Clinical evolution of dengue in hospitalized patients
Keywords:
Dengue hemorrhagic fever, hospitalization, prognosis, adult, child, adolescent, cohort studies
Abstract
Introduction. Dengue hemorrhagic fever has extended to every tropical and subtropical area of the world, resulting in a half million hospitalizations every year. This disease appears to affect increasing numbers of adolescents and young adults.Objective. The clinical characteristics were described for adult and pediatric dengue inpatients to establish risk factors associated with bad prognosis.
Materials and methods. A cohort of dengue inpatients of years 2006 and 2007 was evaluated retrospectively at “Clínica Chicamocha”, a high level hospital in Bucaramanga, Colombia.
Results. Of 328 patients evaluated, 165 were female and 163 were male with a median age of 25 years. Dengue hemorrhagic fever was diagnosed in 116 patients, of which 113 were classified grade II. Of the 212 patients with dengue fever, 156 developed signs of plasma leakage, bleeding or thrombocytopenia. A positive serology was indicated in 82.4% of the patients. Inpatients with dengue hemorrhagic fever were younger (20.1 vs. 25.7 years, p<0.0054). Both lowest level of platelets and highest hematocrit were reached at the sixth day of illness. Children presented the typical symptoms of dengue less frequently, but demonstrated a greater proportion of ascites, pleural effusion and bleeding, and a higher risk of developing respiratory distress (RR=3.59, 95%CI 1.3-9.9, p<0.014) and hypotension (RR=10.77, 95%CI 5.56-20.86, p<0.001).
Conclusions. Age was the most determinant factor of severity in dengue inpatients. In addition, a combination of particular symptoms and laboratory data at the day of admission may predict the development of complications.
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References
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11. Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, et al. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop. 2008;105:39-44.
12. Malavige GN, Velathanthiri VG, Wijewickrama ES, Fernando S, Jayaratne SD, Aaskov J, et al. Patterns of disease among adults hospitalized with dengue infections. QJM. 2006;99:299-305.
13. Kularatne SA, Gawarammana IB, Kumarasiri PR. Epidemiology, clinical features, laboratory investigations and early diagnosis of dengue fever in adults: a descriptive study in Sri Lanka. Southeast Asian J Trop Med Public Health. 2005;36:686-92.
14. Shah I, Deshpande GC, Tardeja PN. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J Trop Pediatr. 2004;50:301-5.
15. Murgue B, Deparis X, Chungue E, Cassar O, Roche C. Dengue: an evaluation of dengue severity in French Polynesia based on an analysis of 403 laboratory-confirmed cases. Trop Med Int Health. 1999;4:765-73.
16. Tai DY, Chee YC, Chan KW. The natural history of dengue illness based on a study of hospitalised patients in Singapore. Singapore Med J. 1999;40:238-42.
17. Malavige GN, Ranatunga PK, Velathanthiri VG, Fernando S, Karunatilaka DH, Aaskov J, et al. Patterns of disease in Sri Lankan dengue patients. Arch Dis Child. 2006;91:396-400.
18. Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol. 2008;42:34-9.
19. Rosso F, Restrepo M, Alzate A, Muñoz J, Moreno C. Dengue hemorrágico en el Hospital Universitario del Valle, 1990-1992. Colomb Med. 1994;25:10-4.
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21. Méndez A, González G. Dengue hemorrágico en niños: diez años de experiencia clínica. Biomédica. 2003;23:180-93.
22. Arboleda M, Campuzano M, Restrepo BN, Cartagena G. Caracterización clínica de los casos de dengue hospitalizados en la E.S.E. "Antonio Roldán Betancur" Apartadó, Antioquia, 2000. Biomédica. 2006;26:286-94.
23. Salgado DM, Rodríguez JA, Garzón M, Cifuentes G, Ibarra M, Vega MR, et al. Clinical and epidemiological characterisation of dengue haemorrhagic fever in Neiva, Colombia, 2004. Rev Salud Pública (Bogotá). 2007;9:53-63. 24. Guha-Sapir D, Schimmer B. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol. 2005;2:1.
25. Park MK, Menard SW, Schoolfield J. Oscillometric blood pressure standards for children. Pediatr Cardiol. 2005;26:601-7.
26. World Health Organization. Clinical diagnosis. In: Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. Second edition. Geneva: WHO; 1997. p. 12-23. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http://www.who.int/entity/csr/resources/ publications/dengue/012-23.pdf
27. McPhee SJ, Papadakis MA, Tierney LM. Appendix, therapeutic drug monitoring & laboratory reference ranges. In: Current medical diagnosis & treatment. 46th edition. New York: McGraw-Hill; 2007. p. 1768-77.
