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

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Surat Nakaviroj
Noparat Luangtongwattana


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.


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