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Severe dengue was perceived as one clinical disease entity until the WHO 2009 classification stratified it into severe vascular leakage, severe bleeding, and severe organ dysfunction. The objectives of this study were to investigate the potential use of severe dengue categories as endpoints for intervention research. 271 patients with severe dengue among 1734 confirmed dengue patients were followed prospectively in this hospital-based observational study in Latin America and Asia. We compared the distribution of severe dengue categories according to gender and age (below/above 15y), and determined the relative frequency and the overlap of severe dengue categories in the same patients. In a next step, we extended the analysis to candidate moderate severity categories, based on recently suggested definitions which were adapted for our purposes. Severe vascular leakage occurred in 244 (90%), severe bleeding in 39 (14%), and severe organ dysfunction in 28 (10%) of 271 severe dengue patients. A higher frequency of severe leakage was seen in children or adolescents (, Author summary Severe dengue (DHF/DSS) was perceived as one clinical disease entity until the WHO 2009 classification defined three categories: severe vascular leakage, severe bleeding, and severe organ dysfunction. Here we provide new insight about the discriminatory power and the overlap or co-occurrence of the severe dengue categories. We also respond to the need to validate standard clinical endpoints for severe dengue in well-characterized data sets. In addition, we respond to the need for moderate disease endpoints, which are recorded more frequently than the severe ones. Severe vascular leakage alone constitutes the largest group among the severe dengue categories and may be useful as endpoint for intervention or pathophysiology research. Other severe dengue categories as for example severe bleeding can also sometimes occur alone–however, this might be associated with the presence of comorbidities or individual predisposition and should be studied in more detail. Moderate disease endpoints were suggested and explored here, but need to be further investigated.

Clinical management of dengue relies on careful monitoring of fluid balance combined with judicious intravenous (IV) fluid therapy. However, in patients with significant vascular leakage IV fluids may aggravate serosal fluid accumulation and result in respiratory distress.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.Most confirmed-dengue patients (1524/1734, 88%) never experienced dengue shock syndrome (DSS). Among those with DSS, 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 24hrs increased (hazard ratio 1.18 per 10 ml/kg increase; p

Patienten mit parasitär bedingten Leberleiden stellen in den meisten europäischen Ländern ein sehr kleines Kollektiv dar. Sie werden in der Differentialdiagnose von hepatischen Raumforderungen, Leberparenchymveränderungen, Schmerzen im rechten Oberbauch, Cholestase oder Transaminasenerhöhung, wenn überhaupt, meist zuletzt in Betracht gezogen. Den meisten Gesundheitseinrichtungen mangelt es an diagnostischer und therapeutischer Erfahrung. Diese Erkrankungen sind in spezialisierten Zentren (dies sind traditionsgemäß meist tropenmedizinische Einrichtungen) am besten aufgehoben. Wichtige Komponenten bei der Abklärung sind: Risikoanamnese (Herkunft, Reisen, Exposition), die geographische Verbreitung der Parasitosen, Inkubations- und Präpatenzzeit, Labor (Eosinophilie, IgE-Erhöhung, direkter Parasitennachweis, Serologie), sowie bildgebende Verfahren. Es werden die wichtigsten Parasitosen der Leber dargestellt: Schistosomiasis, Echinokokkose, Faszioliasis, Toxocariasis.

Viruses have become more mobile alongside with increasing human mobility and speed of travel. At the same time we get access to information on viral outbreaks and epidemics from large parts of the world faster than ever before. Two recent epidemics will be presented to explore the value and the consequences of communicating epidemiological information through the Internet. The epidemiology, clinical features, diagnostic procedures and prophylaxis of imported viral infections are presented. Risk factors for the emergence and resurgence of viral diseases are being discussed.

Background: Large multicenter trials from South-East Asia have demonstrated an improved survival for i.v.-artesunate as compared to quinine for the treatment of severe malaria. For patients with severe malaria in Europe, quinine is still the mainstay of treatment and artesunate has not been evaluated[for full text, please go to the a.m. URL], 10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)