28. Hay W, Levin M, Sondheimer J, Deterding R. Chemistry & hematology reference intervals. In: Current diagnosis & treatment in pediatrics. 18th edition. New York: McGraw-Hill; 2007. p. 1294-306.
29. Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, et al. The WHO dengue classification and case definitions: time for a reassessment. Lancet. 2006;368:170-3.
30. Balmaseda A, Hammond SN, Perez MA, Cuadra R, Solano S, Rocha J, et al. Short report: assessment of the World Health Organization scheme for classification of dengue severity in Nicaragua. Am J Trop Med Hyg. 2005;73:1059-62.
31. Avila-Aguero ML, Avila-Aguero CR, Um SL, Soriano-Fallas A, Canas-Coto A, Yan SB. Systemic host inflammatory and coagulation response in the dengue virus primo-infection. Cytokine. 2004;27:173-9.
32. Venkata Sai PM, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol. 2005;78:416-8.
33. Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S, et al. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. 2007;26:283-90.
34. Díaz FA, Martínez RA, Villar LA. Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad. Biomédica. 2006;26:22-30.
35. Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol. 2008;42:34-9.
36. Tanner L, Schreiber M, Low JG, Ong A, Tolfvensta T, Lai YL et al. Decision tree algorithms predict the diagnosis and outcome of dengue fever in the early phase of illness. PLoS Negl Trop Dis. 2008;2:e196.
2. Kurane I. Dengue hemorrhagic fever with special emphasis on immunopathogenesis. Comp Immunol Microbiol Infect Dis. 2007;30:329-40.
3. World Health Organization. Dengue and dengue haemorrhagic fever. In: WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases. First edition. Geneva: WHO; 2000. p. 75-8. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http:// www.who.int/entity/csr/resources/publications/surveillance/ dengue.pdf
4. Pan American Health Organization. Number of reported cases of dengue and dengue hemorrhagic fever (DHF), Region of the Americas (by country and subregion). Washington D.C.: PAHO; 2008. [Consultada: 5 de marzo de 2008]. Disponible en: http:/ /www.paho.org/English/AD/DPC/CD/dengue-cases- 2008.pdf.
5. Pan American Health Organization. The history of dengue and dengue hemorrhagic fever (DHF) in the Region of the Americas, 1635-2001. Washington D.C.: PAHO; 2001. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http://www.ops-oms.org/English/AD/ DPC/CD/dengue_history.htm
6. Instituto Nacional de Salud. Casos totales en la semana epidemiológica 52 y acumulados del año. Bogotá D.C.: INS; 2006. [Fecha de consulta: 18 de agosto de 2008]. Disponible en: http://www.ins.gov.co/ pdf/vcsp/Tablas/2006/2006_semana_52.pdf
7. Instituto Nacional de Salud. Casos totales en la semana epidemiológica 50 y acumulados del año. Bogotá D.C.: INS; 2007. [Fecha de consulta: 18 de agosto de 2008]. Disponible en: http://www.ins.gov.co/ pdf/vcsp/Tablas/2007/2007_semana_50.pdf
8. World Health Organization. Guidelines for treatment of dengue fever/dengue haemorrhagic fever in small hospitals. Geneva: WHO; 1999. p. 28. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http:// www.searo.who.int/LinkFiles/Dengue_Guidelinedengue. pdf
9. Méndez A, Bárcenas C, González G, Villar LA, Sepúlveda JW, Rey JJ, et al. Protocolo para la atención del dengue y dengue hemorrágico en el municipio de Bucaramanga. Bucaramanga: Secretaría de Salud y del Ambiente; 2003. p. 48. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http://www. bucaramanga. gov. co/docs/Protocolo% 20manejo% 20dengue.pdf
10. Martínez-Vega RA, Díaz-Quijano FA, Villar-Centeno LA. Low concordance between early clinical suspicion of dengue and its serological confirmation. Rev Med Chil. 2006;134:1153-60.
11. Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, et al. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop. 2008;105:39-44.
12. Malavige GN, Velathanthiri VG, Wijewickrama ES, Fernando S, Jayaratne SD, Aaskov J, et al. Patterns of disease among adults hospitalized with dengue infections. QJM. 2006;99:299-305.
