Dengue en adultos
Diagnóstico, tratamiento y abordaje de situaciones especiales
Palabras clave:
DENGUE, DENGUE GRAVEResumen
El virus dengue pertenece a la familia Flaviviridae, es transmitido entre humanos en general por mosquitos del género Aedes. Uruguay estuvo libre de la enfermedad de adquisición autóctona en los últimos 100 años. En febrero del año 2016 se produjo la confirmación de los primeros casos autóctonos en Montevideo y con ello evidencia de un brote local. El objetivo de este trabajo es revisar los aspectos prácticos del manejo clínico de los pacientes con dengue presuntivo o confirmado, contribuyendo así a la discusión del tema y a la formación del equipo de salud en nuestro país. Se revisan desde un punto de vista práctico los aspectos clínicos de presentación de la infección, clasificación, diagnóstico de laboratorio, manejo inicial, y situaciones especiales como embarazo y comorbilidades.
Citas
(1) Simmons CP, Farrar JJ, Nguyen vV, Wills B. Dengue. N Engl J Med 2012; 366(15)):1423-32.
(2) Uruguay. Ministerio de Salud Pública. Dirección general de Salud. División Epidemiologia. Plan de respuesta nacional ante una epidemia de enfermedades transmitidas por Aedes Aegypti: version febrero 2016. Montevideo: MSP, 2016. Disponible en: http://www.msp.gub.uy/sites/default/files/archivos_adjuntos/MSP-Plan%20de%20Respuesta%20Aedes%20Aegypti-OR%281%29.pdf. Consulta: 20 marzo 2016.
(3) de Castro MG, de Nogueira FB, Nogueira RM, Lourenço-de-Oliveira R, dos Santos FB. Genetic variation in the 3’ untranslated region of dengue virus serotype 3 strains isolated from mosquitoes and humans in Brazil. Virol J 2013; 10:3.
(4) Rivera-Osorio P, Vaughan G, Ramírez-González JE, Fonseca-Coronado S, Ruíz-Tovar K, Cruz-Rivera MY, et al. Molecular epidemiology of autochthonous dengue virus strains circulating in Mexico. J Clin Microbiol 2011; 49(9):3370-4.
(5) World Health Organization. Dengue guidelines for diagnosis, treatment, prevention and control. 3rd ed. Geneva: WHO, 2009.
(6) Organización Panamericana de la Salud. Dengue: guías de atención para enfermos en la región de las Américas. La Paz, Bolivia: OPS, 2010.
(7) Argentina. Ministerio de Salud. Enfermedades Infecciosas: Dengue, diagnóstico de dengue: guía para el equipo de salud 2. 3 ed. Buenos Aires: Ministerio de Salud, 2013.
(8) Dalrymple NA, Mackow ER. Endothelial cells elicit immune-enhancing responses to dengue virus infection. J Virol 2012; 86(12):6408-15.
(9) Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Dengue: diagnóstico e manejo clínico: adulto e criança. 5 ed. Brasília: Ministério da Saúde, 2016.
(10) Leo YS, Gan VC, Ng EL, Hao Y, Ng LC, Pok KY, et al. Utility of warning signs in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis 2013; 13:498.
(11) Thein TL, Gan VC, Lye DC, Yung CF, Leo YS. Utilities and limitations of the World Health Organization 2009 warning signs for adult dengue severity. PLoS Negl Trop Dis 2013; 7(1):e2023.
(12) Lye DC, Lee VJ, Sun Y, Leo YS. The benign nature of acute dengue infection in hospitalized older adults in Singapore. Int J Infect Dis 2010; 14(5):e410-3.
(13) Jaenisch T, Tam DT, Kieu NT, Van Ngoc T, Nam NT, Van Kinh N, et al. Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries. BMC Infect Dis 2016; 16(1):120.
(14) Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, Hung NT, et al; European Union, World Health Organization (WHO TDR) supported DENCO Study Group. Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health 2011; 16(8):936-48.
(15) Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, et al. Evaluation of commercially available diagnostic tests for the detection of dengue virus NS1 antigen and anti-dengue virus IgM antibody. PLoS Negl Trop Dis 2014; 8(10):e3171.
(16) Dussart P, Labeau B, Lagathu G, Louis P, Nunes MR, Rodrigues SG, et al. Evaluation of an enzyme immunoassay for detection of dengue virus NS1 antigen in human serum. Clin Vaccine Immunol 2006; 13(11):1185-9.
(17) Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, et al. Evaluation of commercially available anti-dengue virus immunoglobulin M tests. Emerg Infect Dis 2009; 15(3):436-40.
