Janaina Pierce

Reduced

thrombin

formation

and

excessive

fibrinolysis

are

associated with bleeding complications in patients with dengue fever: a case-control study comparing dengue fever patients with and without bleeding manifestations

Dengue is a febrile disease with occurrence of fever, headache and myalgia. It is caused by an insect-born virus and it is transmitted by a bite from an infected mosquito. About 50 million people are infected every year and nearly half of them present bleeding complications. The objective of this study was to determine the significance of certain conditions and processes within the organisms that may play a part in causing bleeding complications in adults with dengue fever. This was a case-control study that included patients infected with dengue fever in the cities of Rio de Janeiro and Campinas, Brazil, from January 2008 through May 2011. Patients had to be older than 17 years of age, and they had to be going through the period of the disease when the body temperatures were decreasing, and not presenting high fevers. Then the patients were divided in two groups. The first group, with 26 patients, presented spontaneous bleeding. The second group, which included 33 patients, had no spontaneous bleeding. Those patients were enrolled in the study and followed up by the same physician until recovery. The control group was made up

of 67 healthy volunteers who matched the patients by gender, age, ethnicity, and blood type. Blood samples were collected from the participants and exams were carried out to evaluate the degree of inflammation, to measure specific markers of fibrinolysis, and to evaluate blood coagulation. Bleeding episodes such as bruises and bleeding of the gum were classified as mild, bleeding of the gastrointestinal and genitourinary tracts were considered moderate, and lastly episodes that caused blood circulation instability were classified severe. Patients without bleeding complications were treated with hydration. Patients with bleeding complications were hospitalized, 57.6 % of them presented mild bleeding episodes, and 42.4 % showed moderate bleeding complications. None of the patients had severe bleeding complications. Platelets and monocytes were very different in patients with bleeding complications. Hemoglobin levels were normal among all the patients. Inflammatory and endothelial cell activation markers were higher in patients with the disease, but similar between patients with and without bleeding complications. Markers of fibrinolysis were very much so increased in patients with bleeding complications. Thrombin formation was decreased in patients with bleeding episodes. This study showed that decreased platelet count was an important factor in the bleeding complications which can occur in patients with Dengue Fever, and that a better understanding of the processes of such complications can help early detection of patients with severe manifestation of the disease. The study also showed that inflammation of the skin may not be associated with bleeding complications, but fibrinolysis was. The study proved that thrombin generation was decreased and

coagulation in patients with Dengue Fever was impaired. Decreased platelet count was an important factor in the bleeding complications. This study concluded that patients with Dengue Fever can present bleeding complications and these complications were related to decreased platelet count, reduced thrombin formation and increased fibrinolysis activity. And a better

understanding of such factors can help with the diagnosis and treatment of patients with Dengue Fever who present bleeding complications.