{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:08:54Z","timestamp":1789099734959,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dengue-associated hemophagocytic lymphohistiocytosis (DA-HLH) is a rare but severe hyperinflammatory complication of dengue. Its clinical overlap with severe dengue often delays recognition. We describe the clinical, laboratory and therapeutic characteristics of pediatric patients with DA-HLH in a dengue-endemic region of Latin America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of pediatric patients diagnosed with DA-HLH at a tertiary-care center in Cali, Colombia, between 2013 and 2024. HLH was diagnosed using HLH-2004 criteria and supported by the HScore. Clinical features, laboratory parameters, treatment regimens and outcomes were analyzed. Associations between extreme biomarker values (below Q1 or above Q3) and mortality were assessed using Fisher exact test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nineteen patients were included, with a median age of 7 years. Fever and cytopenias were present in all cases, and hepatomegaly was frequently observed. Hyperferritinemia occurred in nearly all patients. Viral coinfections\u2014most commonly Epstein\u2013Barr virus and cytomegalovirus\u2014were identified in over one-third of cases. Overall mortality was 21.1% and occurred exclusively among patients with significant underlying comorbidities. In this exploratory analysis, elevated total bilirubin was the only laboratory parameter associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DA-HLH should be considered in pediatric patients with dengue who present with persistent fever, cytopenias, hepatic dysfunction and marked hyperferritinemia. In this exploratory analysis, elevated bilirubin appeared to reflect severe systemic and hepatic involvement rather than an independent prognostic factor, while viral coinfections may contribute to disease severity. Early recognition and individualized immunomodulatory management are essential, and larger multicenter studies are needed to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/inf.0000000000005232","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T17:00:12Z","timestamp":1774285212000},"page":"888-893","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["A Retrospective Analysis of Dengue-associated Hemophagocytic Lymphohistiocytosis in a Dengue-endemic Country"],"prefix":"10.1097","volume":"45","author":[{"given":"Daniel","family":"De Zubir\u00eda Posada","sequence":"first","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Allergy Service, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6167-3001","authenticated-orcid":false,"given":"Vanessa","family":"Cabrera Guar\u00edn","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8295-3958","authenticated-orcid":false,"given":"Jacobo","family":"Trivi\u00f1o Arias","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9792-2359","authenticated-orcid":false,"given":"Oriana","family":"Arias Valderrama","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Fundaci\u00f3n Valle del Lili, Cali, 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Betancur","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3173-6059","authenticated-orcid":false,"given":"Alexis Antonio","family":"Franco Moreno","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Pediatric Hematology-Oncology Service, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela Andrea","family":"Rodr\u00edguez Riveros","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Pediatric Hematology-Oncology Service, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3542-4754","authenticated-orcid":false,"given":"Luz \u00c1ngela","family":"Urcuqui Bustamante","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Pediatric Hematology-Oncology Service, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8614-654X","authenticated-orcid":false,"given":"Mar\u00eda Ximena","family":"Castro Garc\u00eda","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Pediatric Hematology-Oncology Service, Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime Alberto","family":"Pati\u00f1o Ni\u00f1o","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidad Icesi, Cali, Colombia"},{"name":"Pediatric Infectious Diseases Service, Fundaci\u00f3n Valle del Lili, Cali, 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