Hemophagocytic syndrome secondary to dengue: a serious complication in vulnerable patients
DOI:
https://doi.org/10.56294/shp2025203Keywords:
hemophagocytic syndrome, dengue, immunopathology, clinical diagnosis, cytokinesAbstract
Introduction: Hemophagocytic syndrome (HPS) was identified as a rare immunological condition characterized by a dysregulated activation of the immune system, which caused severe systemic inflammation and multiple organ failure. It presented in primary forms, of genetic origin, and secondary forms, associated with infections, neoplasms and autoimmune diseases. In particular, the dengue virus was recognized as a relevant trigger of HS, especially in pediatric populations in endemic regions, where its early diagnosis represented a great clinical challenge.
Development: The work addressed the pathophysiology of HS, in which an exaggerated activation of macrophages and cytotoxic T lymphocytes was described, together with a hypersecretion of pro-inflammatory cytokines. This uncontrolled immune reaction generated manifestations such as persistent fever, pancytopenia, hepatosplenomegaly and hyperferritinemia. The diagnosis was based on clinical and laboratory criteria established by the Histiocyte Society, with the identification of hemophagocytosis in bone marrow or other tissues being essential. Treatment strategies included intensive life support, the use of corticosteroids, intravenous immunoglobulins and, in severe cases, immunosuppressants, with special attention to the associated risks in patients with dengue.
Conclusions: It was concluded that HS secondary to dengue represented a serious and little recognized complication, whose timely diagnosis was essential to improve the prognosis. The study highlighted the importance of strengthening clinical surveillance, updating management protocols and training health personnel to effectively deal with this condition in contexts of high dengue prevalence.
References
1. Runge‐Ranzinger S, McCall PJ, Kroeger A, Horstick O. Dengue disease surveillance: an updated systematic literature review. Trop Med Int Health. 2014 Sep;19(9):1116–60.
2. Fietta P, Manganelli P. [The hemophagocytic syndrome (macrophage activation syndrome)]. Minerva Med. 2003 Feb;94(1):19–27.
3. Lei HY. Transient hemophagocytic activity in dengue immunopathogenesis. J Formos Med Assoc. 2009 Aug;108(8):595–8. doi:10.1016/s0929-6646(09)60379-x. PMID: 19666346.
4. Hein N, Bergara GH, Moura NBV, Cardoso DM, Hirose M, Ferronato AE, et al. Dengue fever as a cause of hemophagocytic lymphohistiocytosis. Autops Case Rep. 2015 Sep 30;5(3):33–6.
5. Brisse E, Wouters CH, Matthys P. Hemophagocytic lymphohistiocytosis (HLH): A heterogeneous spectrum of cytokine-driven immune disorders. Cytokine Growth Factor Rev. 2015 Jun;26(3):263–80.
6. Astigarraga I, Gonzalez-Granado LI, Allende LM, Alsina L. Síndromes hemofagocíticos: la importancia del diagnóstico y tratamiento precoces [Haemophagocytic syndromes: The importance of early diagnosis and treatment]. An Pediatr (Engl Ed). 2018 Aug;89(2):124.e1–8. doi:10.1016/j.anpedi.2018.05.003. PMID: 29871839.
7. Wan Jamaludin WF, Periyasamy P, Wan Mat WR, Abdul Wahid SF. Dengue infection associated hemophagocytic syndrome: Therapeutic interventions and outcome. J Clin Virol. 2015;69:91–5. doi:10.1016/j.jcv.2015.06.004.
8. Hein N, Bergara GH, Moura NBV, et al. Dengue fever as a cause of hemophagocytic lymphohistiocytosis. Autops Case Rep [Internet]. 2015;5(3):33–6. Disponible en: http://dx.doi.org/10.4322/acr.2015.016
9. Lu PL, Hsiao HH, Tsai JJ, Chen TC, Chen TP, Lin SF, Feng MC. Síndrome hemofagocítico asociado al virus del dengue y diseritropoyesis: reporte de un caso. Kaohsiung J Med Sci. 2005 Jan;21(1):34–8. doi:10.1016/S1607-551X(09)70274-8.
10. Nelson ER, Bierman HR, Chulajata R. Fagocitosis hematológica en médula ósea postmortem de fiebre hemorrágica por dengue. Am J Med Sci. 1966;252:68–74.
11. Rueda E, Méndez A, González G. Síndrome hemofagocítico asociado con dengue hemorrágico. Biomedica [Internet]. 2002 Jun 1 [citado 2024 Oct 20];22(2):160–6. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/1155
12. Pérez-Sánchez ML, et al. Síndrome hemofagocítico asociado a dengue grave en una institución pediátrica de Cali - Colombia. Infectio. 2023;27(1):3–6.
13. Simon AC, Delhi Kumar CG, Basu D, Ramesh Kumar R. Hemophagocytic lymphohistiocytosis in children: Clinical profile and outcome. J Pediatr Hematol Oncol. 2020;42(5):e281–5.
14. Bhattacharya D, Angurana SK, Nallasamy K, Iyer R, Jayashree M. Severe dengue and associated hemophagocytic lymphohistiocytosis in PICU. Indian J Pediatr. 2019 Dec;86(12):1094–8.
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Copyright (c) 2025 Natalia Araujo Jaramillo, Diego Balcarce (Author)
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