Do young adults with uncomplicated dengue fever need hospitalisation? A retrospective analysis of clinical and laboratory features.

BACKGROUND

Approximately 80 percent of all notified cases of dengue infections in Singapore were hospitalised from 2000 to 2005. We aimed to determine if hospitalised dengue patients had significant morbidity and mortality, and if admissions were in accordance with previously-published admission criteria.

METHODS

The medical records of the first 20 patients with laboratory-confirmed dengue from two consecutive months in three time periods were retrospectively reviewed. Demographical, clinical and laboratory data on admission, during hospitalisation and on discharge, were compared.

RESULTS

There were 120 patients with a mean age of 35 years. Males comprised 77 percent and foreign workers 51 percent. Of the published admission criteria, 33 percent had vomiting, 22 percent diarrhoea, 13 percent abdominal pain, 18 percent bleeding and one patient had hypotension. 30 percent were above the minimum platelet threshold of 80,000/microL, but 50 percent had safe levels of platelets between 50,000 and 80,000/microL. Dengue haemorrhagic fever occurred in 4 percent with no death. After admission, platelet nadir was below 20,000/microL in only 9 percent and below 10,000/microL in only 2 percent of cases. Bleeding did not correlate with platelet count. Medical referral to the hospital was significantly associated with thrombocytopenia, while self-referral was significantly associated with vomiting.

CONCLUSIONS

Severe adverse outcome among young adults with uncomplicated dengue fever is rare. Instead of hospitalisation, daily outpatient monitoring with symptomatic treatment and medical leave may be a safe and feasible alternative.