Caracterización clínica de Shock por Dengue en menores de 5 años de edad
Palabras clave:
Dengue, fiebre hemorrágica dengue, preescolar.Resumen
Introducción: Variables de manifestaciones clínicas y laboratoriales sobre dengue han sido descritas. Pero pocos reportes hay sobre menores de 5 años. Los médicos que asisten a esta patología deben estar atentos a las manifestaciones poco frecuentes.
Objetivos: Evaluar características clínicas y bioquímicas típicas y atípicas en pacientes con shock compensado.
Materiales y Métodos: Han sido enrolados en forma prospectiva 155 pacientes hospitalizados.
Resultados: Menores de 5 años (m5A) fueron 51 pacientes y mayores de 5 años (M5A) 104 pacientes. Irritabilidad 31(60,8%) vs Mayores de 5 años (M5A) 4(3,8%) p=0,001. Dolor abdominal (m5A) 14(27,5%) vs (M5A) 37(35,6%) p=0,312. Rash Cutáneo (m5A) 17(33,3%) vs (M5A) 91(87,5%) p=<0,001. Hemorragia (m5A) 11(21,6%) vs (M5A) 22(21,2%) p=0,9. Diarrea (m5A) 19(37,3%) vs (M5A) 2(1,9%) p=<0,001. Vómitos (m5A) 20(39,2%) vs (M5A) 27(26,0%) p=0,092. Enzimas hepáticas (m5A) 29(57%) vs (M5A) 16(15%) p=<0,001. Hto al ingreso (m5A) 36,5% vs (M5A) 39,9% p=0,000. Plaquetas (m5A) 215.576/m3 vs (M5A) 171.096/m3 p=0,019. Hto final (m5A) 33,3% vs (M5A) 36,9% p=0,001. Plaquetas (m5A) 155122/m3 vs (M5A) 159543/m3 p=0,791.
Conclusiones: Nuestros resultados indican que además de las manifestaciones clínicas típicas existen algunas inusuales, que si no son detectadas tempranamente pueden pasar desapercibidas. Algunos datos laboratoriales también demuestran cierta particularidad en este grupo etario.
Métricas
Citas
2. Halstead SB, Lan NT, Myint TT, Shwe TN, Nisalak A, Kalyanarooj S, et-al. Dengue hemorrhagic fever in infants: research opportunities ignored. Emerg Infect Dis. 2002;8:1474-1479. [ Links ]
2. Ranjit S, Kissoon N. Dengue hemorrhagic fever and shock syndromes. Pediatr Crit Care. 2011;12(3):1-11. [ Links ]
3. Hung NT, Lei HY, Lan NT, Lin YS, Huang KJ, Lien LB, et-al. Dengue hemorrhagic fever in infants: a study of clinical and cytokine profiles. J Infect Dis. 2004;189:221-32. [ Links ]
4. Dung NM. Fluid replacement in dengue shock syndrome: a randomized double-blind comparison of four intravenous-fluid regimens. Clin Infect Dis. 1999;29(4):787-94. [ Links ]
5. Wills BA. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Eng J Med. 2005;353(9):877-89. [ Links ]
6. Lan NT, Hung NT, Ha DQ, Phuong BT, Lien LB, Tuan LA, et-al. Treatment of dengue haemorrhagic fever at Children s Hospital No. 1, Ho Chi Minh City, 1991-1996. Dengue Bull. 1998;22:150-61. [ Links ]
7. Centers for Diseases Control. Dengue y DHF: dengue and dengue hemorrhagic fever Information for Health Care Practitioners. Atlanta: CDC; 2007. [ Links ]
8. Lee IK, Liu JW, Yang KD. Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue hemorrhagic fever. Am J Trop Med Hyg. 2005;72(2):221-26. [ Links ]
9. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998;11:480-96. [ Links ]
10. World Health Organization. Dengue Hemorrhagic Fever: diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization; 1997. [ Links ]
11. World Health Organization. Dengue and dengue hemorrhagic fever: fact sheet. Geneva: WHO; 2002. [ Links ]
12. Hadinegoro SR, Purwanto SH, Chatab F. Dengue shock syndrome: clinical manifestations, management and outcome, A hospital-based study in Jakarta, Indonesia. Dengue Bull. 1999;23:105-106. [ Links ]
13. WHO. Guidelines for treatment of dengue fever/dengue haemorrhagic fever in small hospitals. New Delhi: WHO; 1999. [ Links ]
14. WHO. TDR: dengue Guidelines for diagnosis, treatment, prevention and control. Geneva: WHO; 2009. [ Links ]
15. Dung NM. Fluid replacement in dengue shock syndrome: a randomized double-blind comparison of four intravenous-fluid regimens. Clin Infect Dis. 1999;29(4):787-94. [ Links ]
16. Wills BA. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Eng J Med. 2005:353(9):877-89. [ Links ]
17. Guzmán MG, Kourí G. Dengue: an update. Lancet Infect Dis. 2002;2:33-42. [ Links ]
18. Basu A, Chaturvedi UC. Vascular endothelium: the battlefield of dengue viruses. FEMS Immunol Med Microbiol. 2008;53:287-99. [ Links ]
19. Kamath S, Ranjit S. Clinical Features, Complications and Atypical Manifestations of Children with Severe forms of Dengue Hemorrhagic Fever In South India. Indian J Pediatr. 2006;73:888-95. [ Links ]
20. Méndez A, González G. Abnormal clinical manifestations of dengue hemorrhagic fever in children. Biomedica. 2006;26(1):61-70. [ Links ]
21. Jhamb R, Kumar A, Ranga GS, Rathi N. Unusual manifestations in dengue. J Commun Dis. 2010;42(4):255-61. [ Links ]
22. Chacko B, Subramanian G. Clinical, Laboratory and Radiological Parameters in Children with Dengue Fever and Predictive Factors for Dengue Shock Syndrome. J Trop Pediatr. 2007;54;2:137-40. [ Links ]
23. Arya SC, Agarwal N. Thrombocytopenia progression in dengue cases during the 2010 outbreak in Indian capital metropolis. Platelets. 2011;22(6):476-77. [ Links ]
24. Almas A. Clinical factors associated with mortality in dengue infection at a tertiary care center. Southeast Asian J Trop Med Public Health. 2010;41(2):333-40. [ Links ]
25. Hongsiriwon S. Dengue Hemorrhagic Fever in Infants. Southest Asian J Trop Md Public Health. 2002;33;1:49-55. [ Links ]
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Todo el contenido de este sitio está bajo una Licencia de Atribución Creative Commons.