Abstract
BackgroundThe physiopathology of dengue hemorrhagic fever (DHF), a severe form of Dengue Fever, is poorly understood. We are unable to identify patients likely to progress to DHF for closer monitoring and early intervention during epidemics, so most cases are sent home. This study explored whether patients with selected co-morbidities are at higher risk of developing DHF.MethodsA matched case-control study was conducted in a dengue sero-positive population in two Brazilian cities. For each case of DHF, 7 sero-positive controls were selected. Cases and controls were interviewed and information collected on demographic and socio-economic status, reported co-morbidities (diabetes, hypertension, allergy) and use of medication. Conditional logistic regression was used to calculate the strength of the association between the co-morbidities and occurrence of DHF.Results170 cases of DHF and 1,175 controls were included. Significant associations were found between DHF and white ethnicity (OR = 4.70; 2.17–10.20), high income (OR = 6.84; 4.09–11.43), high education (OR = 4.67; 2.35–9.27), reported diabetes (OR = 2.75; 1.12–6.73) and reported allergy treated with steroids (OR = 2.94; 1.01–8.54). Black individuals who reported being treated for hypertension had 13 times higher risk of DHF then black individuals reporting no hypertension.ConclusionsThis is the first study to find an association between DHF and diabetes, allergy and hypertension. Given the high case fatality rate of DHF (1–5%), we believe that the evidence produced in this study, when confirmed in other studies, suggests that screening criteria might be used to identify adult patients at a greater risk of developing DHF with a recommendation that they remain under observation and monitoring in hospital.
Highlights
Dengue is the most important viral vector-transmitted disease worldwide in terms of the total number of cases, disease morbidity and mortality [1]
In epidemics most dengue fever cases are sent home as there are too many to be kept in observation, but if it were possible to identify those with a higher risk of progression to dengue hemorrhagic fever (DHF), they could be kept for observation, for early detection of signs, symptoms and alterations in laboratory tests suggestive of DHF, to enable timely and effective clinical management and early intervention. We study this issue and we believe that the evidence produced in this study, when confirmed in other studies, suggests that screening criteria might be used to identify adult patients at a greater risk of developing DHF with a recommendation that they remain under observation and monitoring in a hospital
Of the 170 cases of DHF included in the study, 55.9% were women and around 80% occurred in individuals over 15 years of age
Summary
Dengue is the most important viral vector-transmitted disease worldwide in terms of the total number of cases, disease morbidity and mortality [1]. This arboviral disease affects large areas of countries in tropical and subtropical regions of the world. As the physiopathology of the severe presentations, dengue hemorrhagic fever (DHF)/Dengue Shock Syndrome (DSS), remains poorly understood, there are no effective means to predict or prevent progression to this severe clinical expression of the infection [2,3]. The physiopathology of dengue hemorrhagic fever (DHF), a severe form of Dengue Fever, is poorly understood. This study explored whether patients with selected co-morbidities are at higher risk of developing DHF
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