{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:14:10Z","timestamp":1790043250767,"version":"4.0.1"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,2,3]],"date-time":"2016-02-03T00:00:00Z","timestamp":1454457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000278","name":"Department for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Clinical management of dengue relies on careful monitoring of fluid balance combined with judicious intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) fluid therapy. However, in patients with significant vascular leakage, <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> fluids may aggravate serosal fluid accumulation and result in respiratory distress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Trained physicians followed suspected dengue cases prospectively at seven hospitals across Asia and Latin America, using a comprehensive case report form that included daily clinical assessment and detailed documentation of parenteral fluid therapy. Applying Cox regression, we evaluated risk factors for the development of shock or respiratory distress with fluid accumulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most confirmed dengue patients (1524\/1734, 88%) never experienced dengue shock syndrome (<jats:styled-content style=\"fixed-case\">DSS<\/jats:styled-content>). Among those with <jats:styled-content style=\"fixed-case\">DSS<\/jats:styled-content>, 176\/210 (84%) had fluid accumulation, and in the majority (83%), this was detectable clinically. Among all cases with clinically detectable fluid accumulation, 179\/447 (40%) were diagnosed with shock or respiratory distress. The risk for respiratory distress with fluid accumulation increased significantly as the infused volume over the preceding 24 h increased (hazard ratio 1.18 per 10 ml\/kg increase; <jats:italic>P<\/jats:italic> &lt; 0.001). Longer duration of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> therapy, use of a fluid bolus in the preceding 24 h, female gender and poor nutrition also constituted independent risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Shock and respiratory distress are relatively rare manifestations of dengue, but some evidence of fluid accumulation is seen in around 50% of cases. <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> fluids play a crucial role in management, but they must be administered with caution. Clinically and\/or radiologically detectable fluid accumulations have potential as intermediate severity endpoints for therapeutic intervention trials and\/or pathogenesis studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12666","type":"journal-article","created":{"date-parts":[[2016,1,11]],"date-time":"2016-01-11T18:53:31Z","timestamp":1452538411000},"page":"445-453","source":"Crossref","is-referenced-by-count":28,"title":["Vascular leakage in dengue \u2013 clinical spectrum and influence of parenteral fluid therapy"],"prefix":"10.1111","volume":"21","author":[{"given":"Kerstin D.","family":"Rosenberger","sequence":"first","affiliation":[{"name":"Section Clinical Tropical Medicine Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Lum","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Alexander","sequence":"additional","affiliation":[{"name":"MRC Tropical Epidemiology Group London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Junghanss","sequence":"additional","affiliation":[{"name":"Section Clinical Tropical Medicine Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Wills","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jaenisch","sequence":"additional","affiliation":[{"name":"Section Clinical Tropical Medicine Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the DENCO Clinical Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2,3]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control","author":"WHO","year":"2009"},{"key":"e_1_2_7_3_1","volume-title":"Handbook for Clinical Management of Dengue","author":"WHO","year":"2012"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1110265"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1988.38.172"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113932"},{"key":"e_1_2_7_7_1","first-page":"375","article-title":"Dengue haemorrhagic fever\/dengue shock syndrome: lessons from the Cuban epidemic, 1981","volume":"67","author":"Kouri GP","year":"1989","journal-title":"Bull World Health Organ"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.960"},{"key":"e_1_2_7_9_1","first-page":"283","article-title":"Relationship between body size and severity of dengue hemorrhagic fever among children aged 0\u201314 years","volume":"37","author":"Pichainarong N","year":"2006","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"e_1_2_7_10_1","first-page":"378","article-title":"Is dengue severity related to nutritional status?","volume":"36","author":"Kalayanarooj S","year":"2005","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2011.10-0476"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002412"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2004.07.012"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0001641"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000699"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02793.x"},{"key":"e_1_2_7_17_1","unstructured":"WHO[internet]. 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