (2011-2015) Materiales y métodos: diseño observacional descriptivo de corte trasverso. Fueron incluidas gestantes y puérperas que requirieron ingreso a UCI por complicaciones obstétricas y no obstétricas, descompensación materna, con y sin morbilidad previa. Resultados: necesitaron ingreso a UCI 135 pacientes (0,48%). La edad media fue 27 ± 6,7 años. La muestra estuvo conformada por 21 gestantes (15,5%), 85 puérperas (63%), 27 mujeres con post aborto (20%) y 2 con embarazo ectópico (1,5 %). La complicación obstétrica más frecuente que motivó el ingreso a UCI fue la sepsis y entre las no obstétricas la cardiopatía descompensada. El tiempo medio de internación en la UCI fue 6,47 ± 8,5 días y 50 pacientes (37,03%) necesitaron asistencia respiratoria mecánica. Hubo 19 óbitos (14%) Conclusiones: el ingreso a UCI se observó en 0,48%. La mortalidad en UCI fue 14%.


Introduction: complications of pregnancy and childbirth are the main causes of death among women of childbearing age. Pregnant women or postpartum women entering the Intensive Care Unit (ICU) are mostly acute cases with a high risk of death, which require specialized and complex treatment. They constitute a significant group of obstetric practice. Objective: to determine the clinical and demographic characteristics of the pregnant or puerperal patients who entered the ICU of the National Hospital of Itauguá for 5 years (2011-2015) Materials and methods: descriptive observational cross-sectional design. Pregnant women and postpartum women who required admission to the ICU due to obstetric and non-obstetric complications, maternal decompensation, with and without prior morbidity were included. Results: 135 patients required admission to the ICU. The mean age was 27 ± 6.7 years. The sample consisted of 21 pregnant women (15.5%), 85 postpartum women (63%), 27 women with post abortion (20%) and 2 with ectopic pregnancy (1.5%). The most frequent obstetric complication that led to ICU admission was sepsis and non-obstetric heart disease was decompensated. The mean ICU admission time was 6.47 ± 8.5 days and 50 patients (37.03%) required mechanical ventilation. There were 19 deaths (14%) Conclusions: ICU admission was observed at 0.48%. Mortality in ICU was 14%.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Complicações na Gravidez/epidemiologia , Período Pós-Parto , Unidades de Terapia Intensiva , Pré-Eclâmpsia/epidemiologia , Complicações na Gravidez/mortalidade , Estudos Transversais , Estudos Retrospectivos , Síndrome HELLP/epidemiologia , Sepse/epidemiologia , Dengue Grave/epidemiologia , Eclampsia/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Tempo de Internação
5.
J. pediatr. (Rio J.) ; 92(5): 464-471, Sept.-Oct. 2016. tab
Artigo em Inglês | LILACS | ID: lil-796115

RESUMO

Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. Results: Of the total (n = 145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p < 0.01), but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p < 0.01). Despite statistical significance (p < 0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.


Resumo Objetivo Avaliar a validade dos sinais clínicos e laboratoriais para o dengue com evolução grave em crianças hospitalizadas. Métodos Coorte retrospectivo de crianças (<18 anos) internadas com dengue (2007-2008). Evolução grave foi definida como óbito ou pelo uso de terapia de suporte avançado de vida. Foram calculadas medidas de acurácia e área sob a curva ROC. Resultados Do total (n = 145), 53,1% casos eram do sexo feminino, 69% de 2 a 11 anos e 15,9% evoluíram para gravidade. Letargia obteve a melhor acurácia (razão de verossimilhança positiva RVP > 19 e RV negativa RVN < 0,6). Derrame pleural e distensão abdominal apresentaram maior sensibilidade (se = 82,6%). Relato de sangramentos (epistaxe, gengivorragia ou gastrointestinal) e hemorragia grave (pulmonar ou gastrointestinal) presente no exame físico foi mais frequente nos casos com evolução grave (p <0,01), porém com baixa acurácia (RVP = 1,89 e 3,89; RVN = 0,53 e 0,60, respectivamente). Os níveis de albumina sérica foram mais baixos nas formas graves (p <0,01). Ambos os grupos apresentaram trombocitopenia, apesar da diferença estatística (p <0,05). Contagem de plaquetas, hematócrito e hemoglobina apresentaram área sob a curva ROC < 0,5. Conclusões Letargia, distensão abdominal, derrame pleural e hipoalbuminemia foram os melhores marcadores clínicos e laboratoriais de dengue com evolução grave em crianças hospitalizadas, enquanto sangramento, hemorragia grave, hemoconcentração e trombocitopenia não tiveram boa acurácia diagnóstica. Em hospitais de referência pediátricos, a ausência de hemoconcentração não implica ausência de extravasamento plasmático, particularmente quando há reposição anterior de volume. Esses resultados podem contribuir para o manejo clínico do dengue em crianças em hospitais de referência.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Dengue Grave/diagnóstico , Dengue/diagnóstico , Hipoalbuminemia/sangue , Avaliação de Sintomas , Hospitalização , Derrame Pleural/etiologia , Trombocitopenia/etiologia , Biomarcadores/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade , Dengue Grave/complicações , Dengue Grave/sangue , Dengue/complicações , Dengue/sangue , Hipoalbuminemia/etiologia , Letargia/etiologia , Hematócrito
7.
Acta méd. costarric ; 58(3): 115-121, jul.-sep. 2016. tab
Artigo em Inglês | LILACS | ID: lil-791456

