Search

Background: Incidence of dengue fever as well as dengue hemorrhagic fever is increasing in Sri Lanka especially among elderly population. As the number of cases is rising, rare complications of dengue illness also can be seen in clinical practice when compared to the past few years. Prompt identification and treatment of such complications is challenging due to lack of awareness and unavailability of standard treatment. Case presentation: 69 years old man presented with acute onset fever and was diagnosed as having dengue illness. On the 4th day of illness, the disease was progressed into dengue haemorrhagic fever and recovered uneventfully. Although he recovered from primary illness, his general condition continued to deteriorate due to new onset of features of parkinsonism. Cerebrospinal fluid analysis and electro encephalogram showed evidence of encephalitis. Cerebrospinal fluid analysis also revealed positive IgM antibodies against dengue virus. Then the diagnosis of post encephalitic parkinsonism following dengue viral infection was made and started on. He was started on SINEMET (carbidopa 10 mg and levodopa 100 mg) half tablet 6 hourly started. After 1 week of treatment he showed marked improvement and then patient was discharged with further follow up plan. Conclusion: Although the management of dengue illness and dengue haemorrhagic fever is straightforward, recognition and treatment of rare complications like post encephalitic parkinsonism following dengue viral infection is difficult without great clinical suspicion. [ABSTRACT FROM AUTHOR]

To determine the indicators of severe bleeding in children with severe dengue viral infection (DVI), the medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Severe-bleeding DVI was defined as needing blood products transfusion owing to DVI-caused bleeding. Of the 238 children with severe DVI according to the World Health Organization 2009 criteria, 44 (18.5%) had severe bleeding, of whom 28 (63.6%) died. The international normalized ratio (INR) had high correlations with both transaminase enzymes (Spearman correlation, rs = 0.67-0.69, p <0.01). Multivariate analysis found that patients who had dengue haemorrhagic fever (DHF) grade IV, platelets <20 000/mm3 and INR ≥ 1.5 had increased risk of severe bleeding with odds ratios (95% confidence intervals) of 3.4 (1.4, 8.6), 2.6 (1.1, 6.2) and 10.6 (4.0, 28.4), respectively. Blood products should be at hand in severe DHF children with high risk of severe bleeding. [ABSTRACT FROM AUTHOR]

Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever) and with capillary leakage induces hypovolaemic shock (dengue shock syndrome). Although dengue symptoms and complications have been known for many decades, there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with non-surgical management. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to evaluate the early, specific ultrasonographic (USG) findings in clinically suspected dengue hemorrhagic fever (DHF) along with its prognostic value. Methods: From May 2009 to June 2012, 20 patients were referred with high-grade fever and abdominal pain. All the patients underwent immediate abdominal USG. A specific change and ndash; and ldquo;Honeycomb and rdquo; pattern in the thickened gallbladder (GB) wall (mostly in the fundal area) and ndash; on USG suggested the diagnosis of DHF, which was subsequently confirmed by serology in all patients. Treatment was stated on the bases of USG findings before the positive serology report. After starting treatment the USG on the 3rd day showed reduction in GB wall thickening, which was almost cleared by the 7th day in clinically improving patients. Results: All 20 patients had type-2 dengue fever, i.e., DHF Grades I and II, as confirmed after USG by platelet count and serologic tests. USG features included a much-thickened GB wall in all the patients, but showing a and ldquo;Honeycomb and rdquo; pattern (proposed as Sachar and Sunder's sign) in 19 patients (95%), multilayered (laminated/onion peel) in 1 patient (5%), ascites in 15 patients (75%), splenomegaly in 8 patients (40%), and pleural effusion in 14 patients (70%). (Pleural effusion was either right-sided or bilateral, but never alone on the left side.) Conclusions: Abdominal emergency USG can be used as a first-line imaging modality in patients with suspected DHF to detect early signs that are suggestive of the disease prior to obtaining serologic confirmation test results, especially in a dengue fever epidemic area. Also, reducing GB wall thickness can be used as a prognostic sign in cases of DHF. [Arch Clin Exp Surg 2013; 2(1.000): 38-42]

