Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.
<h4>Background</h4>Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue t...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-12-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0010091 |
| _version_ | 1811296399155789824 |
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| author | Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne |
| author_facet | Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne |
| author_sort | Champica K Bodinayake |
| collection | DOAJ |
| description | <h4>Background</h4>Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future.<h4>Methods/principal findings</h4>From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization.<h4>Conclusions</h4>One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries. |
| first_indexed | 2024-04-13T05:48:49Z |
| format | Article |
| id | doaj.art-c168028a18de4e188ea24c4e46a4e7d6 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-04-13T05:48:49Z |
| publishDate | 2021-12-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-c168028a18de4e188ea24c4e46a4e7d62022-12-22T02:59:53ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352021-12-011512e001009110.1371/journal.pntd.0010091Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.Champica K BodinayakeAjith DeS NagahawatteVasantha DevasiriNiroshana J DahanayakeGaya B WijayaratneNayani P WeerasingheMadureka PremamaliTianchen ShengBradly P NicholsonHarshanie A UbeysekeraRuvini Mp KurukulasooriyaAruna D de SilvaTruls ØstbyeChristopher W WoodsL Gayani Tillekeratne<h4>Background</h4>Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future.<h4>Methods/principal findings</h4>From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization.<h4>Conclusions</h4>One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries.https://doi.org/10.1371/journal.pntd.0010091 |
| spellingShingle | Champica K Bodinayake Ajith DeS Nagahawatte Vasantha Devasiri Niroshana J Dahanayake Gaya B Wijayaratne Nayani P Weerasinghe Madureka Premamali Tianchen Sheng Bradly P Nicholson Harshanie A Ubeysekera Ruvini Mp Kurukulasooriya Aruna D de Silva Truls Østbye Christopher W Woods L Gayani Tillekeratne Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. PLoS Neglected Tropical Diseases |
| title | Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
| title_full | Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
| title_fullStr | Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
| title_full_unstemmed | Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
| title_short | Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden. |
| title_sort | outcomes among children and adults at risk of severe dengue in sri lanka opportunity for outpatient case management in countries with high disease burden |
| url | https://doi.org/10.1371/journal.pntd.0010091 |
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