Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.
Severe Dengue

Background: Dengue, a mosquito-borne flavivirus, is hyperendemic in the Philippines. One of its rare complication is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. Previously known as non-neurotropic, dengue presents with an increasing incidence of neurologic manifestations. Objective: To describe the clinico-demographic profile and outcome of laboratory-confirmed dengue encephalitis patients. Methods: This is a retrospective study that used purposive sampling to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years. The clinico-demographic profiles and outcomes were collected using chart review, and variables were analyzed using descriptive statistics. Results: 14 laboratory-confirmed cases were reviewed. Most (57%) were males aged 3 days-15 years. Fever lasted 3-11 days. Following nonspecific signs and symptoms, neurological manifestations developed within 1-5 days, the most common being seizures (71%). Majority (57%) had anemia. All, except one, exhibited leukopenia and thrombocytopenia. Elevated liver enzymes, bleeding parameter derangements, electrolyte, and glucose imbalances were noted. All were seropositive for dengue IgM, and 5 dengue IgM in the CSF. Most common EEG findings showed generalized slowing. Neuroimaging reports were normal in some or showed cerebral edema in the others. Half of the patients recovered fully, 3 showing partial recovery from neurologic changes, and 3 others had neurologic sequelae. One infant expired. Conclusions and Recommendations Dengue encephalitis should be considered in patients living in an endemic country, presenting with fever with neurologic changes or elevated liver enzymes, with a risk for developing neurologic sequelae or death.
Severe Dengue

Dengue ; Humans ; Severe Dengue

Dengue infection is epidemic but ocular complications of dengue are less reported. We report a case of dengueinfected patient with disturbing ocular symptoms. He was admitted for severe dengue. Subsequently, he presented with symptoms of bilateral central scotoma with metamorphosia. Fundus examination revealed cotton wool spots and flame-shaped haemorrhages at the macula, with dull foveal light reflex. He was diagnosed with bilateral dengue maculopathy. The patient was managed conservatively with surveillance. One week later, his eye symptoms improved and were resolved six months later. Early recognition and close monitoring remains the key to successful management and interventions are rarely needed.
Severe Dengue ; Eye Diseases

INTRODUCTION: Dengue is one of the causes of morbidity and mortality among pediatric patients. Calcium has been shown to play a role in the myocardial function of the patient and is a potential cause of mortality among dengue patients. This study aimed to determine the accuracy of hypocalcemia in predicting the severity of dengue among pediatric patients. METHODS: This is a systematic review and meta-analysis of published studies identified through an electronic literature search using PubMed/Medline, Cochrane Library, Herdin, Google Scholar, and hand search. Validity was assessed using the Cochrane risk of bias tool. Statistical analysis of the diagnostic test accuracy review was done using Review Manager 5.4.1 with the random effects model. Results showed sensitivity and specificity of hypocalcemia in severe dengue with a 95% confidence interval. The predictive values and likelihood ratios were also computed. RESULTS: Four studies were analyzed. The mean serum total and ionized calcium levels of patients were decreased among the severe dengue group. Data showed that there is a 74% sensitivity (95% CI = 0.58, 0.84) and 75% specificity (95% CI = 0.67, 0.81) with a positive predictive value of 67% and a negative predictive value of 90.7%. CONCLUSION This systematic review and meta-analysis showed that hypocalcemia may be a useful tool to predict severe dengue fever. However, further analysis is needed to strengthen the the diagnostic accuracy of hypocalcemia.
Severe Dengue ; Hypocalcemia

