Kalayanarooj Siripen, Nimmannitya Suchitra
WHO Collaborating Center for Case Management of Dengue/DHF/DSS, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
J Med Assoc Thai. 2003 Aug;86 Suppl 3:S673-80.
Dengue infections are endemic in Thailand. Infants are at risk of developing dengue fever (DF) and dengue hemorrhagic fever (DHF). Many infants have severe DHF with unusual manifestations and may suffer from complications and even death because of difficulties in early diagnosis and improper management.
To study the incidence of infants DHF and to compare clinical and laboratory findings of DHF between infants and children in order to improve diagnosis and management of infants with DHF.
A retrospective review of hospital charts of DHF patients who were admitted to the Children's Hospital between 1995-1999 was carried out. Only confirmed DHF cases, either by serologic or virologic studies were included. Clinical and laboratory findings were compared using the standard software package SPSS.
There were 4,595 confirmed dengue patients admitted to the Children's Hospital during this 5-year period and among these 245 infants were under one year old (5.3%). Unusual presentations of DHF including upper respiratory tract infection (URI) symptoms, diarrhea, convulsions and encephalopathy were found more in the infants (4.5%, 13.1%, 12.7% and 4.1%) than in the children (1.7%, 2.0%, 2.0% and 0.6%) but shock was found less in the infants (25%) than in the children (30.9%). The percentages of Tourniquet test positive and low WBC (< or = 5,000 cells/mm3) which help in the early diagnosis of dengue were less in the infants (50.2% and 26.8%) than in the children (92.2% and 71.9%). Liver involvement and/or dysfunction were found more in the infants as shown by mean aspartate aminotransferase/alanine aminotransferase (AST/ALT) elevation and prolonged prothrombin time. Duration of i.v. fluid was shorter in the infants than in the children (21.9 vs 38.2 hours). Complications of fluid overload were found more often in the infants than in the children (9% vs 3.6%). The case fatality rate was 1.2 in the infants and 0.3 in the children.
Management of infants with DHF is critical because early diagnosis is rather difficult and they sometimes present with unusual manifestations (convulsions, encephalopathy and associated infections). Complications such as hepatic dysfunction and fluid overload are more commonly found in infants than in children and adults and also the case fatality rate is higher. Judicious i.v. fluid resuscitation and replacement is critical to the outcome of infants with DHF. It seems that the degree of plasma leakage is less in infants and the duration of plasma leakage is shorter in infants than in children.
登革热感染在泰国呈地方性流行。婴儿有患登革热（DF）和登革出血热（DHF）的风险。许多婴儿患有严重的登革出血热，表现异常，由于早期诊断困难和管理不当，可能会出现并发症甚至死亡。
研究婴儿登革出血热的发病率，并比较婴儿和儿童登革出血热的临床和实验室检查结果，以改善婴儿登革出血热的诊断和管理。
对1995年至1999年期间入住儿童医院的登革出血热患者的医院病历进行回顾性研究。仅纳入经血清学或病毒学研究确诊的登革出血热病例。使用标准软件包SPSS比较临床和实验室检查结果。
在这5年期间，有4595例确诊的登革热患者入住儿童医院，其中245例婴儿年龄在1岁以下（5.3%）。登革出血热的异常表现包括上呼吸道感染（URI）症状、腹泻、惊厥和脑病，在婴儿中（4.5%、13.1%、12.7%和4.1%）比在儿童中（1.7%、2.0%、2.0%和0.6%）更为常见，但婴儿出现休克的比例（25%）低于儿童（30.9%）。有助于登革热早期诊断的束臂试验阳性率和低白细胞计数（≤5000个细胞/mm³）在婴儿中（50.2%和26.8%）低于儿童（92.2%和71.9%）。婴儿中肝受累和/或功能障碍更为常见，表现为平均天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）升高和凝血酶原时间延长。婴儿静脉输液时间短于儿童（21.9小时对38.2小时）。婴儿中液体超负荷并发症的发生率高于儿童（9%对3.6%）。婴儿的病死率为1.2%，儿童为0.3%。
婴儿登革出血热的管理至关重要，因为早期诊断相当困难，且他们有时会出现异常表现（惊厥,脑病和相关感染）。肝功能障碍和液体超负荷等并发症在婴儿中比在儿童和成人中更常见，病死率也更高。明智的静脉液体复苏和补充对婴儿登革出血热患者的预后至关重要。似乎婴儿的血浆渗漏程度较轻，血浆渗漏持续时间短于儿童。
