Lovera Dolores, Martínez-Cuellar Celia, Galeano Fernando, Amarilla Sara, Vazquez Cynthia, Arbo Antonio
Department of Pediatrics, Institute of Tropical Medicine, Asuncion, Paraguay.
Central Laboratory of Public Health, Asuncion, Paraguay.
J Infect Dev Ctries. 2019 Dec 31;13(12):1127-1134. doi: 10.3855/jidc.11584.
Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity.
We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1).
Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05).
The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.
登革病毒（DENV）感染目前是全球发病的主要原因，在过去几年中，其发病率在包括巴拉圭在内的拉丁美洲主要呈上升趋势。本研究的目的是比较登革热的临床和实验室检查结果，并评估血清型是否为严重程度的危险因素。
我们纳入了2007年至2018年在巴拉圭热带医学研究所住院的15岁及以下登革热患者。患者根据2009年世界卫生组织登革热分类指南进行分类，并根据血清型按住院时间分为三组：2007年疫情（DENV-3）、2012 - 2013年疫情（DENV-2）和2016 - 2018年疫情（DENV-1）。
在784名因登革热住院的儿童中，50例（6.3%）由DENV-3引起，471例（60%）由DENV-2引起，263例（33.5%）由DENV-1引起。肌痛和头痛与DENV-3病例相关，腹痛与DENV-2病例相关。出血主要在DENV-1和2病例中观察到。DENV-2感染患者病情更严重，更频繁地需要液体复苏，且更常出现休克和入住重症监护病房。登革热二代病例比一代病例更严重。与DENV-3或DENV-1感染病例（分别为2.9±1.6天和4.36±2.7天）相比，DENV-2感染患者住院时间更长（5.1±2.8天）（p<0.05）。
DENV血清型对登革热的临床表现和严重程度有深远影响。DENV-2感染更频繁地与液体复苏需求、休克和更长住院时间相关。