BACKGROUND: Dengue is a mosquito-borne viral disease that has been a global burden especially in the tropical regions. Cardiac involvement has been discussed in several studies. This is a pilot study to identify electrocardiogram abnormalities and correlate these with the severity of dengue illness. OBJECTIVES: To evaluate the efficiency of electrocardiogram as a predictive tool for the severity and clinical course of pediatric dengue infections. METHODS: This prospective cohort study was conducted at the Philippine Children’s Medical Center from August to October 2017. A total of 325 dengue consults were seen at the pediatric emergency room during the study period. Of these, 66 pediatric patients fulfilled the inclusion criteria for this study. Serial pediatric electrocardiograms (ECG) were performed on days 1, 7, and 14 afebrile. The ECGs were interpreted according to rhythm, axis and duration of waveforms and intervals. These ECG interpretations were subsequently correlated to the patients’ dengue severity and clinical course. RESULTS: Rhythm abnormalities were found in 15 out of the 66 dengue patients for an overall incidence of 23%. All the rhythms were benign and self-limiting, including sinus bradycardia, tachycardia, and first-degree atrio-ventricular block. Majority of the dengue patients had sinus rhythm (42 of 66, 64%), and of these, 8 had heart rates at the lower limits of normal range for age (12%). 23 percent of abnormal rhythms were detected on day 1 of illness. All rhythm abnormalities resolved by day 14 of afebrile. CONCLUSION: The series of ECG did not show clinically significant or life-threatening arrhythmias during the patients’ dengue illness in this cohort. All arrhythmias were benign and self-limiting, regardless of dengue severity. The ECG did not correlate well with and cannot be utilized to predict the clinical course of the dengue illness. RECOMMENDATIONS A retrospective comparative study is recommended to determine predictability of dengue severity using ECG. A bigger cohort of dengue patients may detect significant arrhythmias not caught in this study.
Severe Dengue ; Bradycardia

Biomarkers ; Biomedical Research ; Dengue ; Dengue Virus ; Humans ; Severe Dengue

BACKGROUND: Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) occurs only in a small number of dengue fever (DF).This condition,when coupled with a form of congenital hemolytic nemia called Hereditary Spherocytosis (HS), will turn a relatively manageable case of DF into a complicated condition with very poor prognosis.

CASE PRESENTATION: Here we report a case of a 19-year-old male student from Manila who came in with fever,jaundice, and dengue warning signs. He was also diagnosed with HS. This compounding infection initiated a hemolytic crisis of his HS, causing severe bleeding and multiple organ failure on top of DHF/DSS. The progression of the disease started with bleeding, and later on with altered sensorium (encephalopathy), respiratory failure, and ultimately, demise.

CONCLUSION: DHF/DSS together with HS may cause a hemolytic crisis. High RBC turnover and heightened erythroid marrow activity in HS makes a patient vulnerable to develop aplastic crisis due to dengue virus infection. Erythroid marrow failure may result in profound anemia, heart failure, hypoxia, cardiovascular collapse, and death.

INTRODUCTION: Acute kidney injury (AKI) is one of the severe complications in dengue hemorrhagic fever, usually occurred in shock. We report an interesting case of AKI in a hemodynamically stable dengue hemorrhagic fever patient. CASE PRESENTATION: An 18-year-old male dengue fever patient referred to our institution in his day eight of illness due to three days of decreased urine output. He was hemodynamically stable with thrombocytopenia, increase in creatinine, positive for Anti dengue IgM, proteinuria, and hematuria. Ultrasound examination showed ascites. He was diagnosed with AKI stage III related to dengue hemorrhagic fever and underwent hemodialysis. A total of four series of hemodialysis and furosemide drip were performed during 12 days of admission and he was finally improved. CONCLUSION: Renal injury might occur in hemodynamically stable dengue hemorrhagic patients. It is a reversible condition; hence, appropriate treatment and close monitoring result in good outcomes
Severe Dengue ; Acute Kidney Injury ; Dengue ; Pyelonephritis ; Hemodynamics

Dengue fever is a kind of viral disease which infects people through mosquito bite. It is present in 100 countries and about 5 million to 10 million people are inflicted with this disease every year. Since the 1980s, it has seen a dramatic increase across the globe. One of the reasons for the spread of the disease is that rapid industrialization and urbanization have destroyed the natural habitat of mosquitos. Additionally, dengue fever occurs mostly in underdeveloped countries. These countries have not implemented systematic epidemiological investigation and are yet to come up with effective methods in terms of prevention of mosquito bites. Moreover, more and more people have traveled the areas at risk of this disease. Global the incidence of dengue fever has increased and has also seen a rise in cases among the travelers. One can easily find a case in a clinical setting. On top of that, due to global warming and north warding of dengue occurring latitude in the northern hemisphere, Aedes albopictus which is the vector of dengue fever, has been found in JeJu island. This makes it a major concern that the mosquitos have inhabited the country. Prevention of dengue fever is important since antiviral agents and vaccinations are not still commonly used.
Aedes ; Antiviral Agents ; Culicidae ; Dengue* ; Ecosystem ; Global Warming ; Incidence ; Methods ; Severe Dengue ; Urbanization ; Vaccination ; Virus Diseases