Dengue hemorrhagic fever is a severe form of dengue presenting commonly with bleeding diathesis, but rarely with peripheral nervous system manifestations. Proximal median neuropathy comprises 1% of upper limb compression syndromes, and this case is the first to report injury to the proximal median nerve due to compression from hematoma formation. This case report presents the rehabilitation process of a 25-year-old Filipino female median nerve entrapment from venipuncture-associated hematoma presenting as burning sensation on the medial elbow, forearm and hand, weak flexion movement of her left thumb, index, and middle fingers. The patient was managed conservatively with pain medications, range of motion, gross and fine motor, and sensory re-education exercises. At 12 months, there was partial but functional recovery of median motor distribution and full recovery of median sensory distribution, as evidenced by improved sensory nerve action potential conduction velocity and amplitude, and compound motor action potential conduction velocity, with persistent decreased amplitude at 50%, and decrease in cross-sectional area of the left median nerve.

This paper highlights the functional outcomes of a conservatively managed median nerve entrapment from venipuncture hematoma from dengue hemorrhagic fever. This case report also emphasizes that in the presence of severe bleeding risk of surgery in the background of severe thrombocytopenia, timely rehabilitation medicine referral with monitoring through clinical evaluation, musculoskeletal ultrasound, and electrodiagnostic study presents a viable alternative in the management of compression neuropathy.

OBJECTIVE: This paper aimed to describe the clinical profile and short-term clinical outcomes of children with Acute Kidney Injury (AKI) requiring hemodialysis in a tertiary pediatric hospital. MATERIALS AND METHODS: A retrospective cohort on in-patients who received hemodialysis treatments at our institution was performed. Medical charts of patients admitted between July 2018 and July 2023 were retrieved. Demographic data, clinical profiles and subsequent outcomes in terms of mortality and recovery or non-recovery from AKI were recorded. RESULTS: After meeting the inclusion and exclusion criteria, 129 patients were included in the study‘s statistical analysis. There was an even distribution between males and females. The average age of treated patients was 10 years old (SD ± 4.3). The average weight of patients was 35kg (SD ± 16.9). The most common diagnosis of patients was severe dengue (21.7%), followed by severe sepsis (14.7%). More than half of patients (51.9%) had an existing co-morbidity, of which Systemic Lupus Erythematosus (22.4%) and solid tumors (22.4%) were most common. The most common indication for hemodialysis was uremia (52.7%). In terms of short-term outcome, majority of patients died during the same admission (56.5%), while 31 patients (24.0%) recovered. CONCLUSION The clinical profile of patients who underwent hemodialysis treatments for AKI were comparable to international data. The study did not differentiate deaths from AKI or underlying illness, but demonstrated a higher mortality rate compared to other existing studies. This study is the first known local paper to describe the profile and outcomes of children who received hemodialysis for AKI.
Hemodialysis ; Renal Dialysis ; Severe Sepsis ; Sepsis ; Severe Dengue

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

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

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

PURPOSE: The number of dengue fever cases is rising due to increasing overseas travel. Vaccination makes severe dengue fever in seronegative individuals after vaccination when they exposure to wild-type dengue virus. We investigated the seroepidemiology of the dengue virus for monitoring of Korean dengue virus immunity and establishing the prevention of dengue infection. METHODS: The study was based on 446 residual sera collected from 98 infants (2 months to 1 year old), 152 adolescents (13 to 19 years old), 90 adults (20 to 50 years old), and 106 elderly participants (more than 65 years old) for other studies. Antibody levels for dengue virus immunoglobulin G (IgG) in each age group were measured using an enzyme-linked immunosorbent assay (ELISA). For each dengue virus IgG positive or equivocal result, an IgG ELISA was performed for Japanese encephalitis virus. RESULTS: Of the 446 serum samples, only 1 (0.2%) adolescent had a positive result from the dengue IgG antibody test. In the dengue virus IgG antibody test, 14 (3.1%) samples showed equivocal results (10 adolescents and 4 elderly). In the 1 positive case of dengue virus IgG, the Japanese encephalitis IgG test was also positive. In the 14 equivocal cases of dengue virus IgG, there were 6 positive, 3 equivocal, and 5 negative of Japanese encephalitis IgG. CONCLUSIONS: The seroprevalence rate of dengue virus was very low in Koreans. This study provides important data for establishing the policy for preventive measures of dengue fever. It will be necessary to continuously monitor for dengue virus immunity.
Adolescent ; Adult ; Aged ; Dengue Virus ; Dengue ; Encephalitis Virus, Japanese ; Encephalitis, Japanese ; Enzyme-Linked Immunosorbent Assay ; Fever ; Humans ; Immunoglobulin G ; Infant ; Korea ; Prevalence ; Seroepidemiologic Studies ; Severe Dengue ; Vaccination

Dengue ; Humans ; Severe Dengue

PURPOSE: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ≥1,000 IU/L as a marker of severe DF. METHODS: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L). RESULTS: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p < 0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST < 1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588–0.714; p < 0.001) for ALT and 0.647 (95% CI, 0.582–0.712; p < 0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF. CONCLUSION: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.
Alanine Transaminase ; Arboviruses ; Aspartate Aminotransferases ; Child* ; Dengue ; Female ; Fever* ; Humans ; Sensitivity and Specificity ; Severe Dengue* ; Transaminases*

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

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