Introduction: The most common arthropod-borne viral (arboviral) disease in humans is dengue. It is transmitted by female Aedes mosquitoes. These mosquitoes are widely distributed in subtropical and tropical areas of the world. Study of dengue infection and its complications are scarce from countries like India. Aim: In this prospective observational cross-sectional study, we intended to assess the frequency and degree of hepatobiliary dysfunction in adult patients with dengue infection presenting to a tertiary-care medical facility. Materials and Methods: The details of all patients with serologically proved dengue fever admitted to a tertiary care hospital in eastern India from July 2014 to June 2015 were prospectively reviewed. We collected data including routine blood count, Liver Function Test (LFT), Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), abdominal ultrasonography from 110 patients. Results: The maximum number of cases were seen in the age group between 46 years and 61 years and of all cases 55.5% were male and 44.5% were female. Pain abdomen and vomiting were the commonest presenting complaints next to fever which was present in all the cases. Elevated liver enzymes, abnormal values of PT and APTT, thrombocytopenia were observed more commonly in Dengue Shock Syndrome (DSS). Gall bladder wall thickening, thrombocytopenia were seen more commonly in both DSS and Dengue Haemorrhagic Fever (DHF). Plasma leakage such as ascites and pleural effusion on USG were seen more frequently in patients with DHF (76.9% and 73.1%) followed by DSS (72% and 68%) and DF (33.9% and 32.2%). Conclusion: Hepatobiliary derangement is seen more commonly in severe case of dengue infection. Early recognition of these parameters can also be used as a predictor for assessing the disease severity.

Severe forms of dengue, such as dengue haemorrhagic fever (DHF) and dengue shock syndrome, are examples of a complex pathogenic mechanism in which the virus, environment and host immune response interact. The influence of the host's genetic predisposition to susceptibility or resistance to infectious diseases has been evidenced in several studies. The association of the human leukocyte antigen gene (HLA) class I alleles with DHF susceptibility or resistance has been reported in ethnically and geographically distinct populations. Due to these ethnic and viral strain differences, associations occur in each population, independently with a specific allele, which most likely explains the associations of several alleles with DHF. As the potential role of HLA alleles in the progression of DHF in Brazilian patients remains unknown, we then identified HLA-A alleles in 67 patients with dengue fever and 42 with DHF from Rio de Janeiro, Brazil, selected from 2002-2008 by the sequence-based typing technique. Statistical analysis revealed an association between the HLA-A*01 allele and DHF [odds ratio (OR) = 2.7, p = 0.01], while analysis of the HLA-A*31 allele (OR = 0.5, p = 0.11) suggested a potential protective role in DHF that should be further investigated. This study provides evidence that HLA class I alleles might be important risk factors for DHF in Brazilian patients.

Dengue Haemorrhagic Fever (DHF) is a public health problem in Bayah, Banten Province thus, control of mosquitoes breeding sites (CMBS) and health education is necessary. This study aimed to evaluate the effect of health education on people's level of knowledge on CMBS and the density of Ae. aegypti. This study involved 106 villagers from Bayah in August (pretest) and October (postest) 2009. Data was collected through questionnaires, followed by observation of containers available in the house using single larval method and identified microscopically. Data was analyzed using marginal homogeneity test. The result showed, 64.2% and 1.3% villagers had poor and good knowledge on CMBS. This finding was in accordance to their education level and socio-economic status. After education, there were 14% had good and 54% poor knowledge (p = 0,001). Container index (CI) and house index (HI) were 18% and 52% respectively, suggesting high density of Ae. aegypti in that area. Following health education, CI and HI became 16% and 42% which were still above WHO level of indicator; which gave no significant difference in CI (p = 0,523) and HI (p = 0,174). In conclusion, the level of knowledge increased after health education which was not followed by significant decrease in vector density, suggesting Bayah is still categorized as highly transmitted area of DHF.

This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. Methods: This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded. Results: Among 357 patients with dengue fever, 43 (12.04%) had acute abdomen. There were 15 men and 28 women, with a median age of 29 years. These included 26 cases of acute cholecystitis, 7 cases of acute appendicitis, 7 cases of nonspecific peritonitis, and 3 cases of acute pancreatitis. Dengue hemorrhagic fever/shock syndrome was found in acute pancreatitis, and two of these patients died. Emergency surgery was required in eight patients (5 appendectomy and 3 open cholecystectomy). Substantial transfusion of blood and its components was required in eight patients who underwent emergency surgery. Conclusion: Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity.