(18) Mitra S, Choudhari R, Nori H, Abhilash KP, Jayaseelan V, Abraham AM, et al. Comparative evaluation of validity and cost-benefit analysis of rapid diagnostic test (RDT) kits in diagnosis of dengue infection using composite reference criteria: a cross-sectional study from south India. J Vector Borne Dis 2016; 53(1):30-6.
(19) Hunsperger EA, Muñoz-Jordán J, Beltran M, Colón C, Carrión J, Vazquez J, et al. The Performance of Dengue Diagnostic Tests in a Single-Specimen Diagnostic Algorithm. J Infect Dis 2016; pii: jiw103. Epub ahead of print.
(20) Romero-Santacruz E, Lira-Canul JJ, Pacheco-Tugores F, Palma-Chan AG. Neonatal Dengue. Presentation of clinical cases. Ginecol Obstet Mex 2015; 83(5): 308-15.
(21) Adam I, Jumaa AM, Elbashir HM, Karsany MS. Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan. Virol J 2010; 7:153.
(22) Pouliot SH, Xiong X, Harville E. Maternal dengue and pregnancy outcomes: a systematic review. Obstet Gynecol Surv 2010; 65(2):107-18.
(23) Salgado DM, Rodríguez JA, Lozano L del P, Zabaleta TE. Dengue perinatal. Biomédica 2013; 33(Supl 1):14-21.
(24) Chitra TV, Panicker S. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis 2011; 48(4):210-3.
(25) Paixão ES, Teixeira MG, Costa MD, Rodrigues LC. Dengue during pregnancy and adverse fetal outcomes: a systematic review and meta-analysis. Lancet Infect Dis 2016; pii:S1473-3099(16)00088-8. Epub ahead of print.
(26) McGready R, Hamilton KA, Simpson JA, Cho T, Luxemburger C, Edwards R, et al. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg 2001; 65(4):285-9.
(27) Pesaro AE, D’Amico E, Aranha LFC. Dengue: manifestações cardíacas e implicações na terapéutica antitrombótica. Arq Bras Cardiol 2007; 89(2):e12-5.
(28) Verdeal JC, Costa Filho R, Vanzillotta C, Macedo GL, Bozza FA, Toscano L, et al. Guidelines for the management of patients with severe forms of dengue. Rev Bras Ter Intensiva 2011; 23(2):125-33.
(29) Lee TH, Wong JG, Leo YS, Thein TL, Ng EL, Lee LK, et al. Potential Harm of Prophylactic Platelet Transfusion in Adult Dengue Patients. PLoS Negl Trop Dis 2016; 10(3):e0004576.
(2) Uruguay. Ministerio de Salud Pública. Dirección general de Salud. División Epidemiologia. Plan de respuesta nacional ante una epidemia de enfermedades transmitidas por Aedes Aegypti: version febrero 2016. Montevideo: MSP, 2016. Disponible en: http://www.msp.gub.uy/sites/default/files/archivos_adjuntos/MSP-Plan%20de%20Respuesta%20Aedes%20Aegypti-OR%281%29.pdf. Consulta: 20 marzo 2016.
(3) de Castro MG, de Nogueira FB, Nogueira RM, Lourenço-de-Oliveira R, dos Santos FB. Genetic variation in the 3’ untranslated region of dengue virus serotype 3 strains isolated from mosquitoes and humans in Brazil. Virol J 2013; 10:3.
(4) Rivera-Osorio P, Vaughan G, Ramírez-González JE, Fonseca-Coronado S, Ruíz-Tovar K, Cruz-Rivera MY, et al. Molecular epidemiology of autochthonous dengue virus strains circulating in Mexico. J Clin Microbiol 2011; 49(9):3370-4.
(5) World Health Organization. Dengue guidelines for diagnosis, treatment, prevention and control. 3rd ed. Geneva: WHO, 2009.
(6) Organización Panamericana de la Salud. Dengue: guías de atención para enfermos en la región de las Américas. La Paz, Bolivia: OPS, 2010.
(7) Argentina. Ministerio de Salud. Enfermedades Infecciosas: Dengue, diagnóstico de dengue: guía para el equipo de salud 2. 3 ed. Buenos Aires: Ministerio de Salud, 2013.
(8) Dalrymple NA, Mackow ER. Endothelial cells elicit immune-enhancing responses to dengue virus infection. J Virol 2012; 86(12):6408-15.
(9) Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Dengue: diagnóstico e manejo clínico: adulto e criança. 5 ed. Brasília: Ministério da Saúde, 2016.
