Risk Factors for Severe Dengue

Factor risk of severe dengue need identified by doctor since early so that the doctor could plan proper management and avoidance complications. Dengue is a most common arboviral disease found in the world. In degrees severe where plasma leakage is severe and shock has happened, disease this could cause death.

In Indonesia, the rate incident Fever Dengue Hemorrhagic Fever (DHF) is increasing in 50 years last. In 2021, there will be 73,518 cases of dengue and 705 deaths related to dengue. In 2022 (up to 15th week), already there were 34,503 cases of dengue and 350 deaths related to dengue. [1]

Classification conventional dengue fever that has been used since the 1970s already revised by the World Health Organization (WHO) in 2009. Previously, dengue was divided into on four categories, that is non- classical dengue fever, classic dengue fever, DHF, and Dengue Shock Syndrome (DSS). Then, the WHO revision classifies dengue fever only as non- severe and severe dengue fever. [2-4]

severe dengue then distinguished become dengue with sign danger and dengue without sign danger. Classification this based on degree severity dengue clinical for simplify administration, reporting, and surveillance. [3]

Journey dengue clinical degrees light to degrees heavy often difficult predictable, so doctor need beware factors the risk to the patient since early. Suspected factor is predictor of severe dengue is comorbidity, coinfection, and age patient. Various studies have conducted for prove there is whether or not connection Among factors this with severe dengue incidence. [2,3]

 

Comorbidity

Sangkaew et al did review systematic of 150 studies and meta- analyses of 122 studies that discussed 25 factors predictor dengue severity. Results show that disease chronic such as diabetes, hypertension, disease kidney and disease heart can increase risk of severe dengue up to 2–4 times as much. [5]

Tsheten et al also performed a meta- analysis of 143 studies that studied factor risk of severe dengue. Factor risk progressivity to severe dengue is secondary dengue infection (OR 3.23; 95%CI 2.28–4.57), comorbid diabetes (OR 2.88; 95%CI 1.72–4.81), and kidney (OR 4.54; 95%CI 1.55–13.31). [6]

However, the result second meta- analysis this need interpreted by be careful because existence heterogeneity and publication bias level medium-high in the analyzed studies. Study this is n't it yet could identify is there is role of viremia, viral serotype, and factors genetics for predict severity dengue. [5,6]

Somebody with comorbidity risky taller for have severe dengue because herself possible experience endotoxemia level low grade endotoxemia, dysbiosis gut microbes, and changes phenotype cell immune default. Lipid mediators that are Immunosuppressive and proinflammatory as well as phenotype altered monocytes can influence T cells and B cells, which then disturb system immune adaptive against viruses. [11]

 

Coinfection

worry about impact dengue coinfection with Other viral diseases have also been studied. Irekeola et al did review systematic against 83 trials involving 43,341 patients for knowing impact dengue and chikungunya coinfection. The global prevalence of dengue and chikungunya coinfection is known reach 2.5% with proportion case the most found in Asia. [7]

Manifestation disease heavy suspected more often happened in the case dengue and chikungunya coinfection. However, evidence moment this hint that level severity patient coinfection no different mean with patient monoinfection. [7]

Besides symptom classic dengue, there are also concerns about happening manifestation better neurologic and hemorrhagic weight on case coinfection. Besides that, chronic arthritis persistent and disruptive cognitive is also worried happens to the patient dengue and chikungunya coinfection. However, study prospective advanced about connection coinfection and degree severity clinical disease still required. [7]

COVID-19 in dengue hyperendemic areas also participates Becomes issue health that starts noticed. However, some big existing evidence about dengue and COVID-19 coinfection only in the form of report case from Argentina, Indonesia, India, Brazil, France, Pakistan, and Thailand. [8]

Majority dengue and COVID-19 coinfection were found in adults. Complications from Dengue coinfection and COVID-19 can cover shock septicemia, respiratory distress syndrome, and multiorgan failure. Dead reported occurs in 6 out of 16 cases reported coinfection in analysis Tsheten et al. [8]

Something reports case in Bandung by Alam et al describe a baby 10 months old experiencing COVID-19 and dengue coinfection. the baby experience complications serious, namely severe COVID-19 with dengue accompanied by shock and disseminated intravascular coagulation (DIC). [12]

 

Age Patient

According to various existing studies, figures Dead due to dengue age follow bimodal pattern, which is highest at age children and age old. Meta analysis Tsheten et al of 143 studies that studied factor risk of severe dengue report that age children is one factor risk of severe dengue (OR: 1.96; 95%CI: 1.22–3.13). Age children in meta-analysis this defined as age <20 years. [6]

Studies Retrospectively by Hegazi et al on 17,646 dengue cases also reported that population child (age 18 years) has risk more significant for experience progressivity to severe dengue (OR: 1.96; 95%CI: 1.45–2.65: P < 0.0001). [9]

