Dengue haemorrhagic fever in children in the 1996 Delhi epidemic
Dengue haemorrhagic fever in children in the 1996 Delhi epidemic
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DOI：
10.1016/s0035-9203(99)90027-5
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发表时间：
1999-05-01
影响因子：
2.2
通讯作者：
Seth, V
中科院分区：
文献类型：
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作者：
Kabra, SK;Jain, Y;Seth, V
1996年在德里发生了一次登革出血热流行。对一家医院收治的240名年龄在4个月至13岁之间的男女儿童进行了评估。216名（90%）儿童来自德里。临床诊断为登革热（DF） 25例（10%），登革热伴异常出血（DFB） 22例（9%），登革出血热80例（33%），登革休克综合征113例（47%）。年龄在8岁时达到顶峰。不同的疾病严重程度和年龄组之间没有联系，尽管女孩的疾病更严重。没有观察到营养不良严重程度和疾病严重程度之间的联系。止血带试验阳性率DF为40%，DFB为18%，DHF为62%，DSS为64%。在DSS患者中，呕血55例（49%），鼻出血39例（35%），黑黑1例（50%）。27例（24%），瘀斑34例（30%）。诊断为DFB的儿童分别有12例（55%）和10例（45%）出现呕血和鼻出血。DFB患者静脉液体需要量明显低于DHF/DSS患者。7例（6%）患者表现为黄疸，6例（5%）患者表现为肝性脑病，6例（5%）患者表现为登革热脑病。对50例白纹伊蚊C6/36克隆细胞系进行病毒培养的患者中，有10例分离到登革2型病毒。18例DSS患者死亡，总病死率为7.5%。DHF/DSS病死率为9.3%。这进一步表明，DFB是一个独特的实体。如果使用回顾性堆积细胞体积来评估血浓度，大多数患者可以按照世卫组织的分类进行分类。我们建议制定特定区域的诊断和管理标准是可取的。
An epidemic of dengue haemorrhagic fever (DHF) occurred in Delhi in 1996. A total of 240 children between the age of 4 months to 13 years of either sex, admitted in one hospital, were evaluated. Two hundred arid sixteen (90%) children were from Delhi. A clinical diagnosis of dengue fever (DF) was made in 25 (10%), dengue fever with unusual bleeding (DFB) in 22 (9%), DHF in 80 (33%) and dengue shock syndrome (DSS) in 113 (47%) of the children strictly according to the WHO classification. The age peaked at 8 years. There was no association between various grades of severity of illness and age-groups though girls suffered from more severe illness. No association between severity of malnutrition and severity of illness was observed. Tourniquet test was positive in 40% with DF, 18% with DFB, 62% with DHF and 64% with DSS. In DSS haematemesis was present in 55 (49%), epistaxis in 39 (35%), melaena in. 27 (24%) and ecchymosis in 34 (30%) patients. Children diagnosed as DFB had haematemesis and epistaxis in 12 (55%) and 10 (45%) respectively. Intravenous fluid requirement was clearly less in DFB patients than in DHF/DSS patients. Unusual clinical features in the form of jaundice were present in 7 (6%), hepatic encephalopathy in 6 (5%) and dengue encephalopathy in 6 (5%) patients. Dengue 2 virus was isolated from 10 of the 50 patients for whom viral culture was done on C6/36 clone of Aedes albopictus cell line. Eighteen patients suffering from DSS died giving an overall case fatality of 7.5%. The mortality rate in DHF/DSS was 9.3%. It is further suggested that DFB is a distinct entity. Most patients could be classified by the WHO classification if a retrospective packed cell volume was used to assess haemoconcentration. We suggest that development of area-specific criteria for diagnosis and management is desirable.