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2014, Number 4

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Medisur 2014; 12 (4)

Dengue hemorrhagic fever. Clinical study of hospitalized adult patients

Espinosa BA

Language: Spanish
References: 81
Page: 570-591
PDF size: 299.01 Kb.


ABSTRACT

Background: the description of an epidemic is crucial from a clinical and epidemiological point of view.
Objective: to identify the main clinical characteristics of hospitalized adult patients diagnosed with dengue hemorrhagic fever.
Methods: a prospective case series study was conducted in 997 patients who met the diagnostic criteria for dengue hemorrhagic fever and were discharged from the Dr. Gustavo Aldereguía Lima Hospital from June 1st. to August 31, 1981. An automated database was developed based on the information collected from medical records using forms designed for the purpose.
Results: forty eight point seven percent of the patients were in the third and fourth decades of life; females predominated (60.1 %). General symptoms were fever (97.4 %), asthenia (78.6 %), headache (76.4 %), anorexia (75.9 %), myalgia (62.1 %) and sweating (37.2 %). The digestive symptoms included: nausea (57.8 %), vomiting (46.2 %), abdominal pain (31.6 %) and diarrhea (14.1 %). The rash was developed by 32.5 % of the patients. Among the hemorrhagic manifestations were: petechiae (31.2 %), ecchymosis (11.5 %), epistaxis (7.6 %), hematemesis (6.2 %), hematuria (5.5 %), melena (3.4 %), gingival bleeding (3.4 %), enterorrhagia (2.2 %), metrorrhagia (2.1 %). The signs included: abdominal tenderness (53.6 %), tachycardia (25.9 %), lymphadenopathy (22.1 %), hypotension (12.0 %), pharyngeal redness (11.7 %), hepatomegaly (8.3 %), shock or "pre-shock" (6.9 %) and splenomegaly (6.2%). Symptoms and signs were more frequent and severe among women. Eighty one point five percent of the patients were admitted one to three days after developing the symptoms. Thrombocytopenia (less than 100 000 platelets per mm3) was found in all cases and leukopenia was observed in 38.9 % of females and 20.6 % of men. Fourteen patients were admitted to intensive care, mostly due to shock; four of them with severe hemorrhagic manifestations. Only one patient died.
Conclusions: the high morbidity due to dengue hemorrhagic fever was evident in adults hospitalized during the epidemic of the summer of 1981 in Cienfuegos. The disease was more common and severe among women. A very low lethality was found.


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