[Source: PLoS One, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Management and outcomes of severe dengue patients presenting with sepsis in a tropical country
Prapit Teparrukkul, Viriya Hantrakun, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul
Published: April 24, 2017 / https://doi.org/10.1371/journal.pone.0176233
Dengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.
From June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays.
A total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4), and 5 of them (4%) died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%), and recorded dengue infection as the final diagnosis in 96 patients (76%). Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality.
A number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.
Citation: Teparrukkul P, Hantrakun V, Day NPJ, West TE, Limmathurotsakul D (2017) Management and outcomes of severe dengue patients presenting with sepsis in a tropical country. PLoS ONE 12(4): e0176233. https://doi.org/10.1371/journal.pone.0176233
Editor: Nguyen Tien Huy, Institute of Tropical Medicine (NEKKEN), Nagasaki University, JAPAN
Received: January 9, 2017; Accepted: April 8, 2017; Published: April 24, 2017
Copyright: © 2017 Teparrukkul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are available from figshare at: https://figshare.com/s/a31da6384a6a50c99464.
Funding: The prospective sepsis study was funded by the Wellcome Trust (106698/B/14/Z) and National Heart, Lung and Blood Institute, National Institutes of Health (R01HL113382). The dengue PCR assays were funded by Defense Threat Reduction Agency, USA (W911QY-16-C-0017). DL is supported by an intermediate fellowship from the Wellcome Trust (101103/Z/13/Z).
Competing interests: The authors have declared that no competing interests exist.
Keywords: Dengue Fever; Sepsis.