(10) Leo YS, Gan VC, Ng EL, Hao Y, Ng LC, Pok KY, et al. Utility of warning signs in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis 2013; 13:498.
(11) Thein TL, Gan VC, Lye DC, Yung CF, Leo YS. Utilities and limitations of the World Health Organization 2009 warning signs for adult dengue severity. PLoS Negl Trop Dis 2013; 7(1):e2023.
(12) Lye DC, Lee VJ, Sun Y, Leo YS. The benign nature of acute dengue infection in hospitalized older adults in Singapore. Int J Infect Dis 2010; 14(5):e410-3.
(13) Jaenisch T, Tam DT, Kieu NT, Van Ngoc T, Nam NT, Van Kinh N, et al. Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries. BMC Infect Dis 2016; 16(1):120.
(14) Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, Hung NT, et al; European Union, World Health Organization (WHO TDR) supported DENCO Study Group. Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health 2011; 16(8):936-48.
(15) Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, et al. Evaluation of commercially available diagnostic tests for the detection of dengue virus NS1 antigen and anti-dengue virus IgM antibody. PLoS Negl Trop Dis 2014; 8(10):e3171.
(16) Dussart P, Labeau B, Lagathu G, Louis P, Nunes MR, Rodrigues SG, et al. Evaluation of an enzyme immunoassay for detection of dengue virus NS1 antigen in human serum. Clin Vaccine Immunol 2006; 13(11):1185-9.
(17) Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, et al. Evaluation of commercially available anti-dengue virus immunoglobulin M tests. Emerg Infect Dis 2009; 15(3):436-40.
(18) Mitra S, Choudhari R, Nori H, Abhilash KP, Jayaseelan V, Abraham AM, et al. Comparative evaluation of validity and cost-benefit analysis of rapid diagnostic test (RDT) kits in diagnosis of dengue infection using composite reference criteria: a cross-sectional study from south India. J Vector Borne Dis 2016; 53(1):30-6.
(19) Hunsperger EA, Muñoz-Jordán J, Beltran M, Colón C, Carrión J, Vazquez J, et al. The Performance of Dengue Diagnostic Tests in a Single-Specimen Diagnostic Algorithm. J Infect Dis 2016; pii: jiw103. Epub ahead of print.
(20) Romero-Santacruz E, Lira-Canul JJ, Pacheco-Tugores F, Palma-Chan AG. Neonatal Dengue. Presentation of clinical cases. Ginecol Obstet Mex 2015; 83(5): 308-15.
(21) Adam I, Jumaa AM, Elbashir HM, Karsany MS. Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan. Virol J 2010; 7:153.
(22) Pouliot SH, Xiong X, Harville E. Maternal dengue and pregnancy outcomes: a systematic review. Obstet Gynecol Surv 2010; 65(2):107-18.
(23) Salgado DM, Rodríguez JA, Lozano L del P, Zabaleta TE. Dengue perinatal. Biomédica 2013; 33(Supl 1):14-21.
(24) Chitra TV, Panicker S. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis 2011; 48(4):210-3.
(25) Paixão ES, Teixeira MG, Costa MD, Rodrigues LC. Dengue during pregnancy and adverse fetal outcomes: a systematic review and meta-analysis. Lancet Infect Dis 2016; pii:S1473-3099(16)00088-8. Epub ahead of print.
(26) McGready R, Hamilton KA, Simpson JA, Cho T, Luxemburger C, Edwards R, et al. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg 2001; 65(4):285-9.
(27) Pesaro AE, D’Amico E, Aranha LFC. Dengue: manifestações cardíacas e implicações na terapéutica antitrombótica. Arq Bras Cardiol 2007; 89(2):e12-5.
(28) Verdeal JC, Costa Filho R, Vanzillotta C, Macedo GL, Bozza FA, Toscano L, et al. Guidelines for the management of patients with severe forms of dengue. Rev Bras Ter Intensiva 2011; 23(2):125-33.
(29) Lee TH, Wong JG, Leo YS, Thein TL, Ng EL, Lee LK, et al. Potential Harm of Prophylactic Platelet Transfusion in Adult Dengue Patients. PLoS Negl Trop Dis 2016; 10(3):e0004576.
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Publicado
2016-03-31
Cómo citar
1.
Frantchez V, Fornelli R, Pérez Sartori G, Arteta Z, Cabrera S, Sosa L, et al. Dengue en adultos: Diagnóstico, tratamiento y abordaje de situaciones especiales. Rev. Méd. Urug. [Internet]. 31 de marzo de 2016 [citado 21 de noviembre de 2024];32(1):43-51. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/185
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