Dengue in adults admitted to a referral hospital in Hanoi, Vietnam

• Published in: The American journal of tropical medicine and hygiene Vol. 92; no. 6; pp. 1141 - 1149
• Main Authors: Taylor, Walter R, Fox, Annette, Pham, Khuong Thi, Le, Hoa Nguyen Minh, Tran, Ninh Thi Hai, Tran, Giang Van, Nguyen, Binh Thanh, Nguyen, My Van, Nguyen, Lien Thi, Yacoub, Sophie, Nguyen, Hoai Thi Thu, Nguyen, Ha Hong, Nguyen, Hien Duc, Wertheim, Heiman, Horby, Peter, Farrar, Jeremy, Trinh, Lien Thi Minh, Nguyen, Kinh Van
• Format: Journal Article
• Language: English
• Published: United States The American Society of Tropical Medicine and Hygiene 01.06.2015
• Subjects: Adolescent; Adult; Aged; Dengue - diagnosis; Dengue - epidemiology; Dengue - pathology; Dengue Virus; Enzyme-Linked Immunosorbent Assay; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Polymerase Chain Reaction; Prospective Studies; Vietnam - epidemiology; Young Adult; Vietnam; Vietnam, Hanoi; ISEW, Vietnam
• DOI: 10.4269/ajtmh.14-0472
• ISSN: 0002-9637

Knowledge of adult dengue virus (DENV) infection from Hanoi, Vietnam, is limited. In 2008, we prospectively studied 143 (77 male) confirmed (nonstructural 1 antigen enzyme-linked immunosorbent assay [ELISA], DENV polymerase chain reaction, paired serology) adult dengue patients of median age 23.5 (range 16-72) years. They were admitted to the National Hospital for Tropical Diseases, Hanoi, on median illness day (D) 5 (range 1-8). By D8, 141 (98.6%) were afebrile. Platelet counts and hematocrit (median, interquartile range [IQR]) nadired and peaked on D5 and D4, respectively: 40,000/μL (10,000-109,000/μL), 43.4% (34.9-49.7%). Four (2.8%) patients had severe dengue: 1) D10 shock (N = 1) and 2) aspartate aminotransferase (AST) ≥ 1,000 IU/L (N = 3, D5 and D7). Of 143 patients, 118 (82.5%) had ≥ 1 warning sign (World Health Organization [WHO] 2009 criteria): mucosal bleeding 66/143 (46.1%), soft tissue edema 54/143 (37.7%), and ultrasound detected plasma leakage (pleural effusions/ascites) 30/129 (23.25%). 138 (96.5%) patients received intravenous (IV) fluids: 3 L (IQR: 0.5-8.5 L). Most patients had non-severe dengue with warning signs. High rates of edema and plasma leakage may be explained partly by liberal use of IV fluids. Studies are needed on optimizing fluid management in non-severe adult dengue.