ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Dengue Infection Complicated by Hemophagocytic Lymphohistiocytosis: Experiences From 180 Patients With Severe Dengue.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.
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Who cites it
40 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Hemophagocytic Lymphohistiocytosis Triggered by Dengue: A Narrative Review and Individual Patient Data Meta-Analysis.Viruses · 2025Pooled it
- HLA alleles and dengue susceptibility across populations in the era of climate change: a comprehensive review.Frontiers in immunology · 2025Pooled it
- Clinical profiles and predictors of survival in severe dengue cases.Singapore medical journal · 2026Article
- Beyond the Classic: Atypical Dengue Presentations.Cureus · 2026Article
- Clinical and Laboratory Predictors of Dengue-Associated Hyperinflammation in Children.Indian journal of pediatrics · 2026Article
- Peritoneal effusion as a marker of disease severity in secondary hemophagocytic lymphohistiocytosis: Clinical and immunological insights.SAGE open medicine · 2026Article
- Dengue therapeutics consortium 2025: a global collaboration in action.BMJ public health · 2026Review
- Role of biomarkers in predicting disease severity in acute dengue and SARs-CoV-2-Infected patients.BMC infectious diseases · 2025Article
- Platelet dynamics and thrombocytopenia in dengue fever: A prospective cohort study from Shenzhen, China.New microbes and new infections · 2025Article
- Severe Dengue Associated With Hemophagocytic Lymphohistiocytosis (HLH) in an Adult ICU.Cureus · 2025Article
- The pathophysiology of hemophagocytic lympho-histiocytosis (HLH) syndrome and insights from animal models.Clinical and experimental immunology · 2025Review
- Hemophagocytic Lymphohistiocytosis (HLH): A Rare Complication of Dengue Hemorrhagic Fever.Cureus · 2024Article
- Severe Organ Impairment Was Common in Elderly Individuals with Dengue in Guangdong, China.The American journal of tropical medicine and hygiene · 2024Article
- The HScore to Diagnose HLH in Scrub Typhus: Overdiagnosis or under Diagnosis and Does It Really Matter?Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Predicting Secondary Hemophagocytic Lymphohistiocytosis in Adult Patients with Scrub Typhus and Its Prognostic Significance.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Immuno-Haematologic Aspects of Dengue Infection: Biologic Insights and Clinical Implications.Viruses · 2024Review
- Dengue-Related Hemophagocytic Lymphohistiocytosis in an Adult: A Case Report and Brief Update.Avicenna journal of medicine · 2024Article
- Review
- Dengue-Associated Hemophagocytic Lymphohistiocytosis: A Narrative Review of Its Identification and Treatment.Pathogens (Basel, Switzerland) · 2024Review
- Hemophagocytic Lymphohistiocytosis Secondary to Dengue Fever in a Pediatric Patient: A Case Report.Cureus · 2024Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobally, ~500 000 people with severe dengue (SD) require hospitalization yearly; ~12 500 (2.5%) die. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal hyperinflammatory condition for which HLH-directed therapy (as etoposide and dexamethasone) can be life-saving. Prompted by the high mortality in SD and the increasing awareness that patients with SD may develop sHLH, our objectives were to (1) determine the frequency of dengue-HLH in SD, (2) describe clinical features of dengue-HLH, (3) assess mortality rate in SD and dengue-HLH, and (4) identify mortality-associated risk factors in SD.
methodsA 5-year retrospective single-center study in all adult patients with SD admitted to a tertiary intensive care unit in Malaysia.
resultsThirty-nine of 180 (22%) patients with SD died. Twenty-one of 180 (12%) had HLH defined as an HLH probability ≥70% according to histo score (HScore); 9 (43%) died. Similarly, 12 of 31 (39%) fulfilling ≥4 and 7 of 9 (78%) fulfilling ≥5 HLH-2004 diagnostic criteria died. Peak values of aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase, and creatinine correlated to fatality (odds ratios [ORs], 2.9, 3.4, 5.8, and 31.9; all P < .0001), as did peak ferritin (OR, 2.5; P = .0028), nadir platelets (OR, 1.9; P = .00068), hepatomegaly (OR, 2.9; P = .012), and increasing age (OR, 1.2; P = .0043). Multivariable logistic regression revealed peak AST (OR, 2.8; P = .0019), peak creatinine (OR, 7.3; P = .0065), and SOFA (Sequential Organ Failure Assessment) score (OR, 1.4; P = .0051) as independent risk factors of death.
conclusionsBe observant of dengue-HLH due to its high mortality. A prospective study is suggested on prompt HLH-directed therapy in SD patients with hyperinflammation and evolving multiorgan failure at risk of developing dengue-HLH.
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