Dengue is a mosquito-borne acute febrile illness (AFI) endemic in Puerto Rico. Some dengue patients develop severe dengue, which is characterized by a potentially life-threatening plasma leakage syndrome. Early identification of these patients could enable timely initiation of supportive care.
To identify early clinical features associated with severe dengue, data from a prospective study of AFI patients conducted in Puerto Rico from May 7, 2012 through May 6, 2014 was analyzed. Patients with fever in the past 7 days were enrolled and followed through their illness. Blood and nasopharyngeal swabs were collected and tested by RT-PCR and immunodiagnostic methods for dengue viruses 1-4 and 16 other pathogens. Our analysis was limited to 509 laboratory-positive dengue patients with complete follow-up of their clinical illness. We compared dengue patients not classified as severe at enrollment but who later developed severe dengue (Cases) with patients that did not develop severe dengue (Controls).
Of the 509 dengue patients, 167 (33%) met the 2009 WHO criteria for severe dengue, 101 (20%) at enrollment and 66 (13%) later in their illness. Patients with severe dengue at enrollment were more likely than Cases and Controls to be female (63% vs. 50% and 40%). Cases and Controls were similar with regard to age and sex distribution. At enrollment, Cases were more likely to have headache (92% vs. 82%), nausea (82% vs. 69%), and abdominal pain (75% vs. 60%). Controls were more likely to present with rash (53% vs. 34%). After controlling for age and sex in logistic regression analysis, Cases were more likely to have nausea at enrollment (OR = 2.26, 95% CI: 1.07-4.74), while Controls were more likely to have rash (OR = 0.46, 95% CI: 0.25-0.84). Cases were more likely to have history of asthma (OR = 1.96, 95% CI: 1.03-3.74).
This examination of AFI patients enabled an unbiased determination of early clinical predictors of severe dengue. This data suggests that nausea may be a predictor of developing severe dengue. Clinicians should be aware that patients with asthma or those presenting with abdominal symptoms are at increased risk for developing severe dengue after initial presentation.
A. Rivera-Sánchez, None
E. Gonzalez, None
J. P. Torres, None
E. Lugo, None
T. M. Sharp, None
L. I. Alvarado, None
K. M. Tomashek, None