## Organ System Involvement in Dengue in Children **Key Point:** Dengue shock syndrome (DSS) is the most common serious complication of dengue in children, occurring in 5–10% of hospitalized dengue cases. It represents the most significant cause of morbidity and mortality in pediatric dengue. ### Pathophysiology of Dengue Shock Syndrome **High-Yield:** DSS occurs during the critical phase (days 3–7) when viral load is declining but immune response peaks. Increased vascular permeability leads to: - Plasma leakage into third spaces (pleural effusion, ascites, pericardial effusion) - Hypovolemia and compensatory tachycardia - Hypotension and shock if fluid losses exceed 10–15% of plasma volume ### Comparative Organ System Involvement in Pediatric Dengue | Organ System | Frequency | Severity | Reversibility | |---|---|---|---| | **Cardiovascular (DSS)** | 5–10% of hospitalized cases | Most common cause of death | Reversible with fluid resuscitation | | Hepatic | 80–90% (elevated transaminases) | Mild to moderate | Usually self-limited | | Renal | 2–5% (AKI in severe dengue) | Severe | Often requires dialysis | | Respiratory | <2% (ARDS in severe dengue) | Severe | High mortality | | CNS | <1% (encephalitis) | Rare | Variable | **Clinical Pearl:** The "critical phase" (defervescence phase) is when DSS develops. Paradoxically, fever resolves but the child deteriorates—this is the key teaching point. Careful fluid management during this phase is crucial. **Warning:** Do not confuse hepatic involvement (common but mild) with hepatic failure (rare). Transaminases are elevated in 80% of dengue but acute liver failure is <1%. **Mnemonic for dengue complications:** **CRASH** — Cardiovascular (shock), Respiratory (ARDS), Acute kidney injury, Severe hepatitis, Hemorrhage. [cite:Nelson Textbook of Pediatrics 21e Ch 273]
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