Utility of the Tourniquet Test and the White Blood Cell Count to Differentiate Dengue among Acute Febrile Illnesses in the Emergency Room

Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm3) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2–7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue

Evidência de alterações de permeabilidade vascular na dengue: quando a dosagem de albumina sérica define o quadro? Plasma leakage detection in severe dengue: when serum albumin quantification plays a role?

Evidência de extravasamento vascular decorrente do aumento da permeabilidade capilar caracteriza e diferencia febre hemorrágica da dengue. Este artigo avalia o valor de albumina sérica na detecção de alterações de permeabilidade vascular em casos de dengue. Quatorze pacientes diagnosticados com febre hemorrágica da dengue em dois hospitais privados em Recife, Brasil, entre janeiro e maio de 2002 foram seguidos com dosagens diárias de hematócrito e albumina sérica. Ultra-son e Raio X de tórax foram realizados. Oito (57%) casos apresentaram hemoconcentração de 20% ou mais. Hipoalbuminemia foi detectado em dez (71%) pacientes. Dosagem de albumina sérica aumentou a detecção de alterações de permeabilidade em seis (43%) casos na qual a hemoconcentração foi inferior a 20% e os sintomas foram compatíveis com um a resposta imune exacerbada. Raio-X foi normal em todos os casos. A utilização, portanto, de dosagem de albumina sérica aumenta a sensibilidade de detecção de casos de febre hemorrágica da dengue.<br>Evidence of vascular leakage due to increased capillary permeability characterizes and differentiates dengue hemorrhagic fever. This article assesses the value of serum albumin for detecting vascular permeability abnormalities in dengue cases. Fourteen patients diagnosed with dengue hemorrhagic fever at two private hospitals in Recife, Brazil, between January and May 2002 were followed up with daily hematocrit and serum albumin assays. Ultrasound scans and chest X-rays were also performed. Eight (57%) of the cases presented hemoconcentration of 20% or more. Hypoalbuminemia was detected in ten patients (71%). Serum albumin assays increased the detection of permeability abnormalities in six cases (43%) in which the hemoconcentration was less than 20% and the symptoms were compatible with an exacerbated immune response. The X-rays were normal in all cases. Thus, the use serum albumin quantification increased the sensitivity of dengue hemorrhagic fever detection

Alterações hematológicas em pacientes com dengue Hematological abnormalities in patients with dengue

Dengue é uma doença negligenciada de alta morbidade e mortalidade em crianças e adultos, ocorrendo principalmente em regiões tropicais e subtropicais. O objetivo desse trabalho foi avaliar as alterações hematológicas de pacientes com quadro clínico de dengue. Foram estudados 543 prontuários de atendimentos referentes à epidemia pelo vírus tipo 3, ocorrida no ano de 2007, em Campo Grande, Mato Grosso do Sul. Houve predomínio de casos de dengue clássico (90,2%), com quadro clínico leve sem complicações. As principais alterações hematológicas observadas foram a leucopenia (68,3%), plaquetopenia (66,5%), linfocitopenia (67,2%) e presença de linfócitos atípicos (67%). A febre hemorrágica do dengue apresentou plaquetopenia mais prolongada e maior número de linfócitos atípicos, as demais alterações hematológicas apresentaram evolução diária semelhante às encontradas no dengue clássico. As alterações hematológicas observadas no dengue apresentaram-se de acordo com a evolução clínica e gravidade da doença.<br>Dengue is a neglected disease with high morbidity and mortality among children and adults that occurs mainly in tropical and subtropical regions. The objective of this study was to evaluate hematological changes in patients with clinical manifestations of dengue. Medical records relating to 543 cases of dengue virus 3 that occurred during the 2007 epidemic in Campo Grande, Mato Grosso do Sul, were studied. Cases of classic dengue predominated (90.2%), with mild clinical manifestations lacking complications. The main hematological findings were leukopenia (68.3%), thrombocytopenia (66.5%), lymphocytopenia (67.2%) and atypical lymphocytes (67%). In dengue hemorrhagic fever, thrombocytopenia was more prolonged and the number of atypical lymphocytes was higher, while the other hematological abnormalities presented daily evolution similar to those in classic dengue. The hematological changes observed in dengue present according to the clinical course of the disease and its severity

Evaluation of an algorithm for integrated management of childhood illness in an area of Vietnam with dengue transmission

OBJECTIVES: To determine whether nurses, using the WHO/UNICEF algorithm for integrated management of childhood illness (IMCI), modified to include dengue infection, satisfactorily classified children in an area endemic for dengue haemorrhagic fever (DHF). METHODS: Nurses assessed and classified, using the modified IMCI algorithm, a systematic sample of 1250 children aged 2 months to 10 years (n = 1250) presenting to a paediatric hospital in Dong Nai Province, Vietnam. Their classification was compared with that of a paediatrician, blind to the result of the nurses' assessment, which could be modified in the light of simple investigations, e.g. dengue serology. RESULTS: In children aged 2-59 months (n = 859), the nurses were able to classify, using the modified chart, the presenting illness in &gt;99% of children and found more than one classification in 70%. For the children with pneumonia, diarrhoea, dengue shock syndrome, severe DHF and severe disease requiring urgent admission, the nurse's classification was &gt;60% sensitive and &gt;85% specific compared with that of the paediatrician. For the nurse's classification of DHF the specificity was 50-55% for the children &lt;5 years and in children with definitive dengue serology. Alterations in the DHF algorithm improved specificity at the expense of sensitivity. CONCLUSION: Using the IMCI chart, nurses classified appropriately many of the major clinical problems in sick children &lt;5 years in southern Vietnam. However, further modifications will be required in the fever section, particularly for dengue. The impact of using the IMCI chart in peripheral health stations remains to be evaluated

Self-Microemulsifiyng Suppository Formulation of β-Artemether

Parasitic diseases are of immense global significance as around 30% of world’s population experiences parasitic infections. Among these, malaria is the most life-threatening disease. Various routes of administration have been explored for delivering antimalarial actives. The present investigation aims at formulating self-microemulsifying suppositories of β-artemether with faster onset of action and prolonged effect to be administered by rectal route. These were compared with conventional polyethylene glycol suppositories with respect to melting range, rheology, texture analysis, disintegration time, self microemulsification time, particle size, and drug content. In vitro drug release was studied by using USP apparatus II. Further, the suppositories were evaluated in murine model against virulent rodent malaria parasite Plasmodium berghei wherein the developed self-microemulsifying suppositories could sustain the activity (94%) for 20 days post infection. The survival of animals was also better as compared to the conventional formulation