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      Aspectos clínico-epidemiológicos en pacientes con dengue y signos de alarma Translated title: Clinical-epidemiological features of patient with dengue and alarm signs

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          Abstract

          RESUMEN Se realizó un estudio observacional, descriptivo y retrospectivo de 207 pacientes con el serotipo 3 del virus del dengue y signos de alarma, ingresados en la Sala de Cuidados Progresivos del Hospital General Docente “Dr. Juan Bruno Zayas Alfonso” de Santiago de Cuba, desde septiembre hasta noviembre del 2015, con vistas a determinar los aspectos clínicos y epidemiológicos en ellos. En la serie un elevado porcentaje correspondió al sexo femenino en edades jóvenes y, a diferencia de lo observado en otros brotes epidémicos, los signos de alarma aparecieron tempranamente, entre el 2do y 3er día de evolución de la enfermedad, con predominio de la hipotensión grave. No existió relación directa entre la trombocitopenia y las manifestaciones hemorrágicas, y el daño hepático primó como manifestación inusual. Se demostró que la vigilancia estricta y la actuación oportuna en la sala contribuyeron a disminuir la gravedad de los pacientes y la mortalidad, a pesar de la elevada virulencia de esta cepa.

          Translated abstract

          ABSTRACT An observational, descriptive and retrospective study of 207 patients with the serotype 3 of the dengue virus and alarm signs, admitted in the Progressive Cares room of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, was carried out from September to November, 2015, with the aim of determining the clinical and epidemiological features in them. A high percentage of the series was of female sex in early youth, contrary to what was observed in other epidemic outbreaks, the alarm signs emerged early, between the 2nd and 3rd days of the disease clinical course, with prevalence of the severe hypotension. Direct relationship didn't exist between thrombocytopenia and the hemorrhagic manifestations, and the hepatic damage prevailed as unusual manifestation. It was demonstrated that the strict surveillance and the opportune performance in the room contributed to decrease its severity in the patients and in mortality, in spite of the high virulence of this stump.

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          Most cited references 16

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          Cardiovascular manifestations of the emerging dengue pandemic.

          Dengue is one of the most important emerging viral diseases globally. The majority of symptomatic infections result in a relatively benign disease course. However, a small proportion of patients develop severe clinical manifestations, including bleeding, organ impairment, and endothelial dysfunction with increased capillary permeability causing hypovolaemic shock that can lead to cardiovascular collapse. Evidence is increasing that dengue can also cause myocardial impairment, arrhythmias and, occasionally, fulminant myocarditis. No antiviral agents or vaccines are licensed for dengue, and treatment remains supportive with judicious fluid replacement for patients with severe disease. Defining the role of cardiac dysfunction in the haemodynamic compromise of severe dengue has potentially important management implications. In this Review, we will outline the current understanding of the cardiovascular manifestations of dengue, including myocardial and vascular involvement, and conclude with a discussion of the available therapeutic options and potential future research directions.
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            Autochthonous dengue virus infection in Japan imported into Germany, September 2013.

            In September 2013, dengue virus (DENV) infection was diagnosed in a German traveller returning from Japan. DENV-specific IgM and IgG and DENV NS1 antigen were detected in the patient’s blood, as were DENV serotype 2-specific antibodies. Public health authorities should be aware that autochthonous transmission of this emerging virus may occur in Japan. Our findings also highlight the importance of taking a full travel history, even from travellers not returning from tropical countries, to assess potential infection risks of patients.
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              Resistance of Aedes aegypti to temephos and adaptive disadvantages

              OBJECTIVE To evaluate the resistance of Aedes aegypti to temephos Fersol 1G (temephos 1% w/w) associated with the adaptive disadvantage of insect populations in the absence of selection pressure. METHODS A diagnostic dose of 0.28 mg a.i./L and doses between 0.28 mg a.i./L and 1.40 mg a.i./L were used. Vector populations collected between 2007 and 2008 in the city of Campina Grande, state of Paraíba, were evaluated. To evaluate competition in the absence of selection pressure, insect populations with initial frequencies of 20.0%, 40.0%, 60.0%, and 80.0% resistant individuals were produced and subjected to the diagnostic dose for two months. Evaluation of the development of aquatic and adult stages allowed comparison of the life cycles in susceptible and resistant populations and construction of fertility life tables. RESULTS No mortality was observed in Ae. aegypti populations subjected to the diagnostic dose of 0.28 mg a.i./L. The decreased mortality observed in populations containing 20.0%, 40.0%, 60.0%, and 80.0% resistant insects indicates that temephos resistance is unstable in the absence of selection pressure. A comparison of the life cycles indicated differences in the duration and viability of the larval phase, but no differences were observed in embryo development, sex ratio, adult longevity, and number of eggs per female. CONCLUSIONS The fertility life table results indicated that some populations had reproductive disadvantages compared with the susceptible population in the absence of selection pressure, indicating the presence of a fitness cost in populations resistant to temephos.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                san
                MEDISAN
                MEDISAN
                Centro Provincial de Ciencias Médicas, Santiago de Cuba (Santiago de Cuba, , Cuba )
                1029-3019
                August 2018
                : 540-551
                S1029-30192018000700540

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 12
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                Product Information: SciELO Cuba

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