We reported a case of acute pancreatitis as the complication of dengue hemorrhagic fever (DHF). This complication can cause more severe fatal condition, and difficulties in treatment, although it is rare. Dengue hemorrhagic fever (DHF) is one of the endemic diseases and often come as an outbreak event in South East Asia including Indonesia. Dengue hemorrhagic fever (DHF) is a global public health problem, because until now there has been no medicine to eradicate the dengue virus, no dengue vaccine and difficult to eradicate the mosquitoes as the contagious vector. Diagnosis and treatment of acute pancreatitis as early as possible is important to improve the patient's condition and survival. The patient was a 59 year old male and had been treated conservatively. The patient was admitted to the hospital, oral fasting until the fourth day, given parenteral nutrition, antibiotic and other intravenous medicines. Initial oral liquid diet was given on the fifth day of hospitalization and changed gradually according to the condition. The patient was then improved and discharged from the hospital.

Dengue hemorrhagic fever is characterized by the presence of a capillary leak syndrome. Its pathogenesis is presumed to differ from that of classical dengue fever (DF) and to be associated with secondary dengue infection. Returning travelers given a diagnosis of DF were evaluated for capillary leakage with abdominal sonography. Data were compared between travelers with primary/secondary infection defined by epidemiologic and serologic parameters. A total of 12 (34.3%) of 35 patients had sonographic signs of capillary leakage. Most (85%) patients with capillary leakage had classical DF. Capillary leak was diagnosed in 32% of primary dengue cases and in 40% of secondary dengue cases (P = 0.69). The two patients given a diagnosis of dengue hemorrhagic fever had primary infections. The high prevalence of capillary leakage among travelers, most of them with primary exposure to dengue, calls into question the importance of secondary infection in causing capillary leakage in dengue infection.

Of eight children given a diagnosis of dengue, a complicated course developed in three (38%), including one infant with dengue shock syndrome. Children visiting friends and relatives in dengue-endemic regions are at risk for severe dengue-associated morbidity. Children of families originally from these locations may benefit from pre-travel advice and may represent candidates for a future dengue vaccine.

BACKGROUND A better description of the clinical and laboratory manifestations of fatal patients with dengue hemorrhagic fever (DHF) is important in alerting clinicians of severe dengue and improving management. METHODS AND FINDINGS Of 309 adults with DHF, 10 fatal patients and 299 survivors (controls) were retrospectively analyzed. Regarding causes of fatality, massive gastrointestinal (GI) bleeding was found in 4 patients, dengue shock syndrome (DSS) alone in 2; DSS/subarachnoid hemorrhage, Klebsiella pneumoniae meningitis/bacteremia, ventilator associated pneumonia, and massive GI bleeding/Enterococcus faecalis bacteremia each in one. Fatal patients were found to have significantly higher frequencies of early altered consciousness (≤24 h after hospitalization), hypothermia, GI bleeding/massive GI bleeding, DSS, concurrent bacteremia with/without shock, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage. Among those experienced early altered consciousness, massive GI bleeding alone/with uremia/with E. faecalis bacteremia, and K. pneumoniae meningitis/bacteremia were each found in one patient. Significantly higher proportion of bandemia from initial (arrival) laboratory data in fatal patients as compared to controls, and higher proportion of pre-fatal leukocytosis and lower pre-fatal platelet count as compared to initial laboratory data of fatal patients were found. Massive GI bleeding (33.3%) and bacteremia (25%) were the major causes of pre-fatal leukocytosis in the deceased patients; 33.3% of the patients with pre-fatal profound thrombocytopenia (<20,000/µL), and 50% of the patients with pre-fatal prothrombin time (PT) prolongation experienced massive GI bleeding. CONCLUSIONS Our report highlights causes of fatality other than DSS in patients with severe dengue, and suggested hypothermia, leukocytosis and bandemia may be warning signs of severe dengue. Clinicians should be alert to the potential development of massive GI bleeding, particularly in patients with early altered consciousness, profound thrombocytopenia, prolonged PT and/or leukocytosis. Antibiotic(s) should be empirically used for patients at risk for bacteremia until it is proven otherwise, especially in those with early altered consciousness and leukocytosis.

