Teparrukkul Prapit, Hantrakun Viriya, Day Nicholas P J, West T Eoin, Limmathurotsakul Direk
Medical department, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand.
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
PLoS One. 2017 Apr 24;12(4):e0176233. doi: 10.1371/journal.pone.0176233. eCollection 2017.
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.
登革热是热带国家成年人感染的常见原因。脓毒症是由任何生物体感染引起的全身表现综合征，包括细菌、真菌和病毒病原体。在此，我们在泰国一项关于社区获得性脓毒症的前瞻性研究中，调查了出现脓毒症的登革热患者的诊断、管理和结局。
2015年6月至12月，对874名成年患者（年龄≥18岁）进行评估，这些患者疑似或确诊为社区获得性感染，根据2012年拯救脓毒症运动有≥3项脓毒症诊断标准，且在入院24小时内。储存血清，随后进行登革热PCR检测。
共有126名患者登革热PCR检测呈阳性（2例登革病毒1型，12例登革病毒2型，24例登革病毒3型和88例登革病毒4型），其中5例（4%）死亡。我们发现，主治医生在入院时怀疑84例患者（67%）感染登革热，并将96例患者（76%）的登革热感染记录为最终诊断。5例死亡病例中有4例被诊断并治疗为非登革热所致的感染性休克。在多变量分析中有一种趋势表明，年龄≥60岁、低氧血症和主治医生对登革热的误诊与28天死亡率相关。
一些死于登革热的成年患者被误诊为严重脓毒症和感染性休克。仅根据临床特征诊断登革热很困难。在热带国家，对于出现脓毒症和感染性休克的成年患者，可能需要常规使用登革热快速诊断检测。这种方法可以改善这些患者的诊断和管理。
