Noninvasive measurement of microvascular leakage in patients with dengue hemorrhagic fever

Dengue shock syndrome (DSS) is a potentially lethal complication of dengue virus infection associated with hypotension and leakage of plasma water int o the extravascular space. To determine whether the underlying pathophysiol ogy of DSS is distinct from that in milder forms of the disease, we assesse d microvascular permeability, by use of strain gauge plethysmography, in Vi etnamese children with DSS (n = 19), or dengue hemorrhagic fever (DHF) with out shock (n = 16), and in healthy control children (n = 15). At admission and after fluid resuscitation, the mean coefficient of microvascular permea bility (K-f) for the patients with dengue was similar to 50% higher than th at for the control patients (P = 0.2). There was no significant difference in K-f between the 2 groups of patients with dengue; this suggests the same underlying pathophysiology. We hypothesize that in patients with DSS, the fluctuations in K-f are larger than those in patients with DHF, which leads to short-lived peaks of markedly increased microvascular permeability and consequent hemodynamic shock.