Clinical and laboratory presentations of dengue patients with different serotypes.

Abstract

A five –year retrospective review of confirmed dengue patients admitted to the Children’s Hospital, Bangkok, during 1995-1999 was undertaken to compare the clinical and laboratory presentations between DEN-1,2,3 and 4. Dengue serotype could be identified in 50.6% (‎2398 cases)‎ of all the confirmed cases (‎Total: 4743 cases)‎ during this period. DEN-3 was the predominant serotype found in 50.6%, followed by DEN-1 (‎25.8%)‎, DEN-2 (‎20.9%)‎ and DEN-4 (‎2.7%)‎. There was no gender difference. The mean age of patients was significantly higher in DEN-4 (‎9.8 years)‎ while in DEN-1, DEN-2 and DEN-3 it was 8.2, 8.8 and 8 years, respectively. The peak incidence of DEN-1, DEN-2 and DEN-3 was among children between the age of 5-9 years while in DEN-4 it was between 10-14 years. From this study it was concluded that 91.8% of DEN-2 infections were secondary and it presented with more severe disease as demonstrated by more degree of plasma leakage, more shock and more complication of fluid overload cases. DEN-3 and DEN-4 tended to have more degree of liver involvement as demonstrated by more patients with abnormal elevation of liver enzyme AST and ALT and higher mean value of both AST and ALT. Because 29.6% of DEN -3 presented as primary infections and DEN-4 was the rare serotype, so that hepatic dysfunction / encephalopathy was not a big problem during this study period. DEN-1 seemed to have mildest clinical presentation with 29.6% of DEN-3 presented as primary infections. With this knowledge, if the circulating dengue serotype in the area is known, a better plan for case management can be established; preparation for more colloidal solutions and probably blood transfusion in DEN-2 and DEN-1 outbreaks and preparation for the management of DHF patients with hepatic dysfunction/encephalopathy if there is DEN-3 or DEN-4 outbreak.