The Early Clinical Features of Dengue in Adults: Challenges for Early Clinical Diagnosis

Abstract

BackgroundThe emergence of dengue throughout the tropical world is affecting an increasing proportion of adult cases. The clinical features of dengue in different age groups have not been well examined, especially in the context of early clinical diagnosis.Methodology/Principal FindingsWe structured a prospective study of adults (≥18 years of age) presenting with acute febrile illness within 72 hours from illness onset upon informed consent. Patients were followed up over a 3–4 week period to determine the clinical outcome. A total of 2,129 adults were enrolled in the study, of which 250 (11.7%) had dengue. Differences in the rates of dengue-associated symptoms resulted in high sensitivities when the WHO 1997 or 2009 classification schemes for probable dengue fever were applied to the cohort. However, when the cases were stratified into age groups, fewer older adults reported symptoms such as myalgia, arthralgia, retro-orbital pain and mucosal bleeding, resulting in reduced sensitivity of the WHO classification schemes. On the other hand, the risks of severe dengue and hospitalization were not diminshed in older adults, indicating that this group of patients can benefit from early diagnosis, especially when an antiviral drug becomes available. Our data also suggests that older adults who present with fever and leukopenia should be tested for dengue, even in the absence of other symptoms.ConclusionEarly clinical diagnosis based on previously defined symptoms that are associated with dengue, even when used in the schematics of both the WHO 1997 and 2009 classifications, is difficult in older adults.

Research on Dengue During World War II Revisited

“…Description of naturally occurring clinical cases are widely available. [17][18][19][20][21][22] However, these studies lack detailed information on when the infection was acquired. Case-patients can only be enrolled upon presentation to primary care clinics and these are often a few days after illness onset.…”

Occurrence and Correlates of Symptom Persistence Following Acute Dengue Fever in Peru

“…A study from Singapore noted that older subjects infected with DENV were hospitalized and had severe disease significantly more frequently than younger individuals. 26 Another study showed numerous acute clinical findings more often in Vietnamese adults than children, including arthralgia, myalgia, upper gastrointestional bleeding, abdominal pain, thrombocytopenia, and elevated transaminases. 27 Finally, a study from Singapore that evaluated non-acute symptoms such as fatigue 2 months after first detection of DENV infection found a greater proportion in older subjects as compared with younger subjects.…”

An evaluation of the World Health Organization’s 1997 and 2009 dengue classifications in hospitalized dengue patients in Malaysia

“…Similarly, all the fatal cases during a five-year study in Singapore fulfilled the severe dengue criteria using the WHO 2009 classification, but only 36% fulfilled the same criteria using the WHO 1997 classification [11]. On the other hand, another study indicated that both definitions are sensitive, but the diagnosis of dengue becomes more challenging in elderly patients [12], suggesting that there are still limitations to both guidelines. Hence, a conclusion could not be drawn about its applicability.…”