Clinical and laboratory profile of dengue in the elderly

Abstract

Background:Dengue is the most rapidly spreading mosquito-borne viral disease in the world with a 30-fold increase in incidence in the last 50 years. Approximately, 50 million dengue infections occur annually.Aim:To study the various clinical and laboratory manifestations of dengue in the elderly and observe for any variations in IgM titer elevation with progression of age.Design:Retrospective observational study.Subjects and Methods:Medical charts of all patients admitted to the Division of Geriatrics of the institute during study period were reviewed for collection of demographic, clinical, and laboratory information. The diagnosis of dengue was made based on positive dengue IgM ELISA. An elderly patient referred to one whose age was ≥60 years.Results:Fever and myalgia were noted to be the most common clinical manifestation with only four patients presenting with overt bleeding manifestations. Only one patient presented in delirium and there was no case fatality. Thrombocytopenia was the single most common hematological abnormality noted. Hyponatremia was found to be prevalent in a majority of the patients and were symptomatic in more than half of them. There have been very few studies done worldwide on the varied clinical manifestations of dengue in the elderly.

Arboviroses reemergentes: perfil clínico-epidemiológico de idosos hospitalizados

“…In this study, SAH and diabetes were the main baseline diseases of the hospitalized elderly participants, in agreement with other studies (18,21) . Such chronic diseases are the most frequent among the elderly population and, therefore, should be considered in the therapeutic approach to increase the arbovirus treatment efficacy (22) .…”

“…Fever, myalgia and arthralgia were the most frequent clinical symptoms during hospitalization. A similar result was found in a study about dengue in India (21) and in a study about chikungunya (23) , both conducted with elderly participants. Fever is present in the arboviruses mentioned www.ee.usp.br/reeusp Rev Esc Enferm USP · 2018;52:e03403…”

“…Such chronic diseases are the most frequent among the elderly population and, therefore, should be considered in the therapeutic approach to increase the arbovirus treatment efficacy (22) . The presence of comorbidities in patients with arbovirus has been mentioned as a determinant of the disease severity (21)(22) , since it may favor complications, especially in individuals older than 75 years (20) . In elderly people with diabetes, for example, decompensated diabetes is associated with dehydration, aggravating the patient's clinical situation with acute arbovirus infection.…”

Evaluation of the importance of fever with respect to dengue prognosis according to the 2009 WHO classification: a retrospective study

“…Generally, fever has been present in most [15–17], if not all, patients participating in studies of dengue [18]; however, a lack of fever in patients with dengue might be an obstacle to the initiation of investigations and the classification of arbovirosis as dengue without warning signs, dengue with warning signs, or severe dengue. Fever might not be important in the detection of dengue, as shown by Ho et al in a 2013 study of 581 patients from a hospital in Taiwan in which fever was found to have a moderate sensitivity (67.3%) and positive predictive value (71.7%) and a low specificity (12.3%) and negative predictive value (10.2%) [19].…”

Dengue in the elderly: a review

“…In a study from South India, 73% of elderly dengue patients (aged 60 years and above) were found to have significant hyponatremia which was attributed to continued diuretic use and poor oral intake during dengue [50]. Antiplatelet agents, vitamin K antagonists, and nonsteroidal anti-inflammatory drugs may increase the propensity for bleeding.…”