García-Rivera Enid J, Rigau-Pérez José G
United States of America, Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Dengue Branch, San Juan, Puerto Rico.
Rev Panam Salud Publica. 2003 Jun;13(6):362-8. doi: 10.1590/s1020-49892003000500004.
Severe dengue affects all age groups in the Americas, but little detailed information is available about this disease in the elderly. The objective of this article is to describe the disease in this age group.
We reviewed suspected dengue-case investigation forms submitted with diagnostic samples as well as clinical reports from infection control nurses in Puerto Rico, for the period of 1994 through 1999.
We assigned the laboratory-positive case-patients to four age groups: infants (1 year: 554), youth (2 to 18 years: 6 857), adults (19 to 64 years: 9 433), and elderly (>/= 65 years: 822). Regardless of infecting serotype, the elderly were more likely to have been hospitalized (48% vs. 33%) (P < 0.01) and were less likely to show hemorrhage (26% vs. 33%) (P < 0.01). On multivariate analysis, controlling for gender and the presence of hemorrhage, the elderly had a higher risk for hospitalization and death than did the youths and the adults.
The elderly appear to be more likely than youth and younger adults to develop severe illness when infected with the dengue virus, in a pattern similar to that of infants. The clinical evaluation of elderly patients with dengue must include a careful assessment of increased capillary permeability and occult hemorrhage in order to avoid complications from delayed identification and treatment of severe dengue infection. These findings are of increasing importance for dengue epidemiology and medical care in view of the expanding nature of dengue and dengue hemorrhagic fever in a world that also has a growing number and proportion of elderly persons.
严重登革热影响美洲所有年龄组，但关于老年人患此病的详细信息却很少。本文的目的是描述该年龄组的这种疾病。
我们查阅了1994年至1999年期间随诊断样本提交的疑似登革热病例调查表格以及波多黎各感染控制护士的临床报告。
我们将实验室确诊的病例患者分为四个年龄组：婴儿（1岁：554例）、青年（2至18岁：6857例）、成年人（19至64岁：9433例）和老年人（≥65岁：822例）。无论感染的血清型如何，老年人住院的可能性更高（48%对33%）（P<0.01），出现出血症状的可能性更低（26%对33%）（P<0.01）。多因素分析显示，在控制性别和出血情况后，老年人住院和死亡的风险高于青年人和成年人。
老年人感染登革热病毒后似乎比青年人和年轻人更容易发展为重症，这一模式与婴儿相似。对老年登革热患者的临床评估必须仔细评估毛细血管通透性增加和隐匿性出血情况，以避免因严重登革热感染的识别和治疗延误而引发并发症。鉴于登革热和登革出血热在全球范围不断扩大，且老年人数量及其在总人口中的比例也在不断增加，这些发现对登革热流行病学和医疗保健的重要性日益凸显。
