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Confirmed adult dengue deaths in Singapore: 5-year multi-center retrospective study

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Author(s): Leo Yee-Sin | Thein Tun | Fisher Dale | Low Jenny | Oh Helen | Narayanan Rajmohan | Gan Victor | Lee Vernon | Lye David

Journal: BMC Infectious Diseases
ISSN 1471-2334

Volume: 11;
Issue: 1;
Start page: 123;
Date: 2011;
Original page

ABSTRACT
Abstract Background Dengue re-emerges in Singapore despite decades of effective vector control; the infection predominantly afflicts adults. Severe dengue not fulfilling dengue hemorrhagic fever (DHF) criteria according to World Health Organization (WHO) 1997 guideline was increasingly reported. A new WHO 2009 guideline emphasized warning signs and a wider range of severe dengue manifestations. We aim to evaluate the utility of these two guidelines in confirmed adult dengue fatalities. Methods We conducted a multi-center retrospective chart review of all confirmed adult dengue deaths in Singapore from 1 January 2004 to 31 December 2008. Results Of 28 adult dengue deaths, median age was 59 years. Male gender comprised 67.9% and co-morbidities existed in 75%. From illness onset, patients presented for admission at a median of 4 days and death occurred at a median of 12 days. Intensive care admission was required in 71.4%. Probable dengue was diagnosed in 32.1% by WHO 1997 criteria and 78.6% by WHO 2009. The earliest warning sign was persistent vomiting at a median of 1.5 days. Hematocrit change ≥20% concurrent with platelet count

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