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Gallbladder wall thickening in dengue hemorrhagic fever: an ultrasonographic study
M W Setiawan1, T K Samsi, T N Pool
1Department of Pediatrics, Sumber Waras Hospital, Tarumanagara University, Indonesia.
Insights
Gallbladder wall thickening (GBWT) on ultrasound can predict severe dengue hemorrhage fever (DHF) in children. A GBWT over 3 mm indicates potential severity, aiding early admission and monitoring for DHF.
Area of Science:
- Pediatric infectious diseases
- Medical imaging
- Dengue virus research
Background:
- Dengue hemorrhage fever (DHF) poses a significant global health threat, particularly to children.
- Early identification of severe DHF cases is crucial for timely intervention and improved patient outcomes.
- Current diagnostic criteria for DHF severity may benefit from additional objective markers.
Purpose of the Study:
- To evaluate the utility of gallbladder wall thickening (GBWT) measured via ultrasonography as a predictor of severe DHF in pediatric patients.
- To establish correlations between GBWT measurements and DHF severity grades.
- To determine sonographic criteria for identifying children at high risk of developing severe DHF complications.
Main Methods:
- Prospective study involving 96 pediatric patients diagnosed with DHF.
- Ultrasound examinations focused on gallbladder wall thickness (GBWT) and presence of ascites.
- Patients were categorized into mild (grades I-II) and severe (grades III-IV) DHF groups.
- Statistical analysis to compare GBWT between groups and assess its correlation with disease severity.
Main Results:
- Mean GBWT was significantly higher in severe DHF (grades III-IV) compared to mild DHF (grades I-II) (5.14 mm vs. 2.39 mm, p < 0.001).
- GBWT exceeded 3 mm in 93.8% of severe DHF cases versus 33.3% of mild DHF cases.
- A positive correlation was observed between GBWT and DHF severity (p < 0.001).
- Ascites was associated with significantly thicker gallbladder walls (p < 0.01).
Conclusions:
- Sonographic measurement of GBWT is a reliable, non-invasive criterion for predicting severe DHF in children.
- A GBWT > 3 mm demonstrates high sensitivity (93.8%) for identifying potentially severe DHF, warranting admission and monitoring.
- A GBWT of ≥ 5 mm shows high specificity (91.7%) in identifying patients at high risk for hypovolemic shock.
Abstract:
This study attempts to investigate whether gallbladder wall thickening (GBWT) measured by ultrasonography can be used in children as a reliable criterion to predict the onset of severe dengue hemorrhage fever (DHF). In this prospective study, we performed ultrasound examinations focusing on the gallbladder wall and the presence of intraperitoneal free fluid in 48 mild DHF cases (grades I-II) and 48 severe cases (grades III-IV). GBWT varied between 1 mm and 8 mm with a mean of 3.77 mm +/- 2.04 mm. The mean value of DHF grades I and II (2.39 mm +/- 1.48 mm) is significantly lower than that of grades III and IV (5.14 mm +/- 1.54 mm), p < 0.001. GBWT exceeded 3 mm in only 16 of 48 (33.3%) grade I-II patients and in 45 of 48 (93.8%) grade III-IV patients. A significant positive correlation was apparent between GBWT and the severity of illness, p < 0.001. Patients with ascites have significantly thicker gallbladder walls than those without, p < 0.01. In clinically confirmed DHF cases, the sonographic finding of GBWT > 3 mm to 5 mm, with 93.8% sensitivity, can be used as a criterion indicating the need for admission and monitoring. A GBWT of > or = 5 mm, with 91.7% specificity, is useful as a criterion for identifying DHF patients at high risk of developing hypovolemic shock.