Abstract
Dengue fever is gaining importance in Singapore with an increase in the number of cases and mortality in recent years. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. This study aims to examine the prevalence of prolonged and saddleback fever in dengue as well as their associations with dengue severity. A total of 2843 polymerase-chain reaction (PCR) confirmed dengue patients admitted to Tan Tock Seng Hospital from 2004 to 2008 were included in the study. Sixty-nine percent of them were male with a median age of 34 years. Prolonged fever (fever > 7 days duration) was present in 572 (20.1%) of patients. Dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) and severe dengue (SD) were significantly more likely to occur in patients with prolonged fever. Mucosal bleeding, anorexia, diarrhea, abdominal pain, nausea or vomiting, lethargy, rash, clinical fluid accumulation, hepatomegaly, nosocomial infection, leukopenia, higher neutrophil count, higher hematocrit, higher alanine transaminase (ALT) and aspartate transaminase (AST), higher creatinine, lower protein and prolonged activated partial thromboplastin time (APTT) were significantly associated with prolonged fever but not platelet count or prothrombin time (PT). Saddleback fever was present in 165 (5.8%). Although DHF and SD were more likely to occur in patients in those with saddleback fever, DSS was not. Compared with prolonged fever, saddleback fever did not show many significant associations except for diarrhea, abdominal pain, clinical fluid accumulation, hematocrit and platelet change, and lower systolic blood pressure. This study demonstrates that prolonged fever may be associated with various warning signs and more severe forms of dengue (SD, DSS, DHF), while saddleback fever showed associations with DHF and SD but not DSS. The presence of prolonged or saddleback fever in dengue patients should therefore prompt detailed evaluation for complications of dengue, as well as early investigation to evaluate for development of nosocomial infection.
Highlights
Dengue infection is an acute mosquito-borne viral infection of which there are four serotypes, namely DENV-1, DENV-2, DENV-3, and DENV-4, transmitted by the Aedes mosquito
With this rapidly increasing incidence of dengue cases worldwide, the World Health Organization has recommended that research efforts be directed towards reducing the morbidity and mortality associated with Dengue hemorrhagic fever (DHF). [5] A meta-analysis found that factors such as nausea or vomiting, abdominal pain, gastrointestinal bleeding, hemoconcentration, plasma leakage, elevated transaminases, thrombocytopenia and prolonged coagulation were significantly associated with the development of dengue shock syndrome (DSS)
Findings of a study conducted in India among children with dengue fever found that prolonged fever of more than 7 days was associated with the development of DHF and DSS
Summary
Dengue infection is an acute mosquito-borne viral infection of which there are four serotypes, namely DENV-1, DENV-2, DENV-3, and DENV-4, transmitted by the Aedes mosquito. [1] Global estimates suggest that there may be as many as 390 million dengue infections a year, with about 96 million cases manifesting clinically. Dengue fever has become an infection of public health importance in Singapore since 2004, when a record of 9459 cases was notified that year. A study conducted among hospitalized adult dengue patients in Singapore reported that the incidence of dengue hemorrhagic fever (DHF) was 21.7% and dengue shock syndrome (DSS) 3.4%. [8,9] these reports suggest that saddleback fever may aid in the clinical diagnosis of dengue, the prognostic significance of both prolonged and saddleback fever have not been well studied. The aim of this study was to examine the prevalence of prolonged and saddleback fever as well as their associations with dengue severity
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