13. Kularatne SA, Gawarammana IB, Kumarasiri PR. Epidemiology, clinical features, laboratory investigations and early diagnosis of dengue fever in adults: a descriptive study in Sri Lanka. Southeast Asian J Trop Med Public Health. 2005;36:686-92.
14. Shah I, Deshpande GC, Tardeja PN. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J Trop Pediatr. 2004;50:301-5.
15. Murgue B, Deparis X, Chungue E, Cassar O, Roche C. Dengue: an evaluation of dengue severity in French Polynesia based on an analysis of 403 laboratory-confirmed cases. Trop Med Int Health. 1999;4:765-73.
16. Tai DY, Chee YC, Chan KW. The natural history of dengue illness based on a study of hospitalised patients in Singapore. Singapore Med J. 1999;40:238-42.
17. Malavige GN, Ranatunga PK, Velathanthiri VG, Fernando S, Karunatilaka DH, Aaskov J, et al. Patterns of disease in Sri Lankan dengue patients. Arch Dis Child. 2006;91:396-400.
18. Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol. 2008;42:34-9.
19. Rosso F, Restrepo M, Alzate A, Muñoz J, Moreno C. Dengue hemorrágico en el Hospital Universitario del Valle, 1990-1992. Colomb Med. 1994;25:10-4.
20. Salgado D, Rodríguez A, Vega R. Dengue hemorrágico: emergencia pediátrica en el Huila. Pediatría (Bogotá). 1999;34:78-83.
21. Méndez A, González G. Dengue hemorrágico en niños: diez años de experiencia clínica. Biomédica. 2003;23:180-93.
22. Arboleda M, Campuzano M, Restrepo BN, Cartagena G. Caracterización clínica de los casos de dengue hospitalizados en la E.S.E. "Antonio Roldán Betancur" Apartadó, Antioquia, 2000. Biomédica. 2006;26:286-94.
23. Salgado DM, Rodríguez JA, Garzón M, Cifuentes G, Ibarra M, Vega MR, et al. Clinical and epidemiological characterisation of dengue haemorrhagic fever in Neiva, Colombia, 2004. Rev Salud Pública (Bogotá). 2007;9:53-63. 24. Guha-Sapir D, Schimmer B. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol. 2005;2:1.
25. Park MK, Menard SW, Schoolfield J. Oscillometric blood pressure standards for children. Pediatr Cardiol. 2005;26:601-7.
26. World Health Organization. Clinical diagnosis. In: Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. Second edition. Geneva: WHO; 1997. p. 12-23. [Fecha de consulta: 30 de enero de 2008]. Disponible en: http://www.who.int/entity/csr/resources/ publications/dengue/012-23.pdf
27. McPhee SJ, Papadakis MA, Tierney LM. Appendix, therapeutic drug monitoring & laboratory reference ranges. In: Current medical diagnosis & treatment. 46th edition. New York: McGraw-Hill; 2007. p. 1768-77.
28. Hay W, Levin M, Sondheimer J, Deterding R. Chemistry & hematology reference intervals. In: Current diagnosis & treatment in pediatrics. 18th edition. New York: McGraw-Hill; 2007. p. 1294-306.
29. Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, et al. The WHO dengue classification and case definitions: time for a reassessment. Lancet. 2006;368:170-3.
30. Balmaseda A, Hammond SN, Perez MA, Cuadra R, Solano S, Rocha J, et al. Short report: assessment of the World Health Organization scheme for classification of dengue severity in Nicaragua. Am J Trop Med Hyg. 2005;73:1059-62.
31. Avila-Aguero ML, Avila-Aguero CR, Um SL, Soriano-Fallas A, Canas-Coto A, Yan SB. Systemic host inflammatory and coagulation response in the dengue virus primo-infection. Cytokine. 2004;27:173-9.
32. Venkata Sai PM, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol. 2005;78:416-8.
33. Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S, et al. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. 2007;26:283-90.
34. Díaz FA, Martínez RA, Villar LA. Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad. Biomédica. 2006;26:22-30.
35. Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol. 2008;42:34-9.
36. Tanner L, Schreiber M, Low JG, Ong A, Tolfvensta T, Lai YL et al. Decision tree algorithms predict the diagnosis and outcome of dengue fever in the early phase of illness. PLoS Negl Trop Dis. 2008;2:e196.
How to Cite
1.
González AL, Martínez RA, Villar L Ángel. Clinical evolution of dengue in hospitalized patients. Biomed. [Internet]. 2008 Dec. 1 [cited 2025 Apr. 4];28(4):531-43. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/58
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