Mendoza-Hernandez Martha A, Diaz-Martinez Janet, Hernández-Fuentes Gustavo A, Rojas-Larios Fabian, Cárdenas-Cárdenas Katya A, García de León-Flores Paulina, Rojas-Cruz David A, Aceves-Calvario Roberto, Gómez-Sandoval Ernesto, Árciga-García Montserrat, Guzmán-Esquivel José, Melnikov Valery, Espinoza-Gómez Francisco, Delgado-Enciso Iván
Hospital General de Manzanillo IMSS-Bienestar, Av. Elías Zamora Verduzco S/N, Nuevo Salagua, Manzanillo City 28869, Mexico.
Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico.
Viruses. 2025 Jul 4;17(7):950. doi: 10.3390/v17070950.
Dengue mortality has traditionally been associated with severe thrombocytopenia and hemorrhagic complications. However, during 2024, dengue virus serotype 3 (DENV-3) increased significantly in western Mexico, leading to the emergence of a distinct clinical pattern. We conducted a retrospective cohort study of hospitalized dengue patients at the General Hospital of Colima (January-August 2024). Clinical features, laboratory parameters, and outcomes were compared between survivors and non-survivors. Among 201 hospitalized patients, 6 (3.0%) died. All deceased patients presented with generalized seizures, polyserositis (pleural effusion and/or ascites), and required mechanical ventilation. Contrary to classical patterns, they did not have severe thrombocytopenia. Instead, they showed significantly higher white blood cell counts and notably increased levels of serum urea and BUN, suggesting early renal impairment. ROC analysis indicated that BUN (AUC 0.904) and urea (AUC 0.906) were good to excellent discriminators of mortality. During 2024, with an increase in DENV-3 circulation, mortality was associated with neurological and systemic complications, including seizures and polyserositis, as well as biochemical evidence of renal dysfunction-but not with severe thrombocytopenia. These findings challenge current paradigms and highlight the need for early recognition of atypical clinical patterns.
登革热死亡率传统上与严重血小板减少症和出血并发症相关。然而，在2024年期间，墨西哥西部登革热病毒3型（DENV-3）显著增加，导致一种独特临床模式的出现。我们对科利马综合医院（2024年1月至8月）的住院登革热患者进行了一项回顾性队列研究。比较了幸存者和非幸存者的临床特征、实验室参数及结局。在201名住院患者中，6人（3.0%）死亡。所有死亡患者均出现全身性癫痫发作、多浆膜炎（胸腔积液和/或腹水），并需要机械通气。与经典模式相反，他们没有严重血小板减少症。相反，他们的白细胞计数显著更高，血清尿素和血尿素氮水平明显升高，提示早期肾功能损害。ROC分析表明，血尿素氮（AUC 0.904）和尿素（AUC 0.906）是死亡率的良好至优秀判别指标。在2024年期间，随着DENV-3传播增加，死亡率与神经和全身并发症相关，包括癫痫发作和多浆膜炎，以及肾功能不全的生化证据，但与严重血小板减少症无关。这些发现挑战了当前的范式，并突出了早期识别非典型临床模式的必要性。
