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PubMed2003

Clinical presentations of dengue hemorrhagic fever in infants compared to children.

BACKGROUND: Dengue infections are endemic in Thailand. Infants are at risk of developing dengue fever (DF) and dengue hemorrhagic fever (DHF). Many infants have severe DHF with unusual manifestations and may suffer from complications and even death because of difficulties in early diagnosis and improper management. OBJECTIVE: To study the incidence of infants DHF and to compare clinical and laboratory findings of DHF between infants and children in order to improve diagnosis and management of infants with DHF. MATERIAL AND METHOD: A retrospective review of hospital charts of DHF patients who were admitted to the Children's Hospital between 1995-1999 was carried out. Only confirmed DHF cases, either by serologic or virologic studies were included. Clinical and laboratory findings were compared using the standard software package SPSS. RESULTS: There were 4,595 confirmed dengue patients admitted to the Children's Hospital during this 5-year period and among these 245 infants were under one year old (5.3%). Unusual presentations of DHF including upper respiratory tract infection (URI) symptoms, diarrhea, convulsions and encephalopathy were found more in the infants (4.5%, 13.1%, 12.7% and 4.1%) than in the children (1.7%, 2.0%, 2.0% and 0.6%) but shock was found less in the infants (25%) than in the children (30.9%). The percentages of Tourniquet test positive and low WBC (< or = 5,000 cells/mm3) which help in the early diagnosis of dengue were less in the infants (50.2% and 26.8%) than in the children (92.2% and 71.9%). Liver involvement and/or dysfunction were found more in the infants as shown by mean aspartate aminotransferase/alanine aminotransferase (AST/ALT) elevation and prolonged prothrombin time. Duration of i.v. fluid was shorter in the infants than in the children (21.9 vs 38.2 hours). Complications of fluid overload were found more often in the infants than in the children (9% vs 3.6%). The case fatality rate was 1.2 in the infants and 0.3 in the children. CONCLUSION: Management of infants with DHF is critical because early diagnosis is rather difficult and they sometimes present with unusual manifestations (convulsions, encephalopathy and associated infections). Complications such as hepatic dysfunction and fluid overload are more commonly found in infants than in children and adults and also the case fatality rate is higher. Judicious i.v. fluid resuscitation and replacement is critical to the outcome of infants with DHF. It seems that the degree of plasma leakage is less in infants and the duration of plasma leakage is shorter in infants than in children.

Adolescent↗
PubMed1992

Diagnosis of measles by clinical case definition in dengue-endemic areas: implications for measles surveillance and control.

In many countries, measles surveillance relies heavily on the use of a standard clinical case definition; however, the clinical signs and symptoms of measles are similar to those of dengue. For example, during 1985, in Puerto Rico, 22 (23%) of 94 cases of illnesses with rashes that met the measles clinical case definition were serologically confirmed as measles, but 32 (34%) others were serologically confirmed as dengue. Retrospective analysis at the San Juan Laboratories of the Centers for Disease Control showed also that at least 28% of all laboratory-confirmed cases of dengue in Puerto Rico in 1985 met the measles clinical case definition. If the true measles vaccine efficacy (VE) is assumed to be 90%, the occurrence of laboratory-confirmed dengue cases that meet the measles clinical case definition results in a reduction of the apparent measles VE to only 64% (a 29% relative reduction from the true VE). The results of the study demonstrate the importance of a laboratory-based surveillance system in measles control or elimination efforts in dengue-endemic areas.

Adolescent↗
PubMed2003

Parturient and perinatal dengue hemorrhagic fever.

