exudates and Multiple-Organ-Failure

Dengue imposes substantial economic, societal and personal burden in terms of hospital stay, morbidity and mortality. Early identification of dengue cases with high propensity of increased hospital stay and death could be of value in isolating patients in need of early interventions. The current study was aimed to determine the significant factors associated with dengue-related prolonged hospitalisation and death.. Cross-sectional retrospective study.. Tertiary care teaching hospital.. Patients with confirmed dengue diagnosis were stratified into two categories on the basis of prolonged hospitalisation (≤3 days and >3 days) and mortality (fatal cases and non-fatal cases). Clinico-laboratory characteristics between these categories were compared by using appropriate statistical methods.. Of 667 patients enrolled, 328 (49.2%) had prolonged hospitalisation. The mean hospital stay was 4.88±2.74 days. Multivariate analysis showed that dengue haemorrhagic fever (OR 2.3), elevated alkaline phosphatase (ALP) (OR 2.3), prolonged prothrombin time (PT) (OR 1.7), activated partial thromboplastin time (aPTT) (OR 1.9) and multiple-organ dysfunctions (OR 2.1) were independently associated with prolonged hospitalisation. Overall case fatality rate was 1.1%. Factors associated with dengue mortality were age >40 years (p=0.004), secondary infection (p=0.040), comorbidities (p<0.05), acute kidney injury (p<0.001), prolonged PT (p=0.022), multiple-organ dysfunctions (p<0.001), haematocrit >20% (p=0.001), rhabdomyolosis (p<0.001) and respiratory failure (p=0.007). Approximately half of the fatal cases in our study had prolonged hospital stay of greater than three days.. The results underscore the high proportion of dengue patients with prolonged hospital stay. Early identification of factors relating to prolonged hospitalisation and death will have obvious advantages in terms of appropriate decisions about treatment and management in high dependency units.

Topics: Acute Kidney Injury; Adolescent; Adult; Comorbidity; Cross-Sectional Studies; Female; Hospital Mortality; Humans; Length of Stay; Logistic Models; Malaysia; Male; Middle Aged; Multiple Organ Failure; Multivariate Analysis; Retrospective Studies; Risk Factors; ROC Curve; Severe Dengue; Tertiary Care Centers; Young Adult

Plasmodium knowlesi has been recently identified as the "fifth human malaria species" following the discovery in Malaysian Borneo of a large focus of this simian malaria parasite in humans. Even though it shares microscopic similarities with Plasmodium malariae, it may cause severe illness with risk of fatality. We describe a case of P. knowlesi infection causing multi-organ failure in a patient who was successfully managed due to early recognition of the infection. Clinicians in this region should be more aware of the infection as it is not as rare as previously thought. This case write up highlight the case of severe malaria infection which presented with multi organ involvement which is caused by P. knowlesi.

Topics: Adult; Antimalarials; Doxycycline; Humans; Malaria; Malaysia; Male; Multiple Organ Failure; Plasmodium knowlesi; Treatment Outcome

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Infant, Newborn; Intensive Care Units; Length of Stay; Malaysia; Male; Middle Aged; Multiple Organ Failure; Postoperative Complications; Prognosis; Retrospective Studies; Surgical Procedures, Operative