Dengue virus infections are a major cause of morbidity in tropical countries. Early detection of dengue hemorrhagic fever (DHF) may help identify individuals that would benefit from intensive therapy. Predictive modeling was performed using 11 laboratory values of 51 individuals (38 DF and 13 DHF) obtained on initial presentation using logistic regression. We produced a robust model with an area under the curve of 0.9615 that retained IL-10 levels, platelets, and lymphocytes as the major predictive features. A classification and regression tree was developed on these features that were 86% accurate on cross-validation. The IL-10 levels and platelet counts were also identified as the most informative features associated with DHF using a Random Forest classifier. In the presence of polymerase chain reaction-proven acute dengue infections, we suggest a complete blood count and rapid measurement of IL-10 can assist in the triage of potential DHF cases for close follow-up or clinical intervention improving clinical outcome.

Eighty-one (71.7%) out of 113 patients had confirmed dengue infection (using ELISA IgM serology) at Kassala, Eastern Sudan during the period of August through November 2010. According to the WHO criteria, dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) were observed in 30.9, 58, and 11.1% of these patients, respectively. The mean age of these 81 patients was 25.5 years. Male:female ratio was 1.8:1. Various symptoms including fever (100%), headache (75.3%), vomiting (55.6%), nausea (53.1%), and backache (30.9%) were observed among these patients. Thrombocytopenia (<100/10(9) platelets/L), and leucopenia (WBC count <4,000 × 10(9) cells/L) and hemoconcentration (hematocrit >45) were reported in 86.4, 69.1, and 67.9% of the patients, respectively. High alanine aminotransferase (ALT,>65 U/L) and aspartate aminotransferase (AST >37 U/L) were seen in 9.9 and 14.8% of the patients, respectively. There were five (6.1%) deaths, three of them had DHF and the other two patients had DSS.

A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after the first episode of shock, she had received an excessive amount of crystalloid isotonic solution and 20 ml per kilograms of Dextran-40 however she still had persistently rapid pulse rate and high hematocrit but also had polyuria with more than 4 ml/kg/hr of urine output. She was re-evaluated. Clinical signs showed severe dehydration with some ascites without signs of pleural effusion. Blood gas revealed increased anion gap metabolic acidosis. The cause of polyuria and metabolic acidosis was identified with hyperglycemia, ketouria and glucosuria. Afterwards she was diagnosed and treated as DHF grade III and DKA. Besides insulin administration, fluid resuscitation was very crucial. Intravenous fluid rehydration was needed while the unnecessary extra-volume could cause massive plasma leakage and later on fluid overload. Volume replacement was adjusted to degree of dehydration when signs of volume overload were monitored closely. She was out of DKA at 14 hours after the start of insulin and the intravenous fluid was stopped at 27 hours (36 hours after the first episode of shock). The final diagnosis was DHF grade III, diabetes mellitus with DKA and hepatitis.

