Pathophysiology of dengue and the importance of early recognition of shock in pediatrics

Abstract

Background. Dengue is the most prevalent arboviral disease worldwide transmitted by the bite of the female mosquito Aedes spp. The most significant burden has been observed in children, adolescents and young adults. Environmental factors influence the spread and exposure to the virus in endemic areas. Although most cases present mild to moderate symptoms, a percentage may develop severe disease. The underlying mechanisms are still not completely clear, it is suggested that excessive cytokine-mediated immune activation could be responsible for the main findings in critically ill patients. World Health Organization guidelines offer recommendations on early identification and treatment of severe dengue; However, mortality could be related to the difficulty in recognizing early signs of shock, the severity of the disease, and complications of treatment. Objective: To analyze recent evidence on the pathophysiology of dengue and the importance of early recognition of shock in pediatric patients, through a review of articles published in the last five years in PubMed and, complementarily, in SciELO. Conclusions: The progression to severe dengue in children involves viral, immunological, host, and environmental factors. Combining clinical, physiological, and laboratory markers may improve early detection and guide timely interventions, although further studies are needed to validate these predictors and develop more comprehensive risk models.