Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.
Background Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging o...
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Online Access: | https://doi.org/10.1371/journal.pntd.0010091 https://doaj.org/article/c168028a18de4e188ea24c4e46a4e7d6 |
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ftdoajarticles:oai:doaj.org/article:c168028a18de4e188ea24c4e46a4e7d6 2023-05-15T15:14:55+02:00 Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne 2021-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0010091 https://doaj.org/article/c168028a18de4e188ea24c4e46a4e7d6 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0010091 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0010091 https://doaj.org/article/c168028a18de4e188ea24c4e46a4e7d6 PLoS Neglected Tropical Diseases, Vol 15, Iss 12, p e0010091 (2021) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2021 ftdoajarticles https://doi.org/10.1371/journal.pntd.0010091 2022-12-30T22:27:12Z Background Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future. Methods/principal findings From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization. Conclusions One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 15 12 e0010091 |
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Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future. Methods/principal findings From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization. Conclusions One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries. |
format |
Article in Journal/Newspaper |
author |
Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne |
author_facet |
Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne |
author_sort |
Champica K Bodinayake |
title |
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
title_short |
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
title_full |
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
title_fullStr |
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
title_full_unstemmed |
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
title_sort |
outcomes among children and adults at risk of severe dengue in sri lanka: opportunity for outpatient case management in countries with high disease burden. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2021 |
url |
https://doi.org/10.1371/journal.pntd.0010091 https://doaj.org/article/c168028a18de4e188ea24c4e46a4e7d6 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 15, Iss 12, p e0010091 (2021) |
op_relation |
https://doi.org/10.1371/journal.pntd.0010091 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0010091 https://doaj.org/article/c168028a18de4e188ea24c4e46a4e7d6 |
op_doi |
https://doi.org/10.1371/journal.pntd.0010091 |
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PLOS Neglected Tropical Diseases |
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12 |
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