En el dengue hemorrágico las manifestaciones inusuales como hepatitis, encefalitis y miocarditis están asociadas a las formas graves y muerte. Objetivo. Describir las causas de mortalidad por dengue hemorrágico en niños menores de 13 años en el Hospital Universitario de Neiva. Diseño. Estudio descriptivo, con recolección retrospectiva de la información. Lugar. Neiva, Huila Población: niños menores de 13 años Mediciones. Se registraron todos los pacientes fallecidos con diagnóstico de dengue hemorrágico entre los años 2000 y 2006, para un análisis de variables, clínicas y de laboratorio, por grupos de edad, mediante pruebas no paramétricas. Resultados. De 1.448 niños con dengue hemorrágico, 338 ingresaron a la unidad de cuidados intensivos pediátrica y hubo 15 casos fatales (letalidad 1,03%); el 40% ingresó en estadio III y 60% en estadio IV. Los síntomas gastrointestinales y signos de fuga vascular estuvieron presentes en el 100% de los casos. Hubo una mayor tendencia a la hipotensión, menor número de plaquetas y mayor elevación de transaminasas, en el grupo de niños de 1 a 5 años; no hubo diferencias significativas en las variables analizadas entre los grupos. Nueve pacientes fallecieron de miocarditis aguda (60%) con alteraciones del ritmo, de los cuales, dos presentaron elevación de transaminasas; tres niños fallecieron por hepatitis aguda (20%) y tres fallecieron con coagulación intravascular diseminada (20%). Conclusión. La mortalidad por dengue hemorrágico no sólo tiene como causa el choque hipovolémico y, en la actualidad, debe considerarse el compromiso de órganos como el hígado y el miocardio, que contribuye a la evolución fatal.Unusual clinical manifestations such as hepatitis, encephalitis, myocarditis and even death might be associated to the severe forms of dengue hemorrhagic fever. Aim: To describe mortality cases in children younger than 13 years of age at the Hospital Universitario in Neiva, Colombia. Design: Descriptive study with retrospective collection of data. Place: Neiva, Huila, Colombia. Population: Children younger than 13 years of age. Measurements: All death patients with diagnosis of dengue hemorrhagic fever from 2000 to 2006 were registered; clinical variables and laboratory data were analyzed by age groups by using non parametric tests. Results: Out of 1,448 patients with dengue hemorrhagic fever, 338 were admitted to the Pediatric Intensive Care Unit with 15 deaths (lethality 1.03%); 40% of admissions were in state III whereas 60% in state IV. Gastrointestinal symptoms and vascular leakage signs were present in 100% of cases. There was a higher tendency to hypotension, fewer platelet counts and higher serum transaminases in children between 1 to 5 years; there were no statistical differences between variables in none of the groups. Nine patients died as a consequence of acute myocarditis (60%) with heart rhythm alterations, from which two had elevated serum transaminases; three died because of acute hepatitis (20%) and three died with disseminated vascular coagulation (20%). Conclusion: Mortality associated to dengue hemorrhagic fever is not only due to hypovolemic shock and currently, other organs such as liver and myocardium might be target of the disease.

