Lahiri Manjari, Fisher Dale, Tambyah Paul Ananth
Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Trans R Soc Trop Med Hyg. 2008 Oct;102(10):1011-6. doi: 10.1