RESUMO

Abstract:AimTo describe a simple and efficacious monitoring system for patients presenting with severe dengue with severe plasma leakage.Method: We reviewed sixty-one out of 110 records of patients presenting with dengue in August and September of 1999 at the Hospital Tony Facio, Limón province, Costa Rica.Results: Dengue virus 3 was the cause of the epidemic. Thirty one (51%) patients presented with warning sings, and thirty (49%) had severe dengue with severe plasma leakage. Those patients presenting with hypotension (low mean arterial blood pressure) were treated with an intravenous polyelectrolyte solution in order to maintain the mean arterial pressure between the lower and mean range. When the mean arterial pressure presented a tendency to rise over the normal range, the infusion was withdrawn. The hematocrit was not the parameter used to monitor the treatment of the patients. There were no deaths.Conclusions: Monitoring the mean arterial blood pressure instead of the hematocrit values in patients with severe dengue with severe plasma leakage represents an easier and more efficacious way of treating this patient population.


Resumen:Objetivo:describir un sistema de monitoreo más simple y eficiente para pacientes con dengue grave con extravasación de plasma severa.Método:se revisaron 61 de 110 expedientes de pacientes que presentaban dengue, entre agosto y setiembre de 1999, en el Hospital Tony Facio de la provincia de Limón en Costa Rica.Resultados:el virus de dengue tipo 3 causó la epidemia. Treinta y uno (51%) de los pacientes presentaron signos de alarma, treinta (49%) presentaron dengue grave con extravasación de plasma severa. Los pacientes que presentaban hipotensión (baja presión sanguínea media) fueron tratados con solución de polielectrolitos intravenosa para mantener la presión arterial media entre el rango inferior y la media. En cuanto la presión arterial media presentaba una tendencia a incrementar sobre el rango normal, la infusión era retirada. El hematocrito no fue un parámetro para monitorear el manejo de los pacientes. No hubo muertes.Conclusiones:El monitorear la presión arterial media, en lugar de los valores de hematocritos, en pacientes con dengue grave con extravasación severa representa una manera más fácil y eficiente de tratar a esta población de pacientes.


Assuntos
Humanos , Costa Rica , Dengue Grave/complicações
8.
Biomédica (Bogotá) ; 36(supl.2): 148-155, ago. 2016. graf, tab
Artigo em Espanhol | LILACS | ID: lil-794026

RESUMO

Introducción. El dengue es una de las enfermedades trasmitidas por mosquitos de mayor impacto en el mundo. La evolución clínica de la enfermedad suele ser impredecible, por lo cual su adecuado manejo en las fases tempranas podría incidir en la mejoría del paciente. Objetivo. Evaluar los niveles séricos de algunos reguladores endoteliales (VEGF, sICAM-1, endoglina soluble, Ang-1 y Ang-2) como marcadores de predicción de la gravedad del dengue. Materiales y métodos. Se hizo un estudio de casos y controles anidado en una cohorte. En la fase temprana, los niveles de los reguladores endoteliales se midieron con ELISA. La relación entre las variables clínicas y los reguladores se analizó mediante regresión logística utilizando como variable de salida la gravedad del dengue. Con base en la relación entre las variables de interés y el resultado, se estableció un posible modelo predictor de la gravedad empleando la mejor área bajo la curva (ROC). Resultados. La mediana de la edad fue de 24 años. Los casos graves se asociaron con niveles séricos de Ang-2 a partir de un punto de corte mayor o igual a 1.490 pg/ml, ( Odds ratio, OR=3,1 p=0,015). Los niveles séricos de Ang-2, así como un área de 0,73 bajo la curva ROC, contribuyeron al modelo de predicción de la gravedad, conjuntamente con las variables de exantema, trastorno de conciencia y dolor abdominal, con OR de 3,2 (IC 95% 1,16-8,9; p=0,024). Conclusión. El regulador endotelial Ang-2 podría ser un predictor de la gravedad en el dengue.