A Thai woman in the shock stage of dengue hemorrhagic fever delivered a healthy infant by normal delivery. She had high, prolonged fever for five days, hepatomegaly, thrombocytopenia and a right pleural effusion. The serology performed later established a diagnosis of secondary dengue infection. She had no serious complications except for postpartum anemia. The newborn became febrile at the 48th hour of life. He had fever for 2 days, hepatomegaly, thrombocytopenia and a right pleural effusion. Dengue virus type 1 was detected from his serum by polymerase chain reaction (PCR). Although he developed prolonged, marked thrombocytopenia (12 days), his illness was uncomplicated. He recovered uneventfully and was discharged with his mother. This report was one of dengue vertical transmission with dengue hemorrhagic fever in humans.

Adult↗
PubMed2003

Vertical transmission of dengue: first case report from Bangladesh.

We report a case of vertical transmission of dengue infection in a new born from Bangladesh. The mother was primigravida with an uneventful antenatal period except the fever she developed at 37 weeks of gestation. She underwent cesarean section for decreased fetal movement. The fever lasted for 7 days and was associated with intense bodyache, and a positive tourniquet test. She did not experience any hemorrhages including from the surgical wound. Her platelet count fell at its lowest to 100,000/mm3. She had bilateral mild pleural effusions and positive anti-dengue antibodies (both IgG and IgM). She received symptomatic treatment. The baby was deeply meconium stained and was resuscitated by a pediatrician. His postnatal period went well until day-3 of life when he developed fever and respiratory distress. There were no signs of meconiun aspiration syndrome (MAS) and the septic work up was negative. The platelets count fell to its lowest of 40,000/mm3 on day-3 and day-5 of his illness. Anti-dengue antibodies (both IgG and IgM) were positive with a nearly four-fold rise of IgM antibodies in the convalescent sera. The boy was treated with platelet transfusions and was discharged on day-6 after becoming ill. This report emphasizes that in a dengue epidemic or when dengue is endemic (which Bangladesh has experienced recently), a pregnant woman with fever, myalgia and/or bleeding manifestations should raise a high suspicion that the baby may develop the disease, and both the mother and baby should be closely followed-up. Viral isolation could not be done due to the unavailability of the test.

Adult↗
PubMed2004

Dengue hemorrhagic fever complicated with acute pancreatitis and seizure.

Dengue fever is an acute febrile viral disease, which frequently presents with high fever, headache, bone pain and skin rash. Acute pancreatitis and seizure are rare manifestations of dengue virus infection. A 66-year-old woman with diabetes mellitus presented with epigastralgia, nausea, vomiting, diarrhea and fever. Acute pancreatitis, abnormal liver function and thrombocytopenia were diagnosed at a local hospital. After persistent fever, thrombocytopenia and seizure developed she was transferred to our medical center. Dengue virus infection was confirmed by serology study and dengue hemorrhagic fever grade II was diagnosed. No further neurological symptoms occurred and pancreatitis improved gradually after supportive care. She recovered and had no sequelae at 1 year follow-up. Acute pancreatitis and seizure may be manifestations of dengue virus infection, especially in patients with delayed diagnosis, prolonged fever and thrombocytopenia.

Acute Disease↗
PubMed1992

Dengue haemorrhagic fever in children in Delhi.

An epidemic of dengue haemorrhagic fever occurred in Delhi during 1988. A total of 21 paediatric patients with dengue haemorrhagic fever/dengue shock syndrome were evaluated from September to November 1988. All the patients had fever, restlessness, ecchymotic spots and ascites. Pleural effusion occurred in 19 patients (90%), and 18 (86%) exhibited each of the following: vomiting, thrombocytopenia, and haemoconcentration. Hepatomegaly was observed in 15 patients (71%) and splenomegaly in three (14%). Titres of haemagglutination inhibition (HI) antibodies against dengue virus type 2 were raised in all the 15 cases from whom sera were collected during the acute stage. Convalescent sera from five patients had increased titres of HI antibodies to dengue virus type 2. The remaining 10 cases exhibited raised IgM antibody levels against dengue virus type 2. The fatality rate for serologically proven cases was 13% (2 of 15 patients), while for all patients (including those diagnosed clinically (6) and serologically (15)) it was 33.3% (7 of 21). Patients who survived had no sequelae, except one who had transient hypertension that lasted for two weeks.

