Response to Joob and Wiwanitkit re: “Genetic Polymorphisms of Tumor Necrosis Factor Alpha and Susceptibility to Dengue Virus Infection in a Mexican Population”

To the Editor:

We appreciate comments from Joob B and Wiwanitkit V, in response to our article on “Genetic Polymorphisms of Tumor Necrosis Factor Alpha and Susceptibility to Dengue Virus Infection in a Mexican Population” by Sánchez-Leyva et al. (2,4). We acknowledge their concern for management of the patients, especially for those with hemorrhagic dengue fever, which can reach out a good clinical outcome if a proper fluid therapy is achieved.

In response to the letter, we want to say that all patients in our study were treated by emergency physicians according to the official Mexican policy for the management of dengue fever and dengue hemorrhagic fever established in the official document NOM-032-SSA2-2014 (1), based on the World Health Organization Dengue Guidelines for diagnosis, treatment, prevention, and control (5,6). Also, it is important to note that during our study, no patient was classified as dengue shock syndrome and no death had occurred.

Effectively, clinical management of critically ill patients relies on careful monitoring of fluid balance combined with judicious intravenous fluid therapy. However, we must keep in mind that an excessive fluid administration can lead to fluid overload or causes acute pulmonary edema, cardiopulmonary failure, and death, as main complications (3).

Finally, the study of the human genome applied to susceptibility/resistance to infections is a way to obtain insights into the mechanisms of human response to pathogens. Furthermore, it can help to explain the distribution patterns of infectious diseases in human populations.