Prognostic value of N -terminal pro B-type natriuretic peptide and troponin I in children with dengue shock syndrome

Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin I to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin I,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin I levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin I levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

A Streptococcus suis serotype 2 caused streptococcal toxic shock syndrome(STSS) in a patient

Streptococcus suis （S. suis） is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals. S. suis has also been implicated in disease in humans, especially anaong abattoir workers, swine and pork handlers. Here we report a case of streptococcal toxic shock syndrome（STSS） caused by S. suis in a 59-year-old man. Despite of intensive treatment, the patient died of shock with multiple organ failure 14 h after admission. One bacterial isolate obtained from blood culture was identified to the species level by biochemical tests and serological tests as S. suis serotype 2. Identification was confirmed by PCR amplification of genes encoding 16sRNA of S. suis and the capsule of S. suis serotype 2（cps 23）. Genes encoding virulence factors were also detected. An investigation to identify the source of S. suis revealed that several days before admission the affected man had been handling sick pigs or their meat. Transmission may occur through breaks in the skin of feet with tinea due to that no measures for personal protection was taken. This case should highten awareness of the potential for occupational exposure and human infection with S. suis.

Multi-System Inflammatory Syndrome in Children (MIS-C), Kawasaki Disease and Toxic Shock Syndrome so Different and Similar

Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.

Hematological indices as predictors of mortality in dengue shock syndrome: A retrospective study

Objective:To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients.Methods:Demographic characteristics,hematological parameters,and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups.Results:The mean age was(30.77±11.48)years and 56(56.6%)patients were males.Out of the total 99 patients,72(72.27%)patients were successfully discharged and 27(27.27%)patients eventually succumbed to death.The most common hematological finding was thrombocytopenia(95.95%),followed by anemia(52.52%)and decreased mean platelet volume(37.37%).After controlling other variables,logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality.Conclusions:Total leucocyte count,absolute neutrophil count,and total platelet count are significantly higher,and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group.Absolute neutrophil count and mean platelet volume are predictors associated with mortality.

Streptococcal toxic shock syndrome after hemorrhoidectomy: A case report

BACKGROUND Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic.Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body’s immune response.Though life threatening infection after hemorrhoidectomy rarely occurs,all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.CASE SUMMARY Here,we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management.There was no history of systemic diseases or recent disease infection.Hemorrhoidectomy was suggested and performed.After surgery,the patient developed hypotension,tachycardia,fever with chills and renal function impairment on day 2 post-operation.The clinical condition progressed to severe septic shock and metabolic acidosis.The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation.The results of the blood and wound cultures showed group A streptococcus pyogenes.CONCLUSION Although extremely uncommon,all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.

Sympathetic dysfunction as a cause for hypotension in dengue shock syndrome

Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.

Dengue fever leading to acute dengue hemorrhagic leukoencephalitis:A case report

Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.

Significance of Serum Electrolyte Pattern in an Eastern Sudanese Dengue Fever Patients Population

Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes Egyties which is found in Sudan especially Red Sea and Kassala states in the east. In the year 2020 there was a significant outbreak in the both states. The disease is known to cause renal and electrolyte disturbances and a thorough understanding of that which will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infection patients along with 200 healthy appearing adults (as a control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including electrolyte values. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Although fallen within reference ranges found in the literature, mean serum electrolyte values differed significantly between patients and controls and between different categories of the disease. For our patients, hyponatraemia was seen in 43.5%, hypokalaemia in 37%, hypocalcaemia in 30%, hypophosphataemia in 12% and low magnesium concentrations in 13%. Mean serum sodium concentration differed in the control (138.2 mmol/l) from in the test (132.5 mmol/l) (P. value 0.02). Similarly, mean serum potassium in the control (3.97 mmol/l) differed significantly (P. value 0.01) from test (3.30 mmol/l). Mean calcium and phosphorus (8.80 and 3.50 mg/dl) in the control were also differed from test (8.51 and 3.30), (P. values 0.02 and 0.004, respectively). In contrast, serum magnesium (mg/dl) in the control group (1.96) showed no significant difference from that of test group (1.90) (P. value 0.08). The biochemical parameters studied were neither affected by age nor by gender of the patient group. Clinically, fever was present in 97.5% of patient, headache in 95.5%, joints pain in 71%, lethargy 67%, vomiting in 49%, skin rash in 40%, abdominal pain 24% and bleeding in 17.5%. Conclusion: We strongly conclude that electrolyte evaluation should be considered in the counseling of DENV infected patients. Patients need to be subjected to necessary laboratory investigations including serum electrolyte levels to decrease the rate of morbidity and mortality associated with the disease.

Prediction of Acute Renal Failure in Dengue Fever Patients

Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes aegypti which is found in Sudan especially Red Sea and Kassala states in the east. The disease is known to cause renal disturbances and a thorough understanding of that will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infected patients along with 200 healthy appearing adults (control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including serum urea and creatinine values. Ethical approval was obtained from the ministry of health, Red Sea state and informed written consent was obtained from each participant. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Elevated blood urea levels were detected in 10 (5%) patients while elevated creatinine levels were seen in 17 (8.5%) patients. Although fallen within reference ranges found in the literature, mean blood urea and creatinine values differed significantly between patients and controls and between different categories of the disease. Mean blood urea concentration showed a statistically significant difference between the control (22.3 mg/dl) and the test (28.4 mg/dl) (P value Conclusion: We strongly conclude that renal involvement is not uncommon in Dengue fever and that blood urea and creatinine evaluation should be considered in the counseling of DENV infection patients. Patients need to be subjected to necessary laboratory investigations associated with acute kidney injury to decrease the rate of morbidity and mortality associated with the disease.

Genetic Characterization of Streptococcus pyogenes emm89 Strains Isolated in Japan From 2011 to 2019

Invasive infection caused by Streptococcus pyogenes emm89 strains has been increasing in several countries linked to a recently emergent clade of emm89 strains,designated clade 3.In Japan,the features of emm89 S.pyogenes strains,such as clade classification,remains unknown.In this study,we collected emm89 strains isolated from both streptococcal toxic shock syndrome(STSS)(89 STSS isolates)and noninvasive infections(72 non-STSS isolates)in Japan from 2011 to 2019,and conducted wholegenome sequencing and comparative analysis,which resulted in classification of a large majority into clade 3 regardless of disease severity.In addition,invasive disease-associated factors were found among emm89 strains,including mutations of control of virulence sensor,and absence of the hylP1 gene encoding hyaluronidase.These findings provide new insights into genetic features of emm89 strains.