Antibodies, Viral↗
PubMed2005

Spatial patterns of and risk factors for seropositivity for dengue infection.

Spatial patterns of and risk factors for seropositivity of dengue infection were studied in three sites in northern Thailand. A survey was conducted in 2001 among 1,750 persons. Potential risk factors for dengue infection were measured by questionnaire and IgM antibodies against dengue were detected by an enzyme-linked immunosorbent assay. The role of landscape as a risk factor was studied using land cover maps and a geographic information system. Logistic regression identified risk factors for dengue seropositivity. Spatial patterns of seropositive cases were determined by cluster analyses. Six percent of the study population was seropositive. Risk factors for dengue seropositivity differed per site, demonstrating variation in local infection patterns. In the periurban site, seropositivity depended on human behavior and factors related to housing quality rather than environmental factors. In both rural sites, older persons had a higher risk of seropositivity and persons living in houses surrounded by natural and agricultural land covers had a lower risk of seropositivity.

Adolescent↗
PubMed2005

[Effects of Alternanthera philoxeroides Griseb against dengue virus in vitro].

OBJECTIVE: To investigate the effects of Alternanthera philoxeroides Griseb extracts against dengue virus in vitro. METHODS: MTT assay and observation of cytopathic effect (CPE) were carried out to determine the cytotoxicity of Alternanthera philoxeroides Griseb on C6/36 cell lines and its effects on dengue virus. RESULTS: None of the 4 kinds of Alternanthera philoxeroides Griseb extracts exhibited obvious cytotoxicity on the cells at different concentrations with the exception of that over 320 microg/ml. The 4 extracts all showed inhibitory effects on dengue virus. Statistical analysis of TD(50) and ED(50) by Probit regression method suggested that extracts from coumarin had the lowest toxicity on the cells (TD(50)=535.91), whereas extracts from petroleum ether showed the strongest inhibitory effects on dengue virus (ED(50)=47.43) among the 4 extracts. CONCLUSION: Alternanthera philoxeroides Griseb possesses antiviral effects on dengue virus in vitro.

Amaranthaceae↗
PubMed2005

Survey on the management of dengue infection in Sri Lanka: opinions of physicians and pediatricians.

The management of dengue infection is variable and clinicians often adopt their own methods based on clinical experience. Hence, there is a lack of uniformity in the practice and management of dengue fever (DF) and dengue hemorrhagic fever (DHF) in Sri Lanka. The objectives were to describe the opinions of clinicians regarding certain management issues of, and their clinical experiences in DF/DHF. A self-administered questionnaire survey of 50 consultant physicians and pediatricians that were currently practicing in Government Hospitals was conducted. Their cumulative experience was based on managing approximately 15,119 patients for a period of three years in 15 districts of the island. The WHO guidelines were used by only 16(45%) physicians and 6(40%) pediatricians in the management of DF/DHF Most of the clinicians did not agree on the value of steroids and antibiotics. However, the majority was in favor of platelet and plasma transfusions, although most had no fixed policy on fluid management. In the experience, clinicians observed the recurrence of dengue, post-viral fatigue syndrome, and many other complications. A conclusion was made that a national policy and guidelines should be created to suit the local context, based on the evidence and experiences of clinicians managing dengue infection.

Dengue↗
PubMed2006

[Clinical criteria to diagnose dengue in its early stages].

