Abstract
Knowledge of adult dengue virus (DENV) infection from Hanoi, Vietnam, is limited. In 2008, we prospectively studied 143 (77 male) confirmed (nonstructural 1 antigen enzyme-linked immunosorbent assay [ELISA], DENV polymerase chain reaction, paired serology) adult dengue patients of median age 23.5 (range 16–72) years. They were admitted to the National Hospital for Tropical Diseases, Hanoi, on median illness day (D) 5 (range 1–8). By D8, 141 (98.6%) were afebrile. Platelet counts and hematocrit (median, interquartile range [IQR]) nadired and peaked on D5 and D4, respectively: 40,000/μL (10,000–109,000/μL), 43.4% (34.9–49.7%). Four (2.8%) patients had severe dengue: 1) D10 shock (N = 1) and 2) aspartate aminotransferase (AST) ≥ 1,000 IU/L (N = 3, D5 and D7). Of 143 patients, 118 (82.5%) had ≥ 1 warning sign (World Health Organization [WHO] 2009 criteria): mucosal bleeding 66/143 (46.1%), soft tissue edema 54/143 (37.7%), and ultrasound detected plasma leakage (pleural effusions/ascites) 30/129 (23.25%). 138 (96.5%) patients received intravenous (IV) fluids: 3 L (IQR: 0.5–8.5 L). Most patients had non-severe dengue with warning signs. High rates of edema and plasma leakage may be explained partly by liberal use of IV fluids. Studies are needed on optimizing fluid management in non-severe adult dengue.
Highlights
Serotypes 1–4 of the dengue flavivirus cause dengue, a predominantly tropical infection transmitted to humans by the Aedes mosquito
The median age in the Dengue Control (DENCO) study was 11.5 years (Thomas Janish, personal communication), and in southern Vietnam, shock was about threefold more common in children compared with adults.[13]
We considered a declining IgM titer when the convalescent sample had been taken on illness day (D) 3 14 as evidence of acute dengue infection; D14 is the mean time to peak IgM titers.[29]
Summary
Serotypes 1–4 of the dengue flavivirus cause dengue, a predominantly tropical infection transmitted to humans by the Aedes mosquito. Some patients may experience an increase in systemic vascular permeability that results in the intravascular loss of plasma (plasma leakage), which may manifest as soft tissue edema, serous effusions, hypotension, shock, and bleeding.[3,4,5] Impaired systolic and diastolic cardiac function may occur contemporaneously and contribute to cardiovascular instability.[6] This critical phase occurs usually several days after patients are afebrile on illness days (D) 4–7 and lasts 24–48 hours.[7]. Shock is the most common manifestation of severe dengue, affecting 210/230 (91.3%) patients in the Dengue Control (DENCO) study,[12] and is more common in children. The median age in the DENCO study was 11.5 years (Thomas Janish, personal communication), and in southern Vietnam, shock was about threefold more common in children compared with adults.[13] Dengue warning signs (Box 1) in non-severe dengue may herald the development of severe dengue, forewarning clinicians to monitor their patients closely.[12]
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