Ultrasound signs of plasma leakage help identify severe dengue

Design

Systematic review with random-effects meta-analysis where possible

Population

6,979 patients with confirmed viral haemorrhagic fever infections (6,189 with dengue) in 56 studies

Primary outcome

Ultrasound findings and their association with severe disease

Effect

Plasma leakage signs common; pericardial effusion and several others associated with severe disease

This systematic review included 56 studies of 6,979 patients with confirmed viral haemorrhagic fever infections; 44 studies (6,189 patients) concerned dengue. Most patients were recruited while acutely ill in tertiary centres during high-transmission periods.

Common ultrasound findings were gallbladder wall thickening, ascites, pleural effusions and abnormal lung ultrasound, pericardial effusions, splenomegaly and abdominal lymphadenopathy. Pericardial effusion and several other findings were associated with severe disease. The authors propose an ultrasound-based plasma leakage severity framework, but as a hypothesis for prospective testing.

Heterogeneity was high and the timing of scans relative to illness varied, so no single sign has a firm threshold. But the pathophysiology is sound — plasma leakage is what kills in dengue — and point-of-care ultrasound can detect it before haematocrit or blood pressure change. For emergency departments in India during the monsoon season, a quick look at the gallbladder, pleura and pericardium is a practical adjunct to the WHO warning signs.

• In a febrile patient with suspected dengue, scan the gallbladder wall, abdomen for free fluid, lung bases and pericardium.
• Treat gallbladder wall thickening, ascites or pleural effusion as signs of plasma leakage and a reason to admit and monitor closely.
• A pericardial effusion was associated with severe disease — escalate care.
• Repeat the scan during the critical phase (around defervescence), when leakage peaks.
• Use ultrasound alongside, not instead of, haematocrit trends and clinical warning signs.

Why it matters

It gives a bedside tool to spot leakage before shock, in the setting where dengue fills Indian emergency departments each year.

Don't overread it

Mostly tertiary-centre, heterogeneous studies — ultrasound findings are associated with severity, but no validated threshold or score exists yet.

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