Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic.
Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were iden...
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ftdoajarticles:oai:doaj.org/article:e7e4660e415248108cfc3aa8fa7b2da8 2023-05-15T15:14:31+02:00 Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. Kay M Tomashek Christopher J Gregory Aidsa Rivera Sánchez Matthew A Bartek Enid J Garcia Rivera Elizabeth Hunsperger Jorge L Muñoz-Jordán Wellington Sun 2012-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0001614 https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8 EN eng Public Library of Science (PLoS) https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22530072/?tool=EBI https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0001614 https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8 PLoS Neglected Tropical Diseases, Vol 6, Iss 4, p e1614 (2012) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2012 ftdoajarticles https://doi.org/10.1371/journal.pntd.0001614 2022-12-31T07:27:14Z Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged < 15 years; 7 sought medical care at least once prior to hospital admission, 9 were admitted to hospital and 2 died upon arrival. The nine hospitalized case-patients stayed a mean of 15 hours (range: 3-48 hours) in the emergency department (ED) before inpatient admission. Five of the nine case-patients received intravenous methylprednisolone and four received non-isotonic saline while in shock. Eight case-patients died in the hospital; five had their terminal event on the inpatient ward and six died during a weekend. Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 6 4 e1614 |
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Directory of Open Access Journals: DOAJ Articles |
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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 Kay M Tomashek Christopher J Gregory Aidsa Rivera Sánchez Matthew A Bartek Enid J Garcia Rivera Elizabeth Hunsperger Jorge L Muñoz-Jordán Wellington Sun Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged < 15 years; 7 sought medical care at least once prior to hospital admission, 9 were admitted to hospital and 2 died upon arrival. The nine hospitalized case-patients stayed a mean of 15 hours (range: 3-48 hours) in the emergency department (ED) before inpatient admission. Five of the nine case-patients received intravenous methylprednisolone and four received non-isotonic saline while in shock. Eight case-patients died in the hospital; five had their terminal event on the inpatient ward and six died during a weekend. Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. |
format |
Article in Journal/Newspaper |
author |
Kay M Tomashek Christopher J Gregory Aidsa Rivera Sánchez Matthew A Bartek Enid J Garcia Rivera Elizabeth Hunsperger Jorge L Muñoz-Jordán Wellington Sun |
author_facet |
Kay M Tomashek Christopher J Gregory Aidsa Rivera Sánchez Matthew A Bartek Enid J Garcia Rivera Elizabeth Hunsperger Jorge L Muñoz-Jordán Wellington Sun |
author_sort |
Kay M Tomashek |
title |
Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
title_short |
Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
title_full |
Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
title_fullStr |
Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
title_full_unstemmed |
Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic. |
title_sort |
dengue deaths in puerto rico: lessons learned from the 2007 epidemic. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2012 |
url |
https://doi.org/10.1371/journal.pntd.0001614 https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8 |
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Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 6, Iss 4, p e1614 (2012) |
op_relation |
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22530072/?tool=EBI https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0001614 https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8 |
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https://doi.org/10.1371/journal.pntd.0001614 |
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PLoS Neglected Tropical Diseases |
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e1614 |
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