INTRODUCTION: Clinical differentiation of dengue from other diseases with similar symptoms is difficult. The case definition of the World Health Organization (WHO) has high sensitivity but its specificity is very low. OBJECTIVE: A diagnostic scale was formulated for early clinical diagnosis of dengue that provided greater accuracy than that of the WHO definition. MATERIALS AND METHODS: A cohort of 251 adults (> 12 years of age) with unspecific acute febrile syndrome was selected from clinics located in Bucaramanga, Colombia. They consisted of 125 cases of dengue (serologically and/or virologically confirmed) and 126 with other febrile diseases. Clinical manifestations encountered during the first four days of dengue disease were determined, along with the diverse diagnostic combinations that were presented. RESULTS: : The scale consisted of the following criteria: presence of rash, positive tourniquet test, absence of nasal discharge, arthralgias, absence of diarrhea (1 point for each finding), leukocyte count < 4,000/mm3 (3 points) and platelet count < 180.000/mm3 (2 points). In a receiver-operating-characteristic curve, the predictive area of 81.0% was significantly superior to the one produced with WHO criteria, (70.0%, p < 0.001). Febrile syndrome with at least a 3 point score obtained the following values: sensitivity = 95.2%; specificity = 27.8%; positive predictive value = 56.7%; negative predicative value = 85.4%. With a 6-point score, sensitivity = 70.4%; specificity = 78.6%; positive predictive value = 76.5%; negative predicative value = 72.8%. With at least 8 points: sensitivity = 42.4%; specificity = 96%; positive predictive value = 91.4%; negative predictive value = 62.7%. With 9 or 10 points, specificity and positive predictive value were of 100%. CONCLUSION: The described scale proved useful for early clinical diagnosis of dengue, but requires validation for its application in endemic areas.

Adolescent↗
PubMed2006

Clinical features of 62 imported cases of dengue fever in Japan.

To describe the clinical features of dengue cases in Japan, a retrospective study was conducted on 62 laboratory-confirmed Japanese dengue cases presented to Tokyo Metropolitan Komagome Hospital between 1985 and 2000. Age distribution was from 18 to 62 years old (mean, 31.5 years). All cases were imported from abroad and diagnosed as dengue fever. Clinical manifestations included fever (100%), headache (90%), and skin rash (82%). Laboratory examinations revealed leukocytopenia (71%), thrombocytopenia (57%), elevated levels of serum aspartate aminotransferase (78%), and lactate dehydrogenase (71%). Antibody responses were consistent with that of secondary flavivirus infection in 60% of cases. Severity of symptoms in patients with primary dengue antibody response and those with secondary flavivirus antibody responses didn't show statistical significance. Dengue virus infection should be taken into consideration in the differential diagnosis of febrile patients who recently entered Japan from tropical or subtropical countries.

Adolescent↗
PubMedDate not supplied

Characteristics of dengue fever in a large public hospital, Jeddah, Saudi Arabia.

BACKGROUND: This study aims to determine demographic, clinical and laboratory profile along with disease outcome of all confirmed cases of dengue fever (DF) and dengue hemorrhagic fever (DHF) admitted in King Abdulaziz Hospital & Oncology Center, Jeddah, Saudi Arabia. We also want to highlight the significance of implementing a well targeted community based disease prevention program. METHODS: All patients admitted from May 2004 till April 2005 with a suspected diagnosis of DF and DHF were followed. All cases confirmed by a positive serology (IgM alone or IgM and IgG) to dengue fever were studied in detail to determine age, gender, ethnicity, monthly distribution, clinical and laboratory profile. RESULTS: A total of 80 patients were admitted with a suspected diagnosis of DF. Among these, 39 (48.75%) patients were confirmed by positive serology to have the disease. Male to female ratio was 3.3:1. Their ages ranged from 2 to 60 years with a mean of 27.6 +/- 11.2. Twelve patients were Saudis, while the rest were non-Saudis coming from different countries in Asia, Africa and Middle East. Maximum number of patients (48.72%) was seen in the summer months of June, July and August. Commonest presentation was fever (100%), headache (48.72%), myalgias (66.7%) and vomiting (25.64%). Rash, hemorrhagic manifestations and positive tourniquet test were relatively uncommon. Only two patients fulfilled WHO criteria of DHF. Main hematological abnormalities were thrombocytopenia (79.49%) and leucopenia (48.72%). Significant elevation of PTT was observed in 25.64% of patients. Abnormal liver function tests with high transaminases were seen in about 66.7% of patients, whereas 33.33% of patients had significantly elevated creatine kinase. All patients improved clinically with improvement of chemical and hematological parameters. None of the patients died in this series. CONCLUSION: DF continues to be a significant health problem in Western region of Saudi Arabia. Large number of pilgrims coming from disease endemic areas all over the world facilitates the continued introduction of dengue virus with different strains. Fortunately there has been no serious outbreak of dengue fever in recent years. A sharp vigilance is required by concerned authorities to prevent and minimize any future outbreak. It is extremely important to implement and maintain an effective, sustainable and community based disease prevention program.

