Clinical Features of Dengue in a Large Vietnamese Cohort: Intrinsically Lower Platelet Counts and Greater Risk for Bleeding in Adults than Children

Abstract

BackgroundAs dengue spreads to new geographical regions and the force of infection changes in existing endemic areas, a greater breadth of clinical presentations is being recognised. Clinical experience suggests that adults manifest a pattern of complications different from those observed in children, but few reports have described the age-related spectrum of disease in contemporaneous groups of patients recruited at the same geographical location.Methodology/Principal FindingsUsing detailed prospectively collected information from ongoing studies that encompass the full spectrum of hospitalised dengue cases admitted to a single hospital in southern Vietnam, we compared clinical and laboratory features, management, and outcome for 647 adults and 881 children with confirmed dengue. Signs of vascular leakage and shock were more frequent and more severe in children than adults, while bleeding manifestations and organ involvement were more common in adults. Additionally, adults experienced significantly more severe thrombocytopenia. Secondary infection but not serotype was independently associated with greater thrombocytopenia, although with a smaller effect than age-group. The effect of age-group on platelet count was also apparent in the values obtained several weeks after recovery, indicating that healthy adults have intrinsically lower counts compared to children.Conclusions/SignificanceThere are clear distinctions between adults and children in the pattern of complications seen in association with dengue infection, and these depend partly on intrinsic age-dependent physiological differences. Knowledge of such differences is important to inform research on disease pathogenesis, as well as to encourage development of management guidelines that are appropriate to the age-groups at risk.

A new class of highly potent, broadly neutralizing antibodies isolated from viremic patients infected with dengue virus

“…Of the patients enrolled in the study, two patients were classified as mildly symptomatic of dengue fever, and five patients were classified as severely symptomatic of dengue hemorrhagic fever, with plasma leakage and bleeding (Supplementary Table 1). Secondary infection was defined based on the ratio of DENV-specific IgM to IgG <1.2 on or after day 6 of illness 43 . Blood samples for B cell sorting were collected during the hospitalization period at time points when the blood plasmablast population was apparent.…”

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

“…Even after adjusting for the potential confounding effect of pre-existing comorbidities, age group of 60 years old and above has about three times higher risk for severe organ involvement than those aged 12–29 years old. This may not be surprising as elderly were also reported to be an independent risk factor for severe dengue in Thailand33, Malaysia34, Taiwan35 and Singapore36, and organ impairment was significantly associated with increased age in Vietnam37. This may be due to immunosenescence among elderly, which predisposes them to infectious diseases38.…”

Galectin-9 plasma levels reflect adverse hematological and immunological features in acute dengue virus infection

“…Severe DENV infection complications can occur resulting in dengue hemorrhagic fever (DHF), which is characterized with clinical and laboratory features of thrombocytopenia, coagulation abnormalities, and plasma leakage in children and worse outcomes in adults presenting with increased incidences of bleeding, shock and organ failure. 3, 4 …”