Early clinical and biological features of severe clinical manifestations of dengue in Vietnamese adults

BackgroundDengue is a major public health problem in both children and adults in Vietnam, but dengue severity in adults has been poorly investigated.ObjectivesTo describe severe manifestations of dengue in Vietnamese adults and to identify early indicators of these manifestations.Study designA prospective longitudinal study was carried out from July to October, 2007, in People's Hospital 115, Ho Chi Minh City, Vietnam.ResultsOne hundred ninety-five clinically suspected dengue patients were enrolled. 151 of these were laboratory-confirmed using serum samples on day 3 after onset of fever for RT-PCR and/or virus isolation. Dengue was associated with plasma leakage in 51 patients (33.8%), gallbladder thickening in 30 patients (20%), spontaneous bleeding in 127 patients (84.1%), and internal bleeding in 37 patients (24.5%). Several early indicators were associated with severe manifestations of dengue. Frequent vomiting (≥3 times a day), marked lymphopenia, thrombocytopenia, and elevated liver enzymes on day 3 after onset of fever were significantly associated with plasma leakage and gallbladder thickening. Increased alanine aminotransferase level in plasma on day 3 was significantly associated with internal bleeding. Gallbladder thickening and internal bleeding were more common with specific serotypes.ConclusionSeveral severe manifestations of dengue were observed in Vietnamese adults. These manifestations were associated with early clinical and biological indicators. This information may be useful for clinicians to better monitor adult dengue patients, particularly in tropical areas where health resources may be limited.