Dengue virus infection is a major cause of morbidity within the endemic tropical and subtropical regions of the world. Dengue virus has four distinct serotypes with specific clinical manifestations. In this study, we observed the changing pattern of dengue serotypes, age-wise dengue infection and useful sero-detection methods needed in a dengue endemic region. We identified dengue serotypes during a period of 5 years among patients with dengue symptoms visiting one of the largest tertiary care infectious disease hospitals of eastern India in Kolkata. A total of 433 dengue RNA positive samples were isolated from 712 acute dengue suspected cases. Age wise distribution highlighted the susceptible age group being >21 years (24.02%) followed by 11-15 years (21.71%) and 5-10 years (21.02%) of the total infected population. Higher numbers of infected cases were found within females as they are involved in more indoor works. The period of study experienced two dengue outbreaks one in 2008 and another in 2012. For early dengue detection, NS1 was found to be more confirmatory than IgM ELISA regarding sensitivity and specificity. DENV-1, 2, and 4 serotypes were the common circulating strains from 2008 until 2010, after which DENV-3 serotype infections rise and led to a massive dengue outbreak in Kolkata with increased numbers of DHF and DSS cases in 2012. The finding within our study emphasizes the public health importance of such prospective surveillance programs with respect to the changing dengue viral etiology and serotypes. J. Med. Virol. 88:1697-1702, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction: Dengue viral infection has become a significant public health concern with increased recognition of atypical manifestations apart from the classical clinical features. Appropriate, timely diagnosis and risk stratification for severe disease are crucial in the optimal management of this illness. The study outlines the evolving clinical spectrum of dengue with special emphasis on unusual manifestations. Methodology: A prospective hospital based study was conducted over a period of two years (June-2013 to May-2014). Data of 186 IgM dengue antibody-confirmed hospitalised cases was collected, compiled and analysed. Atypical manifestations in dengue fever were noted and analyzed. Result: The dengue infection was affecting mostly the younger age group with male preponderance. Most common symptoms apart from fever and headache were gastrointestinal symptoms like abdominal pain, vomiting and diarrhoea. Liver injury was almost universally present in the form of transaminitis. Atypical features were seen in 38.17% cases. Platelet count did not correlate exactly with severity of bleeding. Overall recovery rate was good. 4 (2.15%) patients succumbed to multiorgan failure and shock. Conclusion: Dengue illness may have a non-specific and varied presentation, thus mandating its screening in febrile illness especially during the post-monsoon period. An understanding of the course of disease progression, recognition of the warning signs during the different phases of the disease will enable primary care physicians to manage dengue fever in an appropriate and timely manner to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introducción. Desde 1998 se vienen notificando casos de dengue hemorrágico en el municipio de Apartadó y actualmente el dengue se considera endemo-epidémico. Objetivo. Describir el comportamiento clínico del dengue en pacientes hospitalizados por esta causa en la Empresa Social del Estado Hospital Antonio Roldán Betancur de Apartadó en el año 2000. Materiales y métodos. Estudio descriptivo retrospectivo de revisión de historias clínicas de pacientes hospitalizados por dengue. Resultados. Se hospitalizaron 45 casos con diagnóstico serológico de dengue. Tres (6,7%) pacientes con dengue clásico, 22 (48,9%) con dengue con manifestaciones hemorrágicas y 20 (44,4%) con dengue hemorrágico. La edad osciló entre 4 meses y 68 años con un promedio de 22,1 años. La mayoría procedía del área urbana (82,8%). Las manifestaciones clínicas más frecuentes fueron: fiebre (100%), mialgias y artralgias (71,1%), cefalea (70,5%) y dolor abdominal (67,5%). Las manifestaciones hemorrágicas más frecuentes fueron petequias (60%), hematuria (31,7%), equimosis en sitios de venopunción (24,4%), melenas (22,2%), hematemesis (15,5%) y hemorragias vaginales anormales (15,5%). El recuento de plaquetas osciló entre 11.000 y 186.000/mm3, con un promedio de 48.688. Los hematocritos oscilaron entre 26 y 59%, con un promedio de 41,5%. Fallecieron 4 (8,8%) pacientes, tres de éstos menores de un año. En el 40% de los casos se hicieron otros diagnósticos simultáneamente, siendo malaria la coinfección más frecuente, con 17,7% (8/45) de los casos. Conclusión. En este estudio las personas en edad productiva tuvieron mayor riesgo de sufrir dengue y la población menor de un año fue la de mayor riesgo de letalidad; existe, además, la posibilidad de coinfección con otras enfermedades, particularmente malaria.