BACKGROUND Dengue virus infection is an important mosquito-borne disease with the reported 40,000-100,000 cases per year in Thailand. Shock is one of the common presentations at the emergency room (ER) and dengue shock syndrome (DSS) is among the common causes of shock. Proper and timely management of DSS determines the outcomes and prognosis of DSS patients. OBJECTIVE To find the prevalence of DSS at the ER and evaluate the medical management and risk factors associated with the outcome of DSS patients. MATERIAL AND METHOD A retrospective study on patients who presented with shock, including DSS patients at the ER of Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand, from 1st January 2008 to 31st December 2009 was done. The prevalence of patients who presented with shock at the ER was retrieved from the Statistical and Information Technology Departments. Out-patient cards and In-patient charts of DSS patients were reviewed. Clinical and laboratory data were compared between recovered and death cases. Statistical analysis was done by using SPSS version 14.0. RESULTS There were 109 shock patients seen at the ER during the present study period with 59 DSS (54.1%), 30 septic shock (27.5%), 13 hypovolemic shock (11.9%), 1 cardiogenic shock (0.9%) and 6 other non-specific shock (5.5%). DSS cases were found all year round with the peak prevalence from June to August which is the rainy season. Twenty-six of DSS (44.1%) were referred cases and 5 of them died, case fatality rate was 8.8%. All death cases had prolonged shock, massive bleeding and liver failure at presentation while these findings were found in 2 (4.4%), 16 (35.6%) and 10 (22.2%) cases of recovered cases. Encephalopathy, renal failure and respiratory failure were found in 80, 60 and 60% of the death cases while in recovered cases they were found in 11.1, 4.4 and 2.2%. Acidosis was found higher in the death group (60%) than in recovered group (8.9%). Other common presenting findings in death and recovered groups were bleeding (35.6 vs 100.0%), fluid over load (31.1 vs. 80%), hyponatremia (40% for both groups) and hypocalcemia (83.3 vs. 80%). Among the 45 recovered cases; 3 cases were misdiagnosed and another 8 cases (17.8%) received no i.v. fluid at the ER. Cross matching was done in 32 cases (64%) and blood was transfused in 16 cases (50% of the cross matching). CONCLUSION DSS is the most common shock found at the ER especially during June to August. ER physicians should be alert for making the correct diagnosis of DSS with proper intravenous fluid resuscitation and correction of the common complications/laboratory abnormalities, i.e. acidosis, hyponatremia, hypocalcemia and cross matching for massive bleeding. A referred case with liver failure together with renal and respiratory failure was likely associated with mortality while fluid overload and significant bleeding do not if they are managed properly. Early signs of shock should be detected in walk in cases to prevent later shock after admission.

Dengue virus (DENV) circulates in human and sylvatic cycles. Sylvatic strains are both ecologically and evolutionarily distinct from endemic viruses. Although sylvatic dengue cycles occur in West African countries and Malaysia, only a few cases of mild human disease caused by sylvatic strains and one single case of dengue hemorrhagic fever in Malaysia have been reported. Here we report a case of dengue hemorrhagic fever (DHF) with thrombocytopenia (13000/µl), a raised hematocrit (32% above baseline) and mucosal bleeding in a 27-year-old male returning to Spain in November 2009 after visiting his home country Guinea Bissau. Sylvatic DENV-2 West African lineage was isolated from blood and sera. This is the first case of DHF associated with sylvatic DENV-2 in Africa and the second case worldwide of DHF caused by a sylvatic strain.

BACKGROUND Worldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). We explored whether proteinuria could be used as such a marker. METHODS We included patients admitted to hospital with suspected dengue fever. Starting at enrollment until discharge, each patient's daily spot urine protein creatinine ratio (UPCR) was measured. We classified those with confirmed dengue infection as DF or DHF (including DSS) based on WHO criteria. Peak and day of onset of proteinuria was compared between both groups. RESULTS Compared to those with DF, patients with DHF had significantly higher median peak proteinuria levels (0.56 versus 0.08 g/day; p < 0.001). For patients with DHF, the median day of onset of proteinuria was at 6 days of defervescence, with a range of -2 to +3 days after defervescence. There were three patients with DF who did not have proteinuria during their illness; the five remaining patients with DF had a median day of onset of proteinuria of was at 6 days of defervescence with a range of 0 to +28 days. CONCLUSIONS Peak UPCR could potentially predict DHF in patients with dengue requiring close monitoring and treatment.

INTRODUCTION Dengue is the most important mosquito-borne disease in Sri Lanka, leading to more than 340 deaths during the last outbreak (˜35,000 reported cases) starting in mid April 2009. The predominant dengue virus serotypes during the last few years have been DENV-2 and DENV-3. Dengue infection in pregnancy carries the risk of hemorrhage for both the mother and the newborn. Other risks include premature birth, fetal death, and vertical transmission. We report clinical and laboratory findings and outcomes in pregnant women hospitalized with dengue infection during pregnancy. METHODOLOGY Clinical, laboratory, maternal/fetal outcomes and demographic data were collected from patients with confirmed dengue infections during pregnancy treated at De Soysa Maternity Hospital, Sri Lanka from 1 May 2009 to 31 December 2009. RESULTS  Fifteen seropositive dengue infected pregnant women were diagnosed in the period. Multiorgan failure leading to intrauterine fetal and maternal death occurred in one case of dengue hemorrhagic fever (DHF) IV. One patient with DHF III had a miscarriage at the 24th week of gestation. Perinatal outcomes of the other cases were satisfactory. One woman developed dengue myocarditis but recovered with supportive treatments. No cases of perinatal transmission to the neonate occurred. CONCLUSION Dengue in pregnancy requires early diagnosis and treatment. A high index of clinical suspicion is essential in any pregnant woman with fever during epidemic. Further studies are mandatory as evidence-based data in the management of dengue specific for pregnancy are sparse.