Introduction: Dengue is currently among the mosquito-borne diseases of greatest global impact. The clinical course of the disease can be unpredictable, so proper handling in its early stages is critical to ensure optimal outcomes. Objective: To evaluate serum regulators of endothelial integrity (VEGF, sICAM-1, sEndoglina, Ang-1, and Ang-2) as predictive markers of dengue severity. Materials and methods: We conducted a case-control study nested in an appropriate cohort. Endothelial regulator levels were first measured by ELISA, after which analysis was performed using logistic regression of clinical and regulatory variables, with severity as an output variable. A possible severity prediction model, based on the variables of interest and output, was defined using the best area under the ROC curve. Results: The median subject age was 24 years. Severe cases were associated with Ang-2 serum levels of =1,490 ng/ml (OR=3.1; p=0.015). Serum levels of Ang-2 (=1,490 ng/ml) contributed to the severity prediction model, as did a 0.73 area under the ROC curve, together with the variables rash, impaired consciousness and abdominal pain, with an OR of 3.2 (CI 95%: 1.16 to 8.9; p=0.024). Conclusion: The endothelial regulator Ang-2 could be a predictor of severity in dengue.


Assuntos
Dengue Grave , Permeabilidade Capilar , Dengue , Endotélio , Previsões , Risco
9.
Biomédica (Bogotá) ; 36(supl.2): 179-186, ago. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-794029

RESUMO

Introducción. Hay pocas series de casos publicadas sobre la prevalencia y el curso clínico del dengue en adultos mayores con síndrome febril, habitantes en zonas endémicas para la infección. Se cree que tales casos presentan una baja prevalencia pero revisten mayor gravedad, y más complicaciones y mortalidad. Objetivos. Describir la prevalencia y el curso clínico del dengue en adultos mayores atendidos por síndrome febril agudo en un hospital de alta complejidad de una zona endémica de la enfermedad. Materiales y métodos. Se hizo un estudio observacional descriptivo en una cohorte de pacientes adultos mayores con diagnóstico serológico confirmado de dengue entre el 2011 y el 2014. Resultados. Se evaluaron las historias clínicas de 235 pacientes adultos mayores con cuadro febril agudo y se confirmó la infección en solo 43 (18,3 %) de ellos. La mediana de edad de los pacientes con diagnóstico confirmado fue de 71 años y 48,7 % correspondía a mujeres; 89 % de los pacientes presentaba al menos otra enfermedad concomitante; 51,4 % fue positivo para Ag NS1, 27 % para IgM y 54,1 % para IgG, en tanto que 64,8 % correspondió a infecciones secundarias. Los casos clasificados como dengue fueron 13 (35 %), como dengue con signos de alarma, 16 (43 %), y como dengue grave, 8 (22 %). Se hospitalizó a 56,7 % de los pacientes, de los cuales 21,6 % fue internado en la unidad de cuidados intensivos. No hubo casos fatales. Conclusión. La infección por dengue fue frecuente en adultos mayores como causa de síndrome febril agudo. Una importante proporción requirió hospitalización y presentó complicaciones, sin embargo, el manejo adecuado evitó los casos fatales.


Introduction: Little is known about the prevalence and clinical course of dengue infection in elderly patients living in endemic areas; it is presumed that there is a lower prevalence but higher severity, complications and mortality. Objective: To describe the prevalence and clinical course of dengue infection in elderly patients who were admitted to a referral care center for infectious diseases in an endemic region. Materials and methods: We conducted an observational and descriptive study between 2011 and 2014, using a cohort of elderly patients with serological diagnosis of dengue. Results: A total of 235 febrile elderly patients were assessed, of which 43 patients (18.3%) were found to have dengue. The median age was 71 years; 48.7% were female, and 89% of patients had at least one comorbid condition. According to the serological tests, 51.4% of cases were positive for NS1 Ag, 27% for IgM and 54.1% for IgG, while 64.8% were secondary infections. Dengue was diagnosed in 13 patients (35%), dengue with warning signs in 16 cases (43%), and severe dengue in 8 cases (22%). Nearly 56.7% of patients were admitted to hospital and 21.6%, to the intensive care unit. None died. Conclusion: We found dengue infection to be more frequent than expected in this sample of elderly patients, due to acute febrile syndrome. Elderly patients also required higher rate of hospitalization and had more complications, however there were no deaths due to good management.


