Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013

摘要: Background Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH being increasingly reported as complication of dengue, common tropical acute febrile illness. Methodology/Principal Findings After cluster pediatric dengue-associated patients was identified during the 2012–2013 dengue epidemic in Puerto Rico, active surveillance case-control investigation conducted at four referral hospitals to determine incidence children identify risk factors for following dengue. Patients with (cases) were matched month illness onset admission hospital that did not develop (controls). During 2008–2013, total 33 identified, which 22 (67%) associated 1 died (dengue-associated case-fatality rate: 4.5%). Two had 2009, none 2010 epidemic, 20 epidemic. Frequency infection either virus (DENV)-1 or DENV-4 differ between cases controls. Cases younger than controls (median age: vs. 13 years, p < 0.01), hospitalized longer (18 5 days, admitted more frequently intensive care units (100% 16%, 0.01). co-infection (18.2% 4.5%, = 0.04), recent influenza-like (54.5% 25.0%, duration fever (7 days; likely have lymphadenopathy, hepatomegaly, splenomegaly, anemia, elevated liver transaminases (p ≤ 0.02). Conclusions/Significance During this temporally most infants higher morbidity inpatients. Physicians throughout tropics should be aware potential particularly anemia severe injury.