Dengue Associated Multiple Organ Failure

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Dengueis a disease caused by an arbovirus, which has four related virus serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) and is currently the most important mosquito borne viral pathogen affecting humans, emerging as a major threat to global health. Its incidence has increased more than 30-fold in recent decades alongside the geographical expansion of the Aedes vector mosquitoes. It is estimated that 3 billion people live in areas at risk of contracting dengue and some 390 million infections (96 million symptomatic) and 20,000 deaths from dengue occur every year in the endemic regions.

Dengueis a systemic and dynamic infectious disease. The infection may beasymptomatic or presents itself with a broad clinical spectrum that includes both severe and non-severe clinical manifestations for which the timing or sequence of infections can be an important determinant of disease severity and course. Severe Dengue includes Multiple Organ Failure (MOF) which usually but not always is a consequence of prolonged or recurrent shock.

Dengueillness is clinically classified as either dengue with or without warning signs or severe dengue. This classification was launched by the WHO in 2009 for the purpose of improving clinical management. The warning signs permit the early identification of patients with more severe disease manifestations who require supportive therapy. This classification has substituted the previous 1997 WHO system that addressed and underscored the two pathological phenomena, plasma leakage and abnormal haemostasis, associated with the disease. Under this classification, patients were designated as having either Dengue Fever (DF) - a non-specific febrile illness and the most common manifestation of DENV infection - or Dengue Haemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) - a combination of plasma leakage and coagulopathy, sometimes accompanied by bleeding, that can lead to a rapid fall in blood pressure and consequently to circulatory shock and organ impairment.