Assuntos
Dengue Grave/epidemiologia , Idoso , Colômbia , Febre , Hospitalização , Mortalidade
10.
Mem. Inst. Oswaldo Cruz ; 111(6): 378-384, June 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-784249

RESUMO

Dengue is an acute febrile disease caused by the mosquito-borne dengue virus (DENV) that according to clinical manifestations can be classified as asymptomatic, mild or severe dengue. Severe dengue cases have been associated with an unbalanced immune response characterised by an over secretion of inflammatory cytokines. In the present study we measured type I interferon (IFN-I) transcript and circulating levels in primary and secondary DENV infected patients. We observed that dengue fever (DF) and dengue haemorrhagic fever (DHF) patients express IFN-I differently. While DF and DHF patients express interferon-α similarly (52,71 ± 7,40 and 49,05 ± 7,70, respectively), IFN- β were associated with primary DHF patients. On the other hand, secondary DHF patients were not able to secrete large amounts of IFN- β which in turn may have influenced the high-level of viraemia. Our results suggest that, in patients from our cohort, infection by DENV serotype 3 elicits an innate response characterised by higher levels of IFN- β in the DHF patients with primary infection, which could contribute to control infection evidenced by the low-level of viraemia in these patients. The present findings may contribute to shed light in the role of innate immune response in dengue pathogenesis.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Interferon beta/sangue , Dengue Grave/sangue , Doença Aguda , Brasil , Dengue Grave/imunologia
11.
Rev. méd. Urug ; 32(1): 43-51, abr. 2016.
Artigo em Espanhol | LILACS | ID: lil-783955

RESUMO

El virus dengue pertenece a la familia Flaviviridae, es transmitido entre humanos en general por mosquitos del género Aedes. Uruguay estuvo libre de la enfermedad de adquisición autóctona en los últimos 100 años. En febrero del año 2016 se produjo la confirmación de los primeros casos autóctonos en Montevideo y con ello evidencia de un brote local. El objetivo de este trabajo es revisar los aspectos prácticos del manejo clínico de los pacientes con dengue presuntivo o confirmado, contribuyendo así a la discusión del tema y a la formación del equipo de salud en nuestro país. Se revisan desde un punto de vista práctico los aspectos clínicos de presentación de la infección, clasificación, diagnóstico de laboratorio, manejo inicial, y situaciones especiales como embarazo y comorbilidades.


Abstract Dengue virus belongs to the Flaviviridae family and is transmitted among humans by the bite of an Aedes mosquitoes. Uruguay had been free of this autochthonous disease in the last 100 years. In February 2016 the first autochthonous cases were confirmed in Montevideo, and this was the evidence for a local outbreak. This study aims to review practical aspects of the clinical handling of patients with dengue fever, whether presumed or conformed, thus contributing to the discussion of this issue and training the health team in our country. The infection’s clinical manifestation is reviewed in a practical, as well as its classification, laboratory diagnosis, initial handling and special situations such as pregnancy and comorbilities.


Resumo O vírus do dengue pertence à família Flaviviridae, e de maneira geral é transmitido entre humanos por mosquitos do gênero Aedes. Durante os últimos cem anos o Uruguay esteve livre de casos de dengue por infecção autóctone. Em fevereiro de 2016 os primeiros casos autóctones foram confirmados em Montevidéu e também a existência de um surto local. O objetivo deste trabalho é fazer uma revisão dos aspectos práticos do manejo clínico dos pacientes com suspeita de dengue ou com doença confirmada, contribuindo para a discussão do tema e para a formação da equipe de saúde no nosso país. Os aspectos clínicos da infecção, sua classificação, diagnóstico laboratorial, primeiras medidas e circunstâncias especiais como gravidez e outras patológicas concomitantes são discutidos.