The objective of the present study was to assess the circulating TNF-α and IL-2 levels in dengue virus (DENV) infected patients and to correlate these with clinical severity of DENV infections. A single analyte quantitative immunoassay was used to detect TNF-α and IL-2 in 24 dengue fever (DF) and 43 dengue haemorrhagic fever (DHF) patients, 15 healthy adults and 6 typhoid patients. The mean TNF-α and IL-2 levels of DENV- infected patients were higher than that of healthy adults and typhoid patients. No significant difference in TNF-α levels was noted between DF and DHF patients ( p = 0 . 5) but a significant increase in IL-2 levels was observed in DHF compared with DF patients (mean of DF = 59.7 pg/mL, mean of DHF = 166.9 pg/mL; p = 0 . 02). No significant association of TNF-α or IL-2 levels was noted with packed cell volume (>45), thrombocytopenia, leucopenia or the presence of viraemia. The liver function tests measuring AST (aspartate aminotransferase) ( p = 0 . 01) and ALT (alanine aminotransferase) ( p = 0 . 02) levels were significantly elevated in DENV-infected patients. AST:ALT was significantly elevated in DHF/DSS (dengue shock syndrome) compared with DF patients. A significant positive linear correlation was noted between AST and IL-2 ( r = 0 . 31; p = 0 . 01) and ALT and IL-2 elevations ( r = 0 . 2; p = 0 . 02) . Thus, AST and ALT levels correlate with both disease severity and circulating IL-2 levels. We suggest a role for circulating IL-2 in liver dysfunction and propose that a combined assessment of AST/ALT in conjunction with IL-2 at the early stages of symptomatic DENV infection may be useful to predict the severe forms of dengue. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73·9%, 95·2%, 66·7, 22·0 and 0·25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis. [ABSTRACT FROM PUBLISHER]

Background: To determine the electrolyte disturbances in patients of dengue fever and dengue hemorrhagic fever. Methods: In this cross sectional study 110 patients, with dengue fever , were included. Serum electrolytes levels were measured at fifth and sixth day of fever irrespective of stage of dengue infection (DF/DHF). Dengue was confirmed by NS1 or IgM/IgG positivity. DHF was labeled as per WHO criteria of Dengue Hemorrhagic fever. Dengue fever was confirmed in 110 patients by NS1 antigen and IgM/IgG positivity by ELISA. Serum sodium, potassium and chloride concentrations were measured by standard protocols. Results: Average age of patients was 34.02 years with majority of males (63.6%). Seventy (63.6%) patients were diagnosed as case of dengue fever (DF) and 40 (34.4%) patients were diagnosed as case of dengue hemorrhagic fever (DHF). Out of total, 82 (74.5%) patients had NS1 positive, 54 (49.1%) patients had IgG positive and 33 (30%) patients had IgM positive. Although serum electrolytes were higher among patients with DHF as compared to DF but the association was insignificant. Conclusion: Hyponatremia was the most common disturbance in patients with Dengue fever as well as in patients of dengue hemorrhagic fever. No significant association was found in electrolyte disturbances between patients of dengue fever and dengue hemorrhagic fever. [ABSTRACT FROM AUTHOR]

Introduction: Dengue is a most common arthropod borne viral infection. It is endemic in several parts of India. It can lead to life threatening severe complications such as Dengue Haemorrhagic Fever (DHF)/Dengue Shock Syndrome (DSS). Aim: This study was conducted to know the seroprevalence of Dengue virus in a tertiary care hospital, Berhampur, Southern Odisha, India. Materials and Methods: Over a period of four years from January 2013 to December 2016, a total of 7345 blood samples from clinically suspected dengue patients were received in department of Microbiology laboratory. Serum was separated and subjected to enzyme immunoassay for detection of both Non Structural (NS1) antigen and IgM antibody. Results: Out of 7345 serum samples positive infection detected in 712 (9.6%) cases. Maximum number of cases were detected in the year 2016 and less number of cases were detected in 2013. Majority numbers of cases were detected in the month of September. Combination of NS1Ag ELISA and IgM antibody ELISA were used for early detection of dengue infection. Conclusion: Regular epidemiological studies are necessary to monitor the dengue situation in an area which helps in early detection of an outbreak and to initiate effective control measures. [ABSTRACT FROM AUTHOR]

The water consumption characteristics and larval density of dengue haemorrhagic fever (DHF) vectors in DHF transmission and non-DHF transmission villages, as well as the relationship between these factors were investigated. We carried out a stratified cross-sectional survey during October and November 1998 in 160 households selected by randomized stratification from eight villages of Pattani province in southern Thailand. The villages were stratified by seaside or mountainside location, predominant religion of residents (Buddhist or Muslim), and transmission or non-transmission of dengue haemorrhagic fever. The mosquito larvae presence in containers used for storing drinking and washing water and the characteristics of these containers were measured. We used Mantel-Haenszel adjusted odds ratio and logistic regression to evaluate the factors determining DHF transmission in the village and the presence of larvae in the water containers. The larvae indices of dengue vectors were higher in the DHF transmission villages. There were strong associations between the water container characteristics, which varied between villages, and the presence of larvae. In particular, plastic containers were less likely to contain larvae.

