Resumen de Mortalidad por dengue hemorrágico en niños en Colombia: más allá del choque

Doris Martha Salgado, MD. César A. Panqueba, MD. Martha Rocío Vega, MD. Marisol Garzón, MD. Dolly Castro

• español

  En el dengue hemorrágico las manifestaciones inusuales como hepatitis, encefalitis y miocarditis están asociadas a las pformas graves y muerte. Objetivo. Describir las causas de mortalidad por dengue hemorrágico en niños menores de 13 años en el HospitalUniversitario de Neiva. Diseño. Estudio descriptivo, con recolección retrospectiva         .de la información.Lugar. Neiva, Huila                                                Población: niños menores de 13 años  Mediciones. Se registraron todos los pacientes fallecidos con diagnóstico de dengue hemorrágico entre los años 2000 y2006, para un análisis de variables, clínicas y de laboratorio, porgrupos de edad, mediante pruebas no paramétricas.Resultados. De 1.448 niños con dengue hemorrágico, 338 in-gresaron a la unidad de cuidados intensivos pediátrica y hubo15 casos fatales (letalidad 1,03%); el 40% ingresó en estadio IIIy 60% en estadio IV. Los síntomas gastrointestinales y signosde fuga vascular estuvieron presentes en el 100% de los casos.?

• English

  Unusual clinical manifestations such as hepatitis, encephalitis, myocarditis and even death might be associated to the severe forms of dengue hemorrhagic fever.Aim: To describe mortality cases in children younger than 13 years of age at the Hospital Universitario in Neiva, Colombia.Design: Descriptive study with retrospective collection of data.Place: Neiva, Huila, Colombia.Population: Children younger than 13 years of age.Measurements: All death patients with diagnosis of dengue hemorrhagic fever from 2000 to 2006 were registered; clinical variables and laboratory data were analyzed by age groups by using non parametric tests.Results: Out of 1,448 patients with dengue hemorrhagic fever, 338 were admitted to the Pediatric Intensive Care Unit with 15 deaths (lethality 1.03%); 40% of admissions were in state III whereas 60% in state IV. Gastrointestinal symptoms and vascular leakage signs were present in 100% of cases. There was a higher tendency to hypotension, fewer platelet counts and higher serum transaminases in children between 1 to 5 years; there were no statistical differences between variables in none of the groups. Nine patients died as a consequence of acute myocarditis (60%) with heart rhythm alterations, from which two had elevated serum transaminases; three died because of acute hepatitis (20%) and three died with disseminated vascular coagulation (20%).Conclusion: Mortality associated to dengue hemorrhagic fever is not only due to hypovolemic shock and currently, other organs such as liver and myocardium might be target of the disease.