Incidence of Severe Dengue Fever and Dengue Fever with Unusual Manifestations in Patients Older than 15 Years in Prapokklao Hospital, Chanthaburi Province during The 2019 Outbreak
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Dengue infection is a mosquito - borne viral infection. In 2019, an outbreak of dengue infection was reported in Chanthaburi Province, Thailand, in which there were 369.2 cases per 100,000 people and a mortality rate of 0.56 deaths per 100,000 population. This was a major outbreak that had never been reported before in this province. Therefore, the authors conducted a retrospective cohort study to review the medical records of adult dengue fever patients admitted to Prapokklao Hospital.
OBJECTIVES: The primary objective was to study the incidence of severe dengue fever and dengue fever with unusual manifestations, and the secondary objective was to investigate the factors associated with the occurrence of severe dengue fever in dengue infected patients aged older than 15 years who were admitted to Prapakklao Hospital in Chanthaburi Province between January 1 and December 31, 2019.
METHODS: The data were collected from the medical records of patients aged 15 years and older diagnosed with a dengue infection with confirmed laboratory results. The patients’ demographics, clinical characteristics, laboratory results, treatments, and results extracted from the medical records were used for the analysis.
RESULTS: A total of 288 patients were diagnosed with a dengue infection and had confirmed laboratory results. Forty - three patients were diagnosed with severe dengue fever accounting for 14.9% of the incidence, and six patients showing unusual manifestations accounted for 2% of the incidence: one case of PRESS syndrome, two cases of seizures, two cases of severe hepatitis, and one case of pancreatitis. The results of the analysis of the factor data by using the multiple regression method found that obesity (BMI > 30 kg/m2), serum albumin < 3.5 g/dL, serum lactate > 2.5 mmol/L, and elevated APTT > 35 second were associated with severe dengue fever, and the adjusted OR (aOR) were 4.66; 95%CI: (1.45 – 14.8), 2.69; 95%CI: (1.08 – 6.66), 9; 95%CI: (1.88 - 43), and 10.31; 95%CI: (3.2 - 32), respectively.
CONCLUSIONS: The incidence of severe dengue fever and dengue fever with unusual manifestations during the 2019 outbreak was 14.9% and 2%, respectively. This study found that obesity (BMI > 30 kg/m2), serum albumin < 3.5 g/dL, serum lactate > 2.5 mmol/L, and elevated APTT > 35 second were associated with severe dengue fever, which could be used as a prognostic tool that could predict the severity of the disease during treatment.
Article Details
References
World Health Organization. Global strategy for dengue prevention and control 2012–2020. Geneva: WHO; 2012.
World Health Organization. Comprehensive guidelines for prevention and control of dengue and dengue hemorrhagic fever revised and expanded edition. India: WHO; 2011.
Tantawichien T. Dengue fever and dengue haemorrhagic fever in adolescents and adults. Paediatr Int Child Health 2012;32(Suppl 1):22-7.
World Health Organization. Dengue: guidelines for diagnosis, treatment, pre¬vention and control. Geneva: WHO, 2009
Department of Disease Control. Forecast report dengue fever in 2020. Nonthaburi: Department of Disease Control; 2020.
Aung KL, Thanachartwet V, Desakorn V, Chamnanchanunt S, Sahassananda D, Chierakul W, et al. Factors associated with severe clinical manifestation of dengue among adults in Thailand. Southeast Asian J Trop Med Public Health 2013;44:602-12.
Junia J, Garna H, Setiabudi D. Clinical risk factors for dengue shock syndrome in children. Paediatr Indones 2007;47(1):7-11
Chacko B, Subramanian G. Clinical, laboratory and radiological parameters in children with dengue fever and predictive factors for dengue shock syndrome. J Trop Pediatr 2008;54:137-40.
Tan VPK, Ngim CF, Lee EZ, Ramadas A, Pong LY, Ng JI, et al.. The association between obesity and dengue virus (DENV) infection in hospitalised patients. PLoS One [Internet]. 2018 [cited 2021 May 8];13(7):e0200698. Available form: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200698
Tantracheewathorn T, Tantracheewathorn S. Risk factors of dengue shock syndrome in children. J Med Assoc Thai 2007;90:272-7.
Pichainarong N, Mongkalangoon N, Kalayanarooj S, Chaveepojnkamjorn W. Relationship between body size and severity of dengue hemorrhagic fever among children aged 0-14 years. Southeast Asian J Trop Med Public Health 2006;37:283-8.
Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol 2008;42:34-9.
Hsieh CC, Cia CT, Lee JC, Sung JM, Lee NY, Chen PL, et al. A cohort study of adult patients with severe dengue in Taiwanese intensive care units: The elderly and APTT prolongation matter for prognosis. PLoS Negl Trop Dis [Internet]. 2017[cited 2021 May 8];11(1):e0005270. Available form: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005270
Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S, Sahassananda D, Jittmittraphap A, Suwannakudt P, et al. Identification of clinical factors associated with severe dengue among Thai adults: a prospective study. BMC Infect Dis [Internet].2015[cited 2021 May 8];15:420. Available form: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1150-2
Wichmann O, Hongsiriwon S, Bowonwatanuwong C, Chotivanich K, Sukthana Y, Pukrittayakamee S. Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand. Trop Med Int Health 2004;9:1022-9.
Diptyanusa A, Phumratanaprapin W, Phonrat B, Poovorawan K, Hanboonkunupakarn B, Sriboonvorakul N, et al. Characteristics and associated factors of acute kidney injury among adult dengue patients: a retrospective single-center study. PLoS One [Internet]. 2019 [cited 2021 May 8];14(1):e0210360. Available form: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210360
Gallagher P, Chan KR, Rivino L, Yacoub S. The association of obesity and severe dengue: possible pathophysiological mechanisms. J Infect 2020;81:10-16.
Bethell DB, Gamble J, Pham PL, Nguyen MD, Tran TH, Ha TH, et al. Noninvasive measurement of microvascular leakage in patients with dengue hemorrhagic fever. Clin Infect Dis 2001;32: 243-53.
Huang YH, Liu CC, Wang ST, Lei HY, Liu HL, Lin YS, et al. Activation of coagulation and fibrinolysis during dengue virus infection. J Med Virol 2001;63:247-51.
Lin SW, Chuang YC, Lin YS, Lei HY, Liu HS, Yeh TM. Dengue virus nonstructural protein NS1 binds to prothrombin/thrombin and inhibits prothrombin activation. J Infect 2012;64:325-34.