Pancharoen C, Mekmullica J, Thisyakorn U
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health. 2001 Sep;32(3):476-80.
To determine the magnitude of the problem posed by primary dengue infection in children and the distinctive clinical clues that may differ from those with secondary infection, 996 children serologically diagnosed with dengue infection and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand between 1988 and 1995 were retrospectively reviewed. One hundred and thirty-nine cases (14.0%) were serologically proved to be primary dengue infection. Of these, 72 were males and 67 were females, with a mean age of 4.8 years. Common manifestations by order of frequency included fever (97.8%), hepatomegaly (71.9%), vomiting (59.0%), decreased appetite (55.4%), coryza (52.5%), drowsiness (39.6%), diarrhea (34.5%), rash (33.8%), abdominal pain (23.0%) and seizure (15.8%). The mean duration of fever before admission was 4.6 days. Common sites of bleeding were skin (41.7%), mucous membrane (14.4%) and the gastrointestinal tract (12.2%). Clinical diagnosis was categorized into dengue fever (22.3%), dengue hemorrhagic fever (60.4%) and dengue shock syndrome (17.3%). Three patients (2.2%) died. Compared with the children with secondary dengue infection (n=139), children with primary dengue infections tended to be younger, presented more commonly with coryza, diarrhea, rash and seizure; and less commonly with vomiting, headache and abdominal pain (p < 0.05). The maximal hematocrit level, the mean difference between maximal and minimal hematocrit values and the maximal percentage of neutrophils were significantly lower in the study group, whereas the maximal percentage of lymphocytes was significantly higher. Dengue fever was more common and dengue shock syndrome was less common in the study group (p < 0.05). This study has emphasized that primary dengue infection is not uncommon and is less severe than secondary infection. Clinical presentations and laboratory findings are somewhat different between the two conditions.
为了确定儿童原发性登革热感染所带来问题的严重程度以及可能与继发性感染不同的独特临床线索，我们对1988年至1995年间在泰国曼谷朱拉隆功医院儿科住院、血清学诊断为登革热感染的996名儿童进行了回顾性研究。其中139例（14.0%）经血清学证实为原发性登革热感染。这些病例中，男性72例，女性67例，平均年龄4.8岁。按出现频率排序，常见表现包括发热（97.8%）、肝肿大（71.9%）、呕吐（59.0%）、食欲减退（55.4%）、鼻塞（52.5%）、嗜睡（39.6%）、腹泻（34.5%）、皮疹（33.8%）、腹痛（23.0%）和惊厥（15.8%）。入院前发热的平均持续时间为4.6天。出血的常见部位为皮肤（41.7%）、黏膜（14.4%）和胃肠道（12.2%）。临床诊断分为登革热（22.3%）、登革出血热（60.4%）和登革休克综合征（17.3%）。3例患者（2.2%）死亡。与继发性登革热感染儿童（n = 139）相比，原发性登革热感染儿童往往年龄更小，更常出现鼻塞、腹泻、皮疹和惊厥；而呕吐、头痛和腹痛则较少见（p < 0.05）。研究组的最高血细胞比容水平、最高与最低血细胞比容值之间的平均差值以及中性粒细胞的最高百分比显著较低，而淋巴细胞的最高百分比显著较高。研究组中登革热更常见，登革休克综合征则较少见（p < 0.05）。本研究强调原发性登革热感染并不罕见，且不如继发性感染严重。两种情况的临床表现和实验室检查结果有所不同。
