title: Death by dengue fever in a Brazilian child: a case report.
abstract: BACKGROUND
  Dengue is an important worldwide public health problem, and continues to spread in Brazil. This article presents the first Brazilian case report of the death of an indigenous child by dengue fever.
  
  
  METHODS
  In August 2013, a child aged 2 years and from the Tremembé ethnic group, who was previously healthy with no complaints, suddenly presented intense crying, precordial pain, and general malaise. A few minutes after these non-specific symptoms, the patient started tonic-clonic convulsions and had cyanosis, a substantial increase in body temperature to the touch, cold sudoresis, sphincter relaxation, and unconsciousness. This situation remained for 15 minutes, progressing to respiratory insufficiency, with consequent absence of peripheral pulses. Death was confirmed approximately 40 minutes after the first symptoms. An autopsy was performed using the usual techniques. Immunohistochemistry was positive for dengue, and microscopic examination indicated micro perivascular edema and cerebral hemorrhage.
  
  
  CONCLUSIONS
  Considering that the death occurred during the major endemic seasonal period for dengue fever, primary clinical evidence suggestive of viral infection presenting with sudden and quick death, and positive immunohistochemistry results, the case was closed as severe dengue fever. Clinicians must consider dengue as a diagnostic hypothesis among the indigenous population in Brazil.
authors.forename: Rafael Henrique Machado
authors.initials: RH
authors.lastname: Sacramento
authors.forename: Deborah Nunes
authors.initials: DN
authors.lastname: de Melo Braga
authors.forename: Franciane Fardin
authors.initials: FF
authors.lastname: Sacramento
authors.forename: Fernanda Montenegro
authors.initials: FM
authors.lastname: de Carvalho Araújo
authors.forename: Antônio Afonso Bezerra
authors.initials: AA
authors.lastname: Lima
authors.forename: Margarida Maria
authors.initials: MM
authors.lastname: de Lima Pompeu
authors.forename: Danielle Malta
authors.initials: DM
authors.lastname: Lima
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, St, Prof, Costa Mendes 1608, 5th Floor, Fortaleza, CE 60430-140, Brazil. pamplona.luciano@gmail.com.
authors.forename: Luciano Pamplona
authors.initials: LP
authors.lastname: de Góes Cavalcanti
mesh_terms: D001938:Brazil; D002675:Child, Preschool; D003715:Dengue / Q000503:physiopathology* / Q000821:virology; D003716:Dengue Virus / Q000472:pathogenicity* / Q000502:physiology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D044382:Population Groups; D012640:Seizures / Q000503:physiopathology* / Q000821:virology