Assuntos
Adulto , Dengue/diagnóstico , Dengue/terapia , Dengue Grave
12.
Biomédica (Bogotá) ; 36(1): 133-139, ene.-mar. 2016. graf, tab
Artigo em Espanhol | LILACS | ID: lil-779539

RESUMO

Introducción. La infección por el virus del dengue es una de las arbovirosis más importantes en el país y es un grave problema de salud pública. Objetivo. Determinar las características clínicas y los resultados de los exámenes de laboratorio de los pacientes que consultaron por dengue en la Clínica Universitaria Rafael Uribe Uribe de Cali, y analizar la tendencia del número de casos por semanas epidemiológicas durante el 2013. Materiales y métodos. Se hizo un estudio observacional retrospectivo de los pacientes que ingresaron con sospecha de dengue a la Clínica Rafael Uribe Uribe de Cali durante el 2013. Los pacientes con diagnóstico confirmado de infección por dengue se clasificaron de acuerdo con las definiciones de la Organización Mundial de la Salud y, posteriormente, se describieron los parámetros clínicos que presentaban. Resultados. Se notificaron 1.173 casos sospechosos, de los cuales 287 (24,5 %) fueron confirmados por serología; 152 (53,0 %) eran mujeres y 135 (47,0 %), hombres; 40,1 % no presentaba signos de alarma, 34,8 % sí y 25,1 % tuvo manifestaciones graves . Los síntomas más frecuentes fueron la fiebre (287; 100 %), las mialgias (223; 78,0 %), y la cefalea (183; 64,0 %). Las manifestaciones hemorrágicas se presentaron en 100 (34,8 %) de los pacientes. Cuatro pacientes (1,4 %) presentaron manifestaciones neurológicas. Se reportaron tres muertes (0,7 %), dos de las cuales se asociaron a la drepanocitosis. Conclusiones. La forma grave de la infección y la mortalidad que causó durante el periodo de estudio fueron más frecuentes en la población pediátrica. Se sugiere la implementación de estrategias que garanticen la atención específica de los pacientes con enfermedades concomitantes, como la drepanocitosis.


Introduction: Dengue virus infection is amongst the most important arboviral diseases in the country and has become a major global public health concern. Objective: To describe the clinical profile of patients with dengue virus infection hospitalized in a tertiary hospital in the city of Cali, Colombia. We also describe the trend analysis of the number of cases by epidemiological weeks in 2013. Materials and methods: We conducted a retrospective study of admitted patients suspected to have dengue infection in the Rafael Uribe Uribe Clinic in the year 2013. Patients with serological confirmation of dengue infection were classified according to the World Health Organization classification. Subsequently, the clinical parameters of the patients with dengue were described. Results: Of the 1,173 patients with suspected dengue, 287 (24.5%) were confirmed serologically; 152 (53%) were women and 135 (47%) males; 40.1% had no warning signs, 3.8% had warning signs and 25.1% had severe manifestations. The most common symptoms were fever (287;100%), myalgia (223;78%), and headache (183:64%). Hemorrhagic manifestations were recorded in 100 (34.8%) patients; 4 (1.4%) had neurological manifestations. Three deaths (0.7%) were reported, two of which were associated with sickle cell disease. Conclusions: The severe form of the infection and mortality from dengue reported during the outbreak was more frequent in the pediatric population. It is suggested to implement strategies to ensure specific attention to patients with comorbidities such as sickle cell disease.


Assuntos
Dengue/classificação , Anemia Falciforme , Epidemiologia , Dengue Grave , Sinais e Sintomas
13.
Mem. Inst. Oswaldo Cruz ; 111(3): 161-167, Mar. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-777371

RESUMO

Severe dengue pathogenesis is not fully understood, but high levels of proinflammatory cytokines have been associated with dengue disease severity. In this study, the cytokine levels in 171 sera from Mexican patients with primary dengue fever (DF) and dengue haemorrhagic fever (DHF) from dengue virus (DENV) 1 (n = 116) or 2 (n = 55) were compared. DF and DHF were defined according to the patient’s clinical condition, the primary infections as indicated by IgG enzymatic immunoassay negative results, and the infecting serotype as assessed by real-time reverse transcription-polymerase chain reaction. Samples were analysed for circulating levels of interleukin (IL)-12p70, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, IL-6, and IL-8 using a commercial cytometric bead array. Significantly higher IFN-γ levels were found in patients with DHF than those with DF. However, significantly higher IL-12p70, TNF-α, and IL-6 levels were associated with DHF only in patients who were infected with DENV2 but not with DENV1. Moreover, patients with DF who were infected with DENV1 showed higher levels of IL-12p70, TNF-α, and IL-6 than patients with DHF early after-fever onset. The IL-8 levels were similar in all cases regardless of the clinical condition or infection serotype. These results suggest that the association between high proinflammatory cytokine levels and dengue disease severity does not always stand, and it once again highlights the complex nature of DHF pathogenesis.


