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Published on: April 28, 2019
Clinical Characteristics and Risk Factors of Dengue Shock Syndrome in Children
Dolores Lovera1, Celia Martinez de Cuellar, Soraya Araya
1From the *Department of Pediatrics, Institute of Tropical Medicine, Asunción, Paraguay; and †National University of Asuncion, San Lorenzo, Paraguay.
Insights
Dengue shock syndrome (DSS) is a severe dengue complication. Children over 5, abdominal pain, prolonged PTT, and low fibrinogen predict DSS risk, aiding early intervention.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- Dengue shock syndrome (DSS) is the most severe form of dengue virus infection.
- Understanding DSS clinical and laboratory features is crucial for timely management.
Purpose of the Study:
- To analyze clinical and laboratory characteristics of DSS in children.
- Identify risk factors and outcomes associated with DSS in pediatric dengue patients.
Main Methods:
- Retrospective analysis of pediatric patients (<15 years) hospitalized with dengue during a 2012-2013 outbreak in Paraguay.
- Comparison of demographic, clinical, and laboratory data between patients with and without DSS.
Main Results:
- Of 471 children hospitalized, 75% developed DSS. Age >5 years, abdominal pain, prolonged activated partial thromboplastin time, and low fibrinogen levels were significantly associated with DSS.
- Clinical manifestations like rash, myalgias, vomiting, and bleeding were similar between DSS and non-DSS groups.
Conclusions:
- The study validated existing WHO guidelines for severe dengue markers.
- Identified additional predictors, including abdominal pain and specific laboratory values, to anticipate DSS progression.
Background:
Dengue shock syndrome (DSS) represents one of the most severe manifestations of dengue virus infection. The objective of the present study was to analyze the clinical and laboratory characteristics, risk factors and outcome of DSS in children.
Methods:
Patients <15 years old admitted with DSS during the 2012 and 2013 outbreak of serotype 2 of dengue virus in Paraguay were included. Demographic, clinical and laboratory data of patients with/without DSS were analyzed.
Results:
Of 471 children hospitalized with dengue, 354 patients (75%) presented with shock at admission or developed later. The mean age of patients with DSS was 10.2 ± 4 years (no difference with patients without shock), without gender preference. Rash (50% vs. 56%), myalgias (45% vs. 40%), vomiting (66% vs. 68%) and bleeding manifestations (24% vs. 21.2%) were similar for 2 groups. Similarly, there was no difference in the frequency of DSS between primary versus secondary infection cases (76.2% vs. 71.6%, P = 0.3). Age group >5 years [odds ratio (OR) 1.6, 95% confidence interval (CI): 1-2.8, P < 0.05), presence of abdominal pain (OR 2.5, 95% CI: 1.3-4.9, P = 0.006), an activated partial thromboplastin time prolonged (OR 4; 95% CI: 1.6-10, P < 0.001) and low fibrinogen level (OR 2.5; 95% CI: 1-5.9, P = 0.02) were found significantly associated with DSS. About 12% of patients required intensive care unit admission, and 2 patients died (lethality 0.35%).
Conclusions:
This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.
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