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Pediatr Infect Dis J. 2019 Jan 9. doi: 10.1097/INF.0000000000002277. [Epub ahead of print]

Clinical Course and Management of Dengue in Children Admitted to Hospital; A 5 Years Prospective Cohort Study in Jakarta, Indonesia.

Abstract

BACKGROUND:

Dengue incidence is rising globally which was estimated 100 million per year, whereas in Indonesia was estimated 7.5 million per year. Dengue clinical course varies from mild dengue fever (DF) to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Patients, clinicians and care facilities would benefit if reliable predictors can determine at admission which cases with clinically suspected dengue will progress to DHF or DSS.

METHODS:

From 2009 through 2013, a cohort of 496 children admitted with clinically suspected dengue at a tertiary care hospital in Jakarta, Indonesia in, was followed until discharge. We evaluated the clinical course and disease outcome of admitted patients, and estimated the burden of dengue cases hospitalized over time.

RESULTS:

Of all 496 children, 185 (37%) were classified at admission as DF, 158 (32%) as DHF and 153 (31%) as DSS. Of DF patients, 52 (28%) progressed to DHF or DSS, 10 (5%) had other viral diseases. Of DHF patients, 9(6%) progressed to DSS. No patients died. Of 33 routinely collected parameters at admission, duration of fever ≤ 4 days was the only significant predictor of disease progression (p= 0.01). Between 2009 and 2013, annual dengue admissions declined, while the distribution of disease severity remained stable.

CONCLUSIONS:

Almost a third of children admitted to tertiary care with clinically suspected DF progress to DHF or DSS. Among routinely collected parameters at admission, only fever duration was significantly associated with clinical progression, emphasizing the unpredictability of dengue disease course from parameters currently routinely collected.

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