Assuntos
Feminino , Humanos , Masculino , Citocinas/metabolismo , Vírus da Dengue/imunologia , Dengue Grave/imunologia , Vírus da Dengue/classificação , Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Mediadores da Inflamação/metabolismo , Interferon gama/sangue , /sangue , /sangue , /sangue , México , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sorogrupo , Estatísticas não Paramétricas , Dengue Grave/sangue , Fator de Necrose Tumoral alfa/sangue
14.
Rio de Janeiro; s.n; 2016. 53 p. graf, tab.
Tese em Português | LILACS | ID: biblio-983601

RESUMO

Dengue é uma doença viral provocada por quatro sorotipos de arbovírus e transmitida aos seres humanos por mosquitos do gênero Aedes. A dispersão geográfica dos vetores e dos vírus levou a uma reemergência global deste agravo, com destaque para as epidemias e o aparecimento de formas graves nosúltimos anos. Se, por um lado, as recentes publicações revelam baixo impacto nas estratégias de controle vetorial para dengue, por outro lado, houve grande expectativa com o lançamento de vacinas para a prevenção da doença. Em vários países onde a ocorrência de dengue é relevante, a distribuição dos casos por faixa etária não é homogênea, levantando dúvidas sobre quais os fatores interferem na dinâmica da incidência de dengue segundo a idade. Objetivo: Caracterizar o padrão de incidência de dengue e dengue grave ao longo do tempo segundo a faixa etária no período de 2007 a 2012 nas capitais estaduais brasileira.Métodos: Foi realizada a seleção das capitais com maior taxa de incidência entre as séries de dengue edengue grave por faixa etária em cada região do país para prosseguimento da pesquisa, totalizando a análise estatística de 4 capitais, referentes a suas respectivas regiões: Rio Branco (Região Norte), Aracaju(Região Nordeste), Cuiabá (Região Centro-Oeste) e Vitória (Região Sudeste). Seguiu-se a regressão das curvas de incidência de dengue e dengue grave, segundo faixa etária ao longo do tempo, utilizando Modelos Lineares Generalizados com distribuição de probabilidade de Poisson. Resultados e Discussão:Em função da análise exploratória das séries, foram construídos dois modelos de Poisson que incluíram como variáveis dependentes um termo autorregressivo, o grupo etário (<15 e ≥15 anos) e o tempo; no segundo modelo de Poisson, incluiu-se ainda um termo de interação entre o grupo etário e o tempo...


Dengue is a viral disease caused by 4 serotypes of arbovirus and transmitted to humans byAedes mosquitoes. The geographical dispersion of these vectors and viruses has led to a globalresurgence of this disease, with the occurrence of epidemics and the appearance of severe forms in thelast years. Prior studies have shown that vector control can have only limited impact on dengueincidence. We currently have 2 vaccines available to prevent dengue and there is great expectationwith the application of these vaccines on a large scale. In several countries where the incidence ofdengue is relevant, the distribution of cases by age group is not homogeneous, raising questions aboutwhich factors influence the dynamics of dengue incidence according to age. Objective: To characterizethe pattern of the incidence of dengue and severe dengue over time according to age group from 2007to 2012 in the Brazilian state capitals. Methods: Brazilian capitals with highest incidence rate ofdengue and severe dengue by age group in each region of the country were selected for furtherresearch, totaling the statistical analysis of 4 capitals, referring to their respective regions: Rio Branco(North Region), Aracaju (Northeast), Cuiabá (Midwest Region) and Vitória (Southeast). The incidencerate of dengue and severe dengue, according to age over time, were modeled using Generalized LinearModels with Poisson probability distribution. Results and Discussion: Descriptive statistics guided thecreation of two models that included an autoregressive term, age group and time as explanatoryvariables. The second model included also an interaction term of age group and time. In cases ofdengue in Rio Branco, Aracaju and Vitoria, the age group ≥15 years had a incidence rate that wassignificantly higher than that observed among those who were <15 years...


