Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013.
Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH is being increasingly reported as a complication of dengue, a common tropical acute febrile illness.After a cluster of pediatric...
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ftdoajarticles:oai:doaj.org/article:b018a784fcdf496a89553d803cbb89b2 2023-05-15T15:14:43+02:00 Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. Esther M Ellis Tyler M Sharp Janice Pérez-Padilla Liza González B Katherine Poole-Smith Emmaculate Lebo Charlotte Baker Mark J Delorey Brenda Torres-Velasquez Eduardo Ochoa Brenda Rivera-Garcia Hector Díaz-Pinto Luis Clavell Anabel Puig-Ramos Gritta E Janka Kay M Tomashek 2016-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0004939 https://doaj.org/article/b018a784fcdf496a89553d803cbb89b2 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4996422?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0004939 https://doaj.org/article/b018a784fcdf496a89553d803cbb89b2 PLoS Neglected Tropical Diseases, Vol 10, Iss 8, p e0004939 (2016) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2016 ftdoajarticles https://doi.org/10.1371/journal.pntd.0004939 2022-12-31T01:01:25Z Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH is being increasingly reported as a complication of dengue, a common tropical acute febrile illness.After a cluster of pediatric dengue-associated HLH patients was identified during the 2012-2013 dengue epidemic in Puerto Rico, active surveillance and a case-control investigation was conducted at four referral hospitals to determine the incidence of HLH in children and identify risk factors for HLH following dengue. Patients with dengue-associated HLH (cases) were matched by month of illness onset and admission hospital to dengue patients that did not develop HLH (controls). During 2008-2013, a total of 33 HLH patients were identified, of which 22 (67%) were associated with dengue and 1 died (dengue-associated HLH case-fatality rate: 4.5%). Two patients with dengue-associated HLH had illness onset in 2009, none had illness onset during the 2010 dengue epidemic, and 20 had illness onset during the 2012-2013 epidemic. Frequency of infection with either dengue virus (DENV)-1 or DENV-4 did not differ between cases and controls. Cases were younger than controls (median age: 1 vs. 13 years, p < 0.01), were hospitalized longer (18 vs. 5 days, p < 0.01), and were admitted more frequently to pediatric intensive care units (100% vs. 16%, p < 0.01). Cases had co-infection (18.2% vs. 4.5%, p = 0.04), recent influenza-like illness (54.5% vs. 25.0%, p = 0.01), and longer duration of fever (7 vs. 5 days; p < 0.01). Cases were more likely to have lymphadenopathy, hepatomegaly, splenomegaly, anemia, and elevated liver transaminases (p ≤ 0.02).During this cluster of dengue-associated HLH cases that was temporally associated with the 2012-2013 epidemic, most patients with dengue-associated HLH were infants and had higher morbidity than dengue inpatients. Physicians throughout the tropics should be aware of HLH as a potential complication of dengue, ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 10 8 e0004939 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Esther M Ellis Tyler M Sharp Janice Pérez-Padilla Liza González B Katherine Poole-Smith Emmaculate Lebo Charlotte Baker Mark J Delorey Brenda Torres-Velasquez Eduardo Ochoa Brenda Rivera-Garcia Hector Díaz-Pinto Luis Clavell Anabel Puig-Ramos Gritta E Janka Kay M Tomashek Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH is being increasingly reported as a complication of dengue, a common tropical acute febrile illness.After a cluster of pediatric dengue-associated HLH patients was identified during the 2012-2013 dengue epidemic in Puerto Rico, active surveillance and a case-control investigation was conducted at four referral hospitals to determine the incidence of HLH in children and identify risk factors for HLH following dengue. Patients with dengue-associated HLH (cases) were matched by month of illness onset and admission hospital to dengue patients that did not develop HLH (controls). During 2008-2013, a total of 33 HLH patients were identified, of which 22 (67%) were associated with dengue and 1 died (dengue-associated HLH case-fatality rate: 4.5%). Two patients with dengue-associated HLH had illness onset in 2009, none had illness onset during the 2010 dengue epidemic, and 20 had illness onset during the 2012-2013 epidemic. Frequency of infection with either dengue virus (DENV)-1 or DENV-4 did not differ between cases and controls. Cases were younger than controls (median age: 1 vs. 13 years, p < 0.01), were hospitalized longer (18 vs. 5 days, p < 0.01), and were admitted more frequently to pediatric intensive care units (100% vs. 16%, p < 0.01). Cases had co-infection (18.2% vs. 4.5%, p = 0.04), recent influenza-like illness (54.5% vs. 25.0%, p = 0.01), and longer duration of fever (7 vs. 5 days; p < 0.01). Cases were more likely to have lymphadenopathy, hepatomegaly, splenomegaly, anemia, and elevated liver transaminases (p ≤ 0.02).During this cluster of dengue-associated HLH cases that was temporally associated with the 2012-2013 epidemic, most patients with dengue-associated HLH were infants and had higher morbidity than dengue inpatients. Physicians throughout the tropics should be aware of HLH as a potential complication of dengue, ... |
format |
Article in Journal/Newspaper |
author |
Esther M Ellis Tyler M Sharp Janice Pérez-Padilla Liza González B Katherine Poole-Smith Emmaculate Lebo Charlotte Baker Mark J Delorey Brenda Torres-Velasquez Eduardo Ochoa Brenda Rivera-Garcia Hector Díaz-Pinto Luis Clavell Anabel Puig-Ramos Gritta E Janka Kay M Tomashek |
author_facet |
Esther M Ellis Tyler M Sharp Janice Pérez-Padilla Liza González B Katherine Poole-Smith Emmaculate Lebo Charlotte Baker Mark J Delorey Brenda Torres-Velasquez Eduardo Ochoa Brenda Rivera-Garcia Hector Díaz-Pinto Luis Clavell Anabel Puig-Ramos Gritta E Janka Kay M Tomashek |
author_sort |
Esther M Ellis |
title |
Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
title_short |
Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
title_full |
Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
title_fullStr |
Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
title_full_unstemmed |
Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. |
title_sort |
incidence and risk factors for developing dengue-associated hemophagocytic lymphohistiocytosis in puerto rico, 2008 - 2013. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2016 |
url |
https://doi.org/10.1371/journal.pntd.0004939 https://doaj.org/article/b018a784fcdf496a89553d803cbb89b2 |
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Arctic |
geographic_facet |
Arctic |
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Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 10, Iss 8, p e0004939 (2016) |
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http://europepmc.org/articles/PMC4996422?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0004939 https://doaj.org/article/b018a784fcdf496a89553d803cbb89b2 |
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https://doi.org/10.1371/journal.pntd.0004939 |
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PLOS Neglected Tropical Diseases |
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