Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore
Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore
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DOI：
10.1016/j.ijid.2006.02.012
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发表时间：
2007-05-01
影响因子：
8.4
通讯作者：
Sin, Leo Yee
中科院分区：
文献类型：
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作者：
Ong, Adrian;Sandar, Mya;Sin, Leo Yee
背景：登革热在东南亚再次出现。与登革热上升相关的是登革热相关死亡率的增加。为了更好地了解死亡率的预测因素，我们对住院成人登革热感染进行了回顾。方法：对一家大型三级医院登革热相关死亡病例进行回顾性病例对照研究。结果：2004年我院收治登革热/出血性登革热3186例，其中登革出血热130例，登革热相关死亡7例，病死率5.4%。在7例死亡病例中，至少有3例有原发性登革热感染的血清学证据。所有登革热死亡病例在平均发热第4天出现迅速进行性临床恶化，在平均发热5.6天入住重症监护病房。成人呼吸窘迫综合征、弥散性血管内凝血功能障碍和多器官功能衰竭是最常见的死亡原因，尽管早期住院、静脉输液和血液制品支持。结论：登革热与严重疾病相关，尽管目前有支持性管理，但仍发生死亡。致死性登革出血热/登革热休克综合征（DSS）确实发生在成人和原发性登革热感染中。需要更好的疾病严重程度的早期预测和临床干预。(C) 2006年由爱思唯尔有限公司代表国际传染病学会出版。
Background: Dengue fever has seen a significant re-emergence in Southeast Asia. Associated with the rise of dengue has been the increase in dengue-associated mortality. To better understand the predictors of mortality, we conducted a review of hospitalized adult dengue infections within our institution.Methods: This was a retrospective case-control study of dengue-associated deaths at a large tertiary care hospital.Results: In 2004, of 3186 cases of dengue fever (DF)/hemorrhagic dengue fever (DHF) admitted to our institution, there were 130 cases of DHF and seven dengue -associated deaths (case-fatality rate 5.4%). At least three of the seven fatal cases had serological evidence of primary dengue infection. All dengue-mortality cases had rapidly progressive clinical deterioration at an average of day 4 of fever with intensive care admission occurring on a mean of 5.6 days of fever. Adult respiratory distress syndrome, disseminated intravascular coagulopathy, and multi-organ failure were the most common causes of death despite early hospitalization, intravenous fluid, and blood-product support.Conclusion: Dengue is associated with severe disease, and deaths do occur despite current supportive management. Fatal DHF/dengue shock syndrome (DSS) does occur in adults and in primary dengue infection. Better early predictors of disease severity and clinical interventions are needed. (C) 2006 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.