Assuntos
Masculino , Feminino , Humanos , Adolescente , Dengue , Monitoramento Epidemiológico , Sistemas de Alerta , Dengue Grave , Estudos de Séries Temporais , Efeito Idade , Incidência
15.
Rev. Soc. Bras. Med. Trop ; 48(6): 658-664, Nov.-Dec. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-767818

RESUMO

Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dengue/classificação , Índice de Gravidade de Doença , Organização Mundial da Saúde , Autopsia , Brasil/epidemiologia , Dengue/epidemiologia , Epidemias , Estudos Retrospectivos , Dengue Grave/epidemiologia , Avaliação de Sintomas/normas
16.
Rev. Soc. Bras. Med. Trop ; 48(6): 783-785, Nov.-Dec. 2015.
Artigo em Inglês | LILACS | ID: lil-767819

RESUMO

Abstract: Dengue is an arbovirosis that ranges from an asymptomatic presentation to a more severe disease, which is characterized by a vascular leakage syndrome where abdominal pain is a major symptom. Transplant recipients are immunosuppressed and are less likely to develop a severe form of the disease because of a reduction in immune-mediated responses that trigger plasma extravasation events. Herein, we report two cases of severe dengue in the early postoperative period of two kidney transplant recipients. Considering the severity of the cases, we emphasize the importance of dengue screening immediately before transplantation in areas endemic for the disease.


Assuntos
Adolescente , Humanos , Masculino , Adulto Jovem , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/virologia , Dengue Grave/complicações , Evolução Fatal , Hospedeiro Imunocomprometido , Falência Renal Crônica/cirurgia , Dengue Grave/imunologia
17.
Rev. Soc. Bras. Med. Trop ; 48(4): 399-405, July-Aug. 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-755979

RESUMO

AbstractINTRODUCTION:

Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011.

METHODS:

Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression.

RESULTS:

The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036), in patients aged 0-14 years (β=0.48; p=0.030) and in those aged ≥15 years (β=1.1; p<0.01). Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038) and the number of basic health units per population (MRR=0.89; p<0.001). Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002).Factors associated with mortality were inequality (RR=1.02; p=0.001) high income per capita (MRR=0.99; p=0.005), and higher proportions of populations living in urban areas (MRR=1.01; p<0.001).

CONCLUSIONS:

The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes.

.


Assuntos
Adolescente , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem , Dengue/mortalidade , Brasil/epidemiologia , Incidência , Mortalidade/tendências , Fatores de Risco , Dengue Grave/mortalidade
18.
MedUNAB ; 17(3): 135-136, dic. 2014-mar. 2015.
Artigo em Espanhol | LILACS | ID: lil-797191

RESUMO

El dengue como enfermedad viral de afectación exclusiva de áreas tropicales, actualmente endémica en nuestro país, representa una de las principales causas de morbimortalidad por causa de enfermedades transmitidas por vectores (1), su control depende de una articulación intersectorial que actualmente ha sido difícil de implementar fundamentada en el manejo entomológico y el control ambiental de humedales (2,3). En el país es una enfermedad de interés en salud pública, lo que obliga al personal asistencial en salud conocer detalladamente el perfil fisiopatológico de la enfermedad (4). La fiebre de chikungunya ha sido una enfermedad endémica en algunos países tropicales latinoamericanos desde la segunda mitad del siglo XX, extendiéndose progresivamente a otras regiones con las condiciones adecuadas de transmisión vectorial (5). De esta manera, esta carta al editor tiene como finalidad motivar a los Médicos para estar dispuestos a una educación continua que permita tener claridad sobre el perfil clínico de cada una de estas enfermedades.


Assuntos
Dengue , Dengue Grave , Vírus Chikungunya , Vírus da Dengue
19.
Colomb. med ; 46(1): 3-7, Jan.-Mar. 2015. ilus, tab
Artigo em Inglês | LILACS | ID: lil-753528

RESUMO

Background: In Colombia, dengue is an endemic disease and the four serotypes have been reported. Objective: To describe the frequency and severity of dengue in an area of the Colombian Caribbean (Department of Cordoba) Methods: A retrospective study was conducted. Two data sources were analyzed: The database from the Direction of Health in Cordoba, and clinical registers of patients diagnosed with hemorrhagic fevers and fevers of unknown origin in reference hospitals. Results: The mean incidence of dengue between 2003-2010 was 36.5 cases/10(5) inhabitants (CI95%: 34.3-37.5) and adjusted for sub-reporting, could be between 178.5 and 521.6. The mean incidence of severe dengue was 4.7 cases/10(5) inhabitants (CI95%: 4.3-5.0). Mean mortality rate due to dengue was 0.3 cases/10(5) inhabitants. The fatality rate was below 1%. The mean total leukocyte count in patients with dengue was 6,181 mm³ (CI95%: 5,973-6,389) and with severe Dengue was 4,729 mm³ (CI95%: 4,220-5,238). The average platelet count in patients with Dengue was 118,793/mm³ (CI95%: 107,255-130,331) and in patients with Severe Dengue 77,655 (CI95%: 59,640-95,670). Both differences were statistically significant (p <0.05). The frequency of laboratories test per patient in patients with Dengue and severe Dengue were different. Conclusion: The department of Cordoba is a highly endemic zone of Dengue and severe Dengue in the Colombian Caribbean. Moreover, the results show significant differences between dengue and severe dengue so much in tests as in frequency of use of healthcare services.


