¿Por qué y cómo mueren los niños con dengue?

Abstract

Introduction: It is important to find out how the patients with dengue become critical and die, with a view to designing the mortality prevention strategies. Objective: to identify the death- associated conditions (complications and other clinical situations) as well as the specific type of damage observed in some body organs. Methods: A clinical-pathological study of 30 dead children with dengue in El Salvador was performed from 1999 to 2000. All the cases met the WHO clinical and humoral criteria for being classified as either dengue hemorrhagic fever or dengue shock syndrome. Through the analysis of daily and hourly evolution of each case, the research team identified the clinical or the clinical-humoral condition that was associated to the death of a patient. The autopsies of 8 serology- or immunohistochemistry-confirmed cases were studied. Results: In 20 (83 %) of 24 cases that died in the first three days of admission, the associated condition was hypovolemic shock, sometimes related to hemorrhage, disseminated intravascular coagulation, respiratory distress caused by non-cardiogenic pulmonary edema and multiple organ damage, all of which were recurrent shock complications rather than dengue complications. The bacterial co-infection was the most frequent condition associated to death of children with dengue after the third day of hospitalization. The autopsies showed considerable damage of liver, heart and kidneys. Conclusion: Death from dengue is generally preventable if hypovolemic shock is either prevented or treated timely and energetically using intravenously administered crystalloid preparations at the time of detecting alarming signs that would indicate the onset of clinical deterioration of the patient with dengue.