Adolescent↗
PubMed2006

[Detection and typing of dengue virus using polymerase chain reaction and microwell plate hybridization].

OBJECTIVE: To establish a specific, sensitive and practicable method for detection and typing of dengue virus. METHODS: Based on the genomic sequence analysis of dengue virus types 1-4, 4 pairs of primers were designed. The specific capture probes of dengue virus types 1-4 were amplified using RT-PCR, cloned and sequenced before using them for precoating the microwell plate. The samples were amplified using biotin-labeled forward primer and reverse primer, and microwell plate hybridization was carried out for detection and typing of dengue virus types 1-4. RESULTS: The absorbance of the positive samples were higher than 0.5, while the average absorbance of the negative samples was lower than 0.1, with the S/N higher than 10. CONCLUSION: The method of PCR-ELISA we established for early detection and typing of all 4 dengue viruses seretypes.

Dengue Virus↗
PubMed1991

Upper gastrointestinal bleeding in dengue fever.

Twenty-six virologically and serologically confirmed Dengue patients with signs of upper gastrointestinal tract bleeding (13.1%) were studied during the 1987 outbreak in southern Taiwan. Within a 1-yr period from 1987 to 1988 in Kaohsiung Chang Gung Memorial Hospital, there were 198 patients with Dengue fever confirmed. Viral isolation and serological studies indicated that type I Dengue was the cause. There was no evidence of sequential secondary infection among them. The 26 patients were evaluated gastroduodenoscopically. Most of the Dengue patients who developed upper gastrointestinal bleeding had gastric ulcers or duodenal ulcers; superficial and hemorrhagic gastritis are the other relevant endoscopic findings. Thirteen patients (50%) had a past history of peptic ulcer symptoms, whereas the other 13 did not. Dengue infection is a precipitating factor in inducing peptic ulcer bleeding because of hemostatic derangements. Supportive therapy and blood transfusions alone were adequate treatment, except for one patient who required surgery due to massive bleeding of a duodenal ulcer. No mortality was observed in this study.

Adult↗
PubMed1991

Imported dengue--United States, 1990.

In 1990, 102 cases of suspected imported dengue were reported to CDC from 24 states and the District of Columbia. Of these, 24 (22%) cases (from 14 states and the District of Columbia) were serologically or virologically confirmed as dengue. The dengue serotype was identified by virus isolation in two of these cases. Fifty-five of the suspected cases were serologically negative for dengue, and the laboratory diagnosis of 23 remained undetermined because convalescent serum samples were not submitted. Travel histories were available for 22 of the 24 persons with confirmed dengue. Eight cases were acquired in Oceania, six in the Caribbean, six in Asia, and one each in Mexico and Peru.

Adult↗
PubMed1990

Epidemic of fever of unknown origin in rural Thailand, caused by influenza A (H1N1) and dengue fever.

