Clinical and Virological Features of Dengue in Vietnamese Infants

Tran Nguyen Bich Chau,Nguyen Thi Hong Tham,Cameron P Simmons,Katherine L Anders,Le Thi Phuong,Mai Ngoc Lanh,Jeremy J Farrar,Lu Thi Minh Hieu,Nguyen Thanh Hung,Stephen S Whitehead,Tran Thi Thuy,Nguyen Minh Tuan,Le Bich Lien

doi:10.1371/journal.pntd.0000657

Abstract

BackgroundInfants account for a small proportion of the overall dengue case burden in endemic countries but can be clinically more difficult to manage. The clinical and laboratory features in infants with dengue have not been extensively characterised.Methodology/Principal FindingsThis prospective, cross-sectional descriptive study of infants hospitalized with dengue was conducted in Vietnam from November 2004 to December 2007. More than two-thirds of 303 infants enrolled on clinical suspicion of dengue had a serologically confirmed dengue virus (DENV) infection. Almost all were primary dengue infections and 80% of the infants developed DHF/DSS. At the time of presentation and during hospitalization, the clinical signs and symptoms in infants with dengue were difficult to distinguish from those with other febrile illnesses, suggesting that in infants early laboratory confirmation could assist appropriate management. Detection of plasma NS1 antigen was found to be a sensitive marker of acute dengue in infants with primary infection, especially in the first few days of illness.Conclusions/SignificanceCollectively, these results provide a systematic description of the clinical features of dengue in infants and highlight the value of NS1 detection for diagnosis.

Highlights

Dengue represents a substantial disease burden in many tropical and sub-tropical countries, in children and young adults [1]
Infection with any one of the four dengue virus (DENV) serotypes can lead to a sub-clinical infection, or to clinical disease ranging in severity from a non-specific febrile illness to classical dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS)
Dengue cases occur in children and young adults; severe dengue occurs in infants less than 1 year of age

Summary

Introduction

Dengue represents a substantial disease burden in many tropical and sub-tropical countries, in children and young adults [1]. In dengue-endemic areas infants under one year of age comprise between 1–5% of the dengue cases admitted to hospital each year [4,5], only a limited number of studies have documented clinical and laboratory findings in infants with dengue [8,9]. This evidence indicates that the clinical manifestations of dengue in infants may differ from older children and adults, with a greater frequency of low platelet count (,50000 cells/mm3), plasma leakage and shock and fewer haemorrhagic manifestations in infants compared with dengue in older children [8,9]. The clinical and laboratory features in infants with dengue have not been extensively characterised

Results

Discussion

Conclusion