Antecedentes: en Colombia el Dengue es una enfermedad endémica en la que se han descrito los cuatro serotipos que la producen. Objetivo: Describir la frecuencia y severidad del Dengue en el departamento de Córdoba de la región caribe colombiana. Métodos: Se llevó a cabo un estudio retrospectivo a partir del análisis de dos fuentes de datos: a) la base de datos de los casos reportados a la dirección de salud departamental y b) los registros clínicos de pacientes con diagnóstico de fiebres hemorrágicas y fiebre de origen desconocido., en hospitales de referencia del departamento de Córdoba. Resultados: La incidencia media de dengue entre 2003-2010 fue de 36.5 casos por cien mil habitantes (IC95%: 34.3-37.5) y ajustando por sub-registro podría estar entre 178.5 y 521.6. La incidencia media de dengue grave fue de 4.7 casos por cien mil habitantes (IC95%: 4.3-5.0). La tasa promedio de mortalidad por el dengue durante el período fue de 0.3 casos por cien mil habitantes. El recuento leucocitario total promedio en los pacientes con dengue fue 6,181 x mm³ (IC95%: 5,973-6,389) y con dengue grave fue 4,729 x mm³ (IC95%: 4,220-5,238). El recuento medio de plaquetas en pacientes con Dengue fue 118,793/mm³ (IC95%: 107,255-130,331) y en pacientes con Dengue Grave fue 77,655 (IC95%: 59,640-95,670). Las diferencias fueron estadísticamente significativas (p <0.05). La frecuencia de los laboratorios de pruebas por paciente en los pacientes con dengue y dengue grave fueron diferentes. Conclusión: El departamento de Córdoba es una zona altamente endémica de dengue y dengue grave en el Caribe colombiano. Los resultados muestran diferencias significativas en algunas pruebas de laboratorio entre el dengue y el dengue severo.


Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem , Dengue/epidemiologia , Dengue Grave/epidemiologia , Região do Caribe/epidemiologia , Colômbia/epidemiologia , Bases de Dados Factuais , Incidência , Contagem de Leucócitos , Estudos Retrospectivos
20.
Rev. Nac. (Itauguá) ; 7(1): 17-23, jun 2015.
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-884747

RESUMO

Introducción: el dengue presenta diversas formas clínicas, desde asintomáticas hasta fatales. Existen diversos factores de riesgo asociados a la mortalidad por dengue. Objetivo: determinar los factores de riesgo asociados a la mortalidad por dengue. Metodología: estudio de casos (adultos fallecidos por dengue) y controles (adultos sobrevivientes al dengue), durante la epidemia verano 2012-2013 en Paraguay. Resultados: los factores de riesgo asociados significativamente a la mortalidad por dengue fueron: presencia de comorbilidades, hemorragias, hepatitis, hipoproteinemia e hipoalbuminemia. El choque por dengue fue la causa de óbito más frecuente (49%). Conclusiones: los factores asociados a la mortalidad por dengue son inherentes al paciente (comorbilidades) y a la gravedad de la infección, resultante de las manifestaciones hemorrágicas, afectación sistémica y fuga capilar.


Introduction: Dengue has several clinical forms, from asymptomatic to fatal. There are several risk factors associated with mortality from dengue. Objective: To determine the risk factors associated with mortality from dengue. Methodology: case studies (death of dengue adults) and controls (survivors dengue adults) during summer 2012-2013 epidemic in Paraguay. Results: Risk factors significantly associated with mortality from dengue were: presence of comorbidities, hemorrhage, hepatitis, hypoproteinemia and hypoalbuminemia. Dengue shock syndrome was the most common cause of death (49%). Conclusions: The mortality associated with dengue factors are inherent to the patient (comorbidities) and the severity of infection, resulting in hemorrhagic manifestations, systemic involvement and capillary leak.osus reaction.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Dengue/mortalidade , Paraguai/epidemiologia , Estudos de Casos e Controles , Comorbidade , Fatores de Risco , Causas de Morte , Dengue Grave/mortalidade
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