En Bucaramanga, Colombia, el dengue hemorrágico se presenta en forma endemoepidémica desde 1992. Con el objetivo de mostrar nuestras propias observaciones sobre las características clínicas, de laboratorio y evolución de la enfermedad realizamos este estudio durante un período de 10 años (febrero de 1992 a febrero de 2002), en niños menores de 13 años hospitalizados en el hospital universitario. Se incluyeron 763 pacientes, de los cuales 617 fueron clasificados como dengue hemorrágico de acuerdo con los criterios de la OMS (9,2%, grado I; 61,5%, grado II; 21,7%, grado III, y 7,5%, grado IV). No se pudieron clasificar 146 pacientes. La mayor incidencia se presentó en 1997, 1998 y 2001. Del total, 74,9% procedía del área metropolitana de Bucaramanga; 48% eran del género masculino; 0,3% eran recién nacidos; lactantes, 11,8%; preescolares, 23,1%, y escolares, 64,9%. Las principales manifestaciones clínicas fueron: fiebre, 100%; manifestaciones hemorrágicas, 100%; vómito, 60%; dolor abdominal, 57%; cefalea, 50%; dolor osteomuscular, 40,8%; hepatomegalia, 33%, y exantemas, 29,4%. Entre las manifestaciones hemorrágicas, 56% correspondió a petequias; 35% a prueba de torniquete positiva; 34% a hemorragias digestivas, y 32% a epistaxis. Presentaron derrames serosos 17,7%. Entre los signos de alarma para choque se destacó el dolor abdominal intenso. En 52% de los pacientes se encontró leucopenia y linfocitos atípicos en 37,3%. Entre otras manifestaciones inusuales se presentaron hepatitis, encefalopatía, colecistitis acalculosa, insuficiencia renal aguda, síndrome hemofagocítico, infecciones sobreagregadas y enfermedades concomitantes. La evolución fue favorable en la mayoría de los pacientes. Fallecieron 12 pacientes (1,5%).

El síndrome hemofagocítico se caracteriza por proliferación histiocítica con fagocitosis de células hemáticas que ocasionan citopenia. Ha sido relacionado antes con diversas infecciones, principalmente por virus. Informamos de tres pacientes con síndrome hemofagocítico secundario a dengue hemorrágico, confirmado por exámenes específicos de laboratorio, quienes fueron internados en el Hospital Universitario Ramón González Valencia de Bucaramanga, Colombia, durante los últimos dos años. Los tres pacientes fueron escolares que presentaron dengue hemorrágico y manifestaron dolor abdominal intenso, fiebre prolongada, hipotensión y hepatomegalia dolorosa; los exámenes paraclínicos mostraron plaquetopenia, anemia y leucopenia; en la ecografía abdominal se observó colecistitis acalculosa y en todos los aspirados de medula ósea se encontraron histiocitos fagocitando células hemáticas de la serie eritroide, mieloide o plaquetaria. Se definió y clasificó el síndrome hemofagocítico, según la Sociedad Internacional de Histiocitosis, en tres grandes clases, recalcando que los casos informados corresponden a histiocitosis clase II y, más específicamente, al síndrome hemofagocítico secundario. Se mencionan las diversas asociaciones de este síndrome con infecciones, principalmente virales, y otras enfermedades no infecciosas; se hace diferenciacion entre síndrome hemofagocítico familiar o primario y el secundario. Finalmente, se enfatiza que los tres pacientes con este síndrome asociado con dengue hemorrágico tuvieron una evolución atípica durante el curso de su enfermedad; la fiebre prolongada y el dolor abdominal persistente fueron los síntomas más importantes. Los autores recomiendan realizar un aspirado de médula ósea como parte de los estudios para el diagnóstico diferencial de casos atípicos de dengue, especialmente con fiebre prolongada, buscando la posibilidad de un síndrome hemofagocítico secundario.