Arboviruses continue to be a significant source of disease, especially in regions where their insect hosts are endemic. This article highlights these diseases, with particular focus on dengue, yellow fever, and viral hemorrhagic fever. A general background is provided, as well information concerning diagnosis and treatment.

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To provide a comprehensive review of dengue, with an emphasis on clinical syndromes, classification, diagnosis, and management, and to outline relevant aspects of epidemiology, immunopathogenesis, and prevention strategies. Dengue, a leading cause of childhood mortality in Asia and South America, is the most rapidly spreading and important arboviral disease in the world and has a geographic distribution of > 100 countries. Boolean searches were carried out by using PubMed from 1975 to March 2009 and the Cochrane Database of Systematic Reviews from 1993 to March 2009 to identify potentially relevant articles by key search terms such as:"dengue";"dengue fever";"dengue hemorrhagic fever";"dengue shock syndrome";"severe dengue" and "immunopathogenesis," pathogenesis,""classification,""complications," and "management." In addition, authoritative seminal and up-to-date reviews by experts were used. Original research and up-to-date reviews and authoritative reviews consensus statements relevant to diagnosis and therapy were selected. We considered the most relevant articles that would be important and of interest to the critical care practitioner as well as authoritative consensus statements from the World Health Organization and the Centers for Disease Control and Prevention. Dengue viral infections are caused by one of four single-stranded ribonucleic acid viruses of the family Flaviviridae and are transmitted by their mosquito vector, Aedes aegypti. The clinical syndromes caused by dengue viral infections occur along a continuum; most cases are asymptomatic and few present with severe forms characterized by shock. Management is predominantly supportive and includes methods to judiciously resolve shock and control bleeding while at the same time preventing fluid overload. Dengue is no longer confined to the tropics and is a global disease. Treatment is supportive. Outcomes can be optimized by early recognition and cautious titrated fluid replacement, especially in resource-limited environments.

Dengue infection, one of the most devastating mosquito-borne viral diseases in humans, is now a significant problem in several tropical countries. The disease, caused by the four dengue virus serotypes, ranges from asymptomatic infection to undifferentiated fever, dengue fever (DF), and severe dengue hemorrhagic fever (DHF) with or without shock. DHF is characterized by fever, bleeding diathesis and a tendency to develop a potentially fatal shock syndrome. Consistent hematological findings include vasculopathy, coagulopathy, and thrombocytopenia. There are increasing reports of dengue infection with unusual manifestations that mainly involve cerebral and hepatic symptoms. Laboratory diagnosis includes virus isolation, serology, and detection of dengue ribonucleic acid. Successful treatment, which is mainly supportive, depends on early recognition of the disease and careful monitoring for shock. Prevention depends primarily on control of the mosquito vector. Further study of the pathogenesis of DHF is required for the development of a safe and effective dengue vaccine.

During the past two decades, epidemics of dengue fever have been causing concern in several South-East Asian countries, including India. A study was conducted in a tertiary care hospital situated in Southern India to determine the trends and outcome of dengue cases. There was a steady rise in number of cases from 2002 to 2007, with the largest number of cases seen in 2007. Most cases were observed in the post-monsoon season in the month of September. Out of a total of 344 cases, 285 (82.8%) patients had dengue fever, 34 (9.8%) had dengue haemorrhagic fever and 25 (7.3%) had dengue shock syndrome. Deaths were reported in nine cases, with the majority of deaths occurring in 2003. The disease control programme should emphasise on vector surveillance, integrated vector control, emergency response, early clinical diagnosis and appropriate management of the cases.