A Two-Year Review on Epidemiology and Clinical Characteristics of Dengue Deaths in Malaysia, 2013-2014

Abstract

BackgroundDengue infection is the fastest spreading mosquito-borne viral disease, which affects people living in the tropical and subtropical countries. Malaysia had large dengue outbreaks in recent years. We aimed to study the demographics and clinical characteristics associated with dengue deaths in Malaysia.MethodsWe conducted a retrospective review on all dengue deaths that occurred nationwide between 1st January 2013 and 31st December 2014. Relevant data were extracted from mortality review reports and investigational forms. These cases were categorized into children (<15 years), adults (15–59 years) and elderly (≥60 years) to compare their clinical characteristics.ResultsA total of 322 dengue deaths were reviewed. Their mean age was 40.7±19.30 years, half were females and 72.5% were adults. The median durations of first medical contact, and hospitalization were 1 and 3 days, respectively. Diabetes and hypertension were common co-morbidities among adults and elderly. The most common warning signs reported were lethargy and vomiting, with lethargy (p = 0.038) being more common in children, while abdominal pain was observed more often in the adults (p = 0.040). But 22.4% did not have any warning signs. Only 34% were suspected of dengue illness at their initial presentation. More adults developed severe plasma leakage (p = 0.018). More than half (54%) suffered from multi-organ involvement, and 20.2% were free from any organ involvement. Dengue deaths occurred at the median of 3 days post-admission. Dengue shock syndrome (DSS) contributed to more than 70% of dengue deaths, followed by severe organ involvement (69%) and severe bleeding (29.7%).ConclusionIn Malaysia, dengue deaths occurred primarily in adult patients. DSS was the leading cause of death, regardless of age groups. The atypical presentation and dynamic progression of severe dengue in this cohort prompts early recognition and aggressive intervention to prevent deaths.Trial RegistrationNational Medical Research Registry (NMRR, NMRR-14-1374-23352)

Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study

“…Severe organ involvement has been associated with severe dengue, intensive care requirement, and fatality1314151617. Chronic medical disorders have also been implicated in the development of severe dengue diseases32.…”

“…One of the major dengue complications of concern is the progression to severe organ involvement, which has been associated with SD, intensive care treatment, and fatality1314151617. Dengue associated severe organ involvement were cardiovascular18, hepatic141920, renal2122, as well as central nervous systems2324, and to some extent, respiratory252627 and muscular systems2829.…”

Diagnosis Klinis Demam Berdarah Dengue di Tiga Kabupaten/Kota Sulawesi Tengah Tahun 2015-2016

“…bahwa angka kematian kasus dengue juga paling banyak ditemukan pada usia dewasa, 15-59 tahun (72,5%). 5 Sejak DBD pertama kali dilaporkan di Jakarta dan Surabaya pada tahun 1968, angka kesakitan DBD menunjukkan kecenderungan peningkatan dari tahun ke tahun dan wilayah penyebarannya pun semakin luas hampir seluruh kabupaten/kota di Indonesia. Pada tahun 2014, DBD berjangkit di 433 kabupaten/kota dengan angka kesakitan sebesar 39,83 per 100.000 penduduk, namun angka kematian akibat DBD dalam satu dekade terakhir dapat ditekan sampai dibawah 1%.…”

Causes of death among hospitalized adults with dengue fever in Tainan, 2015: emphasis on cardiac events and bacterial infections

“…This is likely related to the following: first, public awareness of dengue was low during the early phase of the epidemic and less than one half (6) of the 13 patients that experienced cardiac arrest sought medical care before their death. Early medical care could be life-saving before dengue deteriorated [13-15]. Second, ED overclouding may be associated with increased mortality rates and morbidity [24, 25], and the role of patient diversion [24, 26] and the short stay ward at the ED [27] during large outbreaks of infectious diseases is mentioned.…”

“…However, this information was limited in the literature. A two-year review in Malaysia has discussed deaths that were directly caused by dengue [13]. The causes of death stratified by the pathophysiology of dengue fever include dengue shock syndrome, severe bleeding, and severe organ involvement.…”