Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic.

<h4>Background</h4>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.<h4>...

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Autores principales:	Kay M Tomashek, Christopher J Gregory, Aidsa Rivera Sánchez, Matthew A Bartek, Enid J Garcia Rivera, Elizabeth Hunsperger, Jorge L Muñoz-Jordán, Wellington Sun
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8
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spelling	oai:doaj.org-article:e7e4660e415248108cfc3aa8fa7b2da82021-11-18T09:14:16ZDengue deaths in Puerto Rico: lessons learned from the 2007 epidemic.1935-27271935-273510.1371/journal.pntd.0001614https://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da82012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22530072/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Kay M TomashekChristopher J GregoryAidsa Rivera SánchezMatthew A BartekEnid J Garcia RiveraElizabeth HunspergerJorge L Muñoz-JordánWellington SunPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 6, Iss 4, p e1614 (2012)
institution	DOAJ
collection	DOAJ
language	EN
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 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.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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
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://doaj.org/article/e7e4660e415248108cfc3aa8fa7b2da8
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Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic.

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