Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic.

OBJECTIVE

This study investigated the clinical manifestations and risk factors for dengue fever (DF) and dengue hemorrhagic fever (DHF) and disease severity during the 2002 outbreak in the Kaohsiung area.

METHODS

We analyzed the clinical characteristics of 644 patients with virologically or serologically positive results for dengue virus at Kaohsiung Medical University Hospital from January 1 to December 31, 2002.

RESULTS

The case rate peaked in November. The male-to-female ratio was 1:1.2 and the mean age was 47.5 +/- 17.9 years (range, 7 months to 88 years). The criteria for DHF were fulfilled in 232 cases, including 12 cases of dengue shock syndrome (DSS). The most common symptoms were fever (96.1%), myalgia (68.5%), headache (55.4%), and skin rash (53.7%). Hemorrhagic manifestations were noted in 73.0% of patients. The mean age of patients with DHF/DSS was 53.6 +/- 16.3 years, and the highest incidence occurred in those aged 60-69 years (27.2%). Significant risk factors for DHF/DSS were age >65 years, diabetes mellitus, hypertension, and uremia. Gallbladder wall thickening was found in 64.7% of DHF cases who underwent abdominal ultrasound examination. 164 of the 232 DHF cases (71%) were discharged without a diagnosis of DHF. The number of DHF cases identified by our study was nearly equal to that reported through the established passive surveillance system (232 cases vs 242).

CONCLUSIONS

DHF was under-reported in hospital, suggesting that continuous surveillance and education for clinicians in the recognition of DHF, especially in elderly patients and those with chronic pre-existing comorbidities, is needed.