Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand
Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand
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DOI：
10.1111/j.1365-3156.2004.01295.x
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发表时间：
2004-09-01
影响因子：
3.3
通讯作者：
Pukrittayakamee, S
中科院分区：
文献类型：
--
作者：
Wichmann, O;Hongsiriwon, S;Pukrittayakamee, S
登革出血热（DHF）是东南亚发病的一个重要原因，过去几乎只发生在幼儿身上。近年来，年龄分布逐渐向年龄较大的儿童和成人转移。我们调查了2001年在泰国流行区发生的一起儿童和成人登革热暴发疫情。方法回顾性研究了2001年春武里医院登革热流行期间收治的347例经血清学证实的登革热感染患者。DHF患者的年龄明显大于DF患者（11岁vs. 8岁）。在124例DF（n = 24）和DHF（n = 100）患者中观察到临床出血，并且在成人中更常见。29例（13.2%）DHF病例由原发感染引起。儿童继发登革感染与DHF的发生显著相关，OR（95%CI）= 3.63（1.94-6.82），P < 0.0001，而成人继发登革感染与DHF的发生无关，OR（95%CI）= 0.6（0.02-6.04），P = 1。在23例患者中观察到不寻常的临床表现：3例出现脑病，20例出现肝酶高度升高。在后者组中，4例黄疸和9消化道bleeding.CONCLUSION这些结果表明，DHF在东南亚是常见的儿童和成人。在登革热流行的国家，登革热应被视为与肝酶升高相关的临床消化道出血患者的鉴别诊断。
OBJECTIVES Dengue haemorrhagic fever (DHF) is an important cause of morbidity in South-east Asia and used to occur almost exclusively in young children. In recent years, there has been a progressive shift in age-distribution towards older children and adults. We investigated an outbreak in 2001 in both children and adults, in an endemic area of Thailand.METHODS Retrospective study of 347 patients with serologically confirmed dengue infection admitted to Chonburi Hospital during an epidemic in 2001.RESULTS A total of 1.28 (37%) patients had dengue fever (DF) and 219 (63%) had DHF. Patients with DHF were significantly older than patients with DF (11 years vs. 8 years). Clinical bleeding was noted in 124 individuals, both with DF (n = 24) and DHF (n = 100), and significantly more frequently in adults. Twenty-nine (13.2%) of all DHF cases were caused by primary infection. Secondary dengue infection was associated significantly with the development of DHF in children, OR (95% CI) = 3.63 (1.94-6.82), P < 0.0001, but not in adults, OR (95% CI) = 0.6 (0.02-6.04), P = 1. Unusual clinical manifestations were observed in 23 patients: three presented with encephalopathy and 20 with highly elevated liver-enzymes. In the latter group, four patients were icteric and nine had gastrointestinal bleeding.CONCLUSION These results indicate that DHF in South-east Asia is common in both children and adults. In dengue-endemic countries, dengue should be considered as a differential diagnosis in patients with clinical gastrointestinal bleeding in association with increased liver enzymes.