Unexpected Predictors of Mortality During a DENV-3 Outbreak in Western Mexico: Seizures, Polyserositis, and Renal Dysfunction Without Severe Thrombocytopenia.

Publisher: MDPI Country of Publication: Switzerland NLM ID: 101509722 Publication Model: Electronic Cited Medium: Internet ISSN: 1999-4915 (Electronic) Linking ISSN: 19994915 NLM ISO Abbreviation: Viruses Subsets: MEDLINE

Original Publication: Basel, Switzerland : MDPI

Seizures*/epidemiology ; Seizures*/mortality ; Seizures*/virology ; Dengue*/mortality ; Dengue*/epidemiology ; Dengue*/complications ; Dengue*/virology ; Serositis*/epidemiology ; Serositis*/mortality ; Serositis*/virology ; Disease Outbreaks* ; Dengue Virus*/classification ; Kidney Diseases*; Humans ; Mexico/epidemiology ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adult ; Thrombocytopenia ; Aged ; Young Adult ; Adolescent

Dengue mortality has traditionally been associated with severe thrombocytopenia and hemorrhagic complications. However, during 2024, dengue virus serotype 3 (DENV-3) increased significantly in western Mexico, leading to the emergence of a distinct clinical pattern. We conducted a retrospective cohort study of hospitalized dengue patients at the General Hospital of Colima (January-August 2024). Clinical features, laboratory parameters, and outcomes were compared between survivors and non-survivors. Among 201 hospitalized patients, 6 (3.0%) died. All deceased patients presented with generalized seizures, polyserositis (pleural effusion and/or ascites), and required mechanical ventilation. Contrary to classical patterns, they did not have severe thrombocytopenia. Instead, they showed significantly higher white blood cell counts and notably increased levels of serum urea and BUN, suggesting early renal impairment. ROC analysis indicated that BUN (AUC 0.904) and urea (AUC 0.906) were good to excellent discriminators of mortality. During 2024, with an increase in DENV-3 circulation, mortality was associated with neurological and systemic complications, including seizures and polyserositis, as well as biochemical evidence of renal dysfunction-but not with severe thrombocytopenia. These findings challenge current paradigms and highlight the need for early recognition of atypical clinical patterns.

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Keywords: dengue virus serotype 3 (DENV-3); epidemiology; neurological complications; polyserositis; renal dysfunction

Date Created: 20250730 Date Completed: 20250730 Latest Revision: 20250820

20250821

PMC12299529

10.3390/v17070950

40733567