{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T20:40:36Z","timestamp":1790973636977,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"11","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01CK000437"],"award-info":[{"award-number":["U01CK000437"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01CK000580"],"award-info":[{"award-number":["U01CK000580"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We evaluated clinical and laboratory findings among patients with nonsevere or severe dengue in Puerto Rico to examine whether clinical manifestations vary by age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>During 2012\u20132014, we enrolled patients who arrived at the emergency department with fever or history of fever within 7 days of presentation. Serum samples were tested for dengue virus (DENV) by reverse transcriptase-polymerase chain reaction (RT-PCR) and IgM enzyme-linked immunosorbent assay (ELISA). Severe dengue was defined as severe plasma leakage or shock, severe bleeding, or organ involvement at presentation, during hospitalization, or follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1089 dengue patients identified, 281 (26%) were severe. Compared to those with nonsevere dengue, patients with severe dengue were more often aged 10\u201319 years (55% vs 40%, P &amp;lt; .001) and hospitalized (87% vs 30%, P &amp;lt; .001). Severe plasma leakage or shock was more common among children aged 0\u20139 (59%) or 10\u201319 years (86%) than adults (49%) (P &amp;lt; .01). Severe bleeding was less common among 10\u201319 year olds (24%) compared to 0\u20139 year olds (45%) and adults (52%; P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Severe plasma leakage was the most common presentation among children, highlighting important differences from adults. Vaccination against dengue could help prevent severe dengue among children in Puerto Rico.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiac165","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T03:39:38Z","timestamp":1651203578000},"page":"1949-1958","source":"Crossref","is-referenced-by-count":13,"title":["Predominance of Severe Plasma Leakage in Pediatric Patients With Severe Dengue in Puerto Rico"],"prefix":"10.1093","volume":"226","author":[{"given":"Gabriela","family":"Paz-Bailey","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Torres-Velasquez","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma S","family":"Jones","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Perez-Padilla","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler M","family":"Sharp","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"},{"name":"US Public Health Service , Rockville, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Delorey","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge L","family":"Munoz-Jordan","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay M","family":"Tomashek","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"},{"name":"US Public Health Service , Rockville, Maryland , USA"},{"name":"National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H","family":"Waterman","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention , San Juan , Puerto Rico"},{"name":"US Public Health Service , Rockville, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa I","family":"Alvarado","sequence":"additional","affiliation":[{"name":"Ponce Health Sciences University\/Ponce Research Institute , Ponce, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Rivera-Amill","sequence":"additional","affiliation":[{"name":"Ponce Health Sciences University\/Ponce Research Institute , Ponce, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,1]]},"reference":[{"key":"2023053018510423400_jiac165-B1","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1126\/science.aac5017","article-title":"Dengue viruses cluster antigenically but not as discrete serotypes","volume":"349","author":"Katzelnick","year":"2015","journal-title":"Science"},{"key":"2023053018510423400_jiac165-B2","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S0140-6736(18)32560-1","article-title":"Dengue","volume":"393","author":"Wilder-Smith","year":"2019","journal-title":"Lancet"},{"key":"2023053018510423400_jiac165-B3","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1038\/s41564-019-0476-8","article-title":"The current and future global distribution and population at risk of dengue","volume":"4","author":"Messina","year":"2019","journal-title":"Nat Microbiol"},{"key":"2023053018510423400_jiac165-B4","article-title":"PLISA Health Information Platform for the Americas. 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