The differences of clinical manifestations and laboratory findings in children and adults with dengue virus infection
Introduction
Dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) are now considered the most important arthropod-borne viral diseases worldwide. The global prevalence of dengue cases has increased in South-East Asia, Africa, the Western Pacific and the Americas (Calisher, 2005, Guzman and Kouri, 2002). An annually estimated 500,000 DHF patients require hospitalization. DHF is a leading cause of death in children. Case-fatality rates are usually 2.5%, can exceed 20% but can be reduced to <1% with rapid diagnosis and proper treatment of the patients. DHF is a major public health problem in Thailand and continues as an endemic disease with outbreaks every rainy season and large epidemics every 2–3 years or every in consecutive years (Department of Communicable Disease, 2004). DHF occurs primarily in children less than 15 years of age with the highest attack rate in the 5–9 years age group (Nimmannitya, 1987), recently, however, the peak age of DHF patients has shifted to 10–14 years of age (Kittigul et al., 2003; Department of Communicable Disease, 2004). The shift in age predominance of DHF patients might be related to changes in places of dengue virus transmission, from households to the school environment, or to changes in the age structure of the population (Patumanond et al., 2003). A gradually marked increase of dengue virus infection in adults has been noted in several countries (Hammond et al., 2005, Kularatne et al., 2005, Wichmann et al., 2004). In Thailand, affected adults aged over 15 years old are reported to comprise 30–40% of dengue virus infected cases according to the Epidemiological Surveillance System. Previous studies have described the severity of clinical bleeding found in adult dengue patients (Lee et al., 2006, Malavige et al., 2006, Wichmann et al., 2004). Age-related differences in dengue severity are poorly understood and the data on clinical features in dengue adults are limited. This study was carried out to determine the differences in the clinical manifestations and laboratory findings of hospitalized children and adults with dengue virus infection.
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Patients and methods
All patients admitted at Phetchabun Provincial Hospital, Phetchabun Province, 346 km north of Bangkok, from September 2003 to August 2004 who had the following criteria were enrolled in this study: (1) fever, (2) positive tourniquet test, (3) leukopenia or (4) thrombocytopenia or (5) haemoconcentration. Children were defined as patients with an age less than 15 years and adults with an age greater than or equal to 15 years. The total number of patients was calculated from the formula of
Statistical analysis
Descriptive statistics were used to describe the distribution of the patient characteristics data, signs and symptoms, and laboratory values of dengue virus infection. Comparisons of clinical and laboratory findings in children and adults were analysed by Chi-squared test, one way ANOVA, and t-test.
Results
A total of 300 patients who met the study criteria were admitted to Phetchabun Provincial Hospital from September 2003 to August 2004. With clinical and laboratory confirmation, 286 patients were diagnosed as having dengue virus infection. The high peak of dengue cases (60.8%) was in June–July, during the rainy season. The incidence was highest in the age group of 5–9 years old (37.8%) followed by 10–14 years old (37.2%) and 15–19 years old (11.8%). Three female cases were aged less than 1
Discussion
DHF has been recognized as a leading cause of childhood hospitalization. However, an increased number of DHF in adults has been reported (Hammond et al., 2005, Kularatne et al., 2005, Wichmann et al., 2004). The mean age of the present study subjects was 11 years, range was from 8 months to 50 years old, and a high incidence among the 10–14 years (37.2%) age group indicated a progressive shift in age distribution of DHF from a pediatric age to teenage groups. This finding is similar to previous
Acknowledgements
The authors thank the patients and medical staff at Phetchabun Provincial Hospital for their participation and assistance in this study, and Mr. Peter John Hall, The Language Center, Faculty of Graduate Studies, Mahidol University for editorial assistance.
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