In the late summer (rainy season) of 1987, a sharp outbreak of fever of unknown origin (FUO) in rural southern Thailand was investigated by a field epidemiology team. In a random survey of households, 40 percent of the children and 20 percent of adults were reported to have had febrile illnesses within the last month. There was at least one death, possibly from Reye's syndrome. Testing 34 pairs of acute and convalescent sera showed significant HI antibody titer rises to influenza A (Taiwan/(H1N1) (9 cases) and dengue virus (12 cases). Testing 79 single sera with the antibody capture ELISA test for dengue, revealed that 23 percent had high titers in the IgM serum fraction suggesting recent infection. There were also six antibody titer rises to coxsackie B viruses, three from well controls. Dengue has previously been observed as a cause of FUO in rural areas in the tropics, but finding a combined epidemic of dengue and influenza was unexpected. With cooperative villagers, adequate personnel and laboratory support, especially the antigen capture ELISA test for dengue infections, it is feasible to successfully investigate disease outbreaks with serologic methods in remote villages.

Chikungunya virus↗
PubMed1989

[Epidemiology of dengue fever in Taiwan].

Dengue fever, a tropical communicable disease, is caused by an infectious viral disease. It is also known as break bone fever. There have been a number of epidemics over the last century in Taiwan. Following an islandwide epidemic in 1942, dengue fever had not been presented on the island for about forty years. In 1981, an outbreak of dengue occurred in Liuchiu Hsiang, a small off-shore island of Pingtung county. The estimated attack rate was 80%. DEN-2 was isolated during that outbreak. Another occurrence occurred in the fall of 1987 in the southern part of Taiwan. The accumulated reported cases reached 1,387 at the end of that year. A majority of cases were reported in the Sanmin district of Kaohsiung city. The reported cumulative incidence was 0.2% in Sanmin. However, according to one survey, the attack rate in that area was 2.9%. DEN-1 was most commonly isolated but DEN-2 was also found in five cases. The latest outbreak took place in 1988. The estimation of reported cases exceeded 10,000 at the end of November, 1988. Two cases of dengue haemorrhagic fever were confirmed. More than fifty percent of the report case came from Kaohsiung city. The reported cumulative incidence rate was 0.5% in that area. Another survey reported that the adult attack rate exceeded 5% in the same area. It is estimated that the number of patients with mild symptoms and those without any symptoms would be a few times more than the number of those actually reported. However, a large space of herd immunity for susceptible hosts has remained. DEN-1 was isolated from all of the reported cases except two in which DEN-4 were isolated. Among the various variables which would effect the proliferation of disease, such as Aedes aegypti density, precipitation, and temperature, only a prior month of precipitation can explain the outbreak of dengue by stepwise multiple regression. Besides this, there was also a higher relative risk due to a higher population density with a trend correlation. Because of the ineffectiveness of the present control program, it is predicted that there may be yet another outbreak in the following year effecting those susceptible when the rainfall season comes.

Dengue↗
PubMed1989

[Clinical observations of dengue fever among children].

From November 1987 to October 1988, seventy-seven cases diagnosed as dengue fever and confirmed by viral culture or serological examination in the Pediatric Department of Kaohsiung Medical College Hospital were studied. In nearly two thirds (64.9%) of the total cases, the ages were between 10 and 14 years old. No significant sexual difference could be found in this study. Two peaks of cases distribution occurred at November 1987 and October 1988. The major clinical manifestations of Dengue Fever were fever, headache, skin rash and cough. Nearly half of the total cases had nausea, vomiting, myalgia and skin itching. 29 cases (37.7%) had hemorrhagic complications during the course of disease. The most common features of hemorrhage was petechiae followed by epistaxis. Two cases were confirmed as hemorrhagic dengue fever and one was also dengue shock syndrome. Most (92.5%) of the cases had body temperatures over 38.5 degrees C at the onset of the disease. The mean duration of fever was 5.9 days. No fatality was found. It is concluded that eradication of vectors in the school environment might be one of the major points of disease control according to the age distribution of this study. The appearance of hemorrhagic dengue fever is a major problem and should be closely followed by clinicians and workers of public health in Taiwan.

Adolescent↗