According to data from the Indonesian Ministry of Health in 2020, the proportion of the highest dengue mortality is in children 5–14 years old then followed with child ages 1-4 years. Proportion deaths per group age is as following:

Age <1 year : 10.32%

Age 1-4 years : 28.57%

Age 5–14 years : 34.13%

Age 15–44 years : 15.87%

Age >44 years : 11.11 %[13]

According to studies cohort retrospectively by Fonseca- Portilla et al of 24,495 patients in Mexico, patients dengue fever aged <10 years and aged >60 years have risk more tall for experience complications. Complications in the group age old possible related with a lot comorbidities, such as diabetes, hypertension, cirrhosis, suppression system immunity and disease kidney chronic. [10]

 

Conclusion

Dengue has journey dynamic disease, so that identification factor risk of severe dengue plays a role important in determine monitoring and management more continued. Factor risk of severe dengue estimated could in the form of age child, age advanced, and comorbidities chronic such as diabetes, disease kidney, hypertension, and disease heart.

Coinfection with disease others, such as COVID-19 or chikungunya, are also suspected can Becomes factor risk of severe dengue. However, the available evidence moment this still limited and study more carry on still required for confirmation.

Remember journey dengue clinical difficult predictable, prevention permanent be the main strategy in dengue management.

 

References

1.     Kementrian Kesehatan Republik Indonesia. Informasi Ringkas Dengue. 2022. http://ptvz.kemkes.go.id/berita/situasi-dengue-dbd-di-indonesia-pada-minggu-ke-15-tahun-2022.

2.     Wilder-Smith A, Ooi EE, Horstick O, et al. Dengue. Lancet. 2019;393(10169):350–63. doi: 10.1016/S0140-6736(18)32560-1

3.     World Health Organization. Dengue Guidelines For Diagnosis, Treatment, Prevention And Control: New Edition. World Health Organization; 2009. https://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf

4.     Ajlan BA, Alafif MM, Alawi MM, et al. Assessment Of The New World Health Organization’s Dengue Classification For Predicting Severity Of Illness And Level Of Healthcare Required. PLoS Negl Trop Dis. 2019;13(8):1–16.

5.     Sangkaew S, Ming D, Boonyasiri A, et al. Risk Predictors Of Progression To Severe Disease During The Febrile Phase Of Dengue: A Systematic Review and Meta-Analysis. Lancet Infect Dis. 2021;21(7):1014–26. http://dx.doi.org/10.1016/S1473-3099(20)30601-0

6.     Tsheten T, Clements ACA, Gray DJ, et al. Clinical Predictors Of Severe Dengue: A Systematic Review And Meta-Analysis. Infect Dis Poverty. 2021;10(1):1–10. https://doi.org/10.1186/s40249-021-00908-2

7.     Irekeola AA, Engku Nur Syafirah EAR, Islam MA, et al. Global Prevalence Of Dengue And Chikungunya Coinfection: A Systematic Review And Meta-Analysis Of 43,341 Participants. Acta Trop. 2022;231:106408. https://linkinghub.elsevier.com/retrieve/pii/S0001706X22001061

8.     Tsheten T, Clements ACA, Gray DJ, et al. Clinical Features And Outcomes Of COVID-19 And Dengue Co-Infection: A Systematic Review. BMC Infect Dis. 2021;21(1):1–9.

9.     Hegazi MA, Bakarman MA, Alahmadi TS, et al. Risk Factors and Predictors of Severe Dengue in Saudi Population in Jeddah, Western Saudi Arabia: A Retrospective Study. Am J Trop Med Hyg. 2020 Mar;102(3):613-621. doi: 10.4269/ajtmh.19-0650

10. Fonseca-Portilla R, Martínez-Gil M, Morgenstern-Kaplan D. Risk factors for hospitalization and mortality due to dengue fever in a Mexican population: a retrospective cohort study. Int J Infect Dis. 2021 Sep;110:332-336. doi: 10.1016/j.ijid.2021.07.062

11. Malavige GN, Jeewandara C, Ogg GS. Dysfunctional Innate Immune Responses and Severe Dengue. Front Cell Infect Microbiol. 2020;10:590004. doi:10.3389/fcimb.2020.590004

12. Alam A, Sudarwati S, Hakim DDL, Mahdiani S. Case Report: Severe COVID-19 and Dengue in an Indonesian Infant. Am J Trop Med Hyg. 2021;104(4):1456-1460. doi:10.4269/ajtmh.20-1244

13. Kementerian Kesehatan Republik Indonesia. Data Kasus Terbaru DBD di Indonesia. 2020. https://sehatnegeriku.kemkes.go.id/baca/umum/20201203/2335899/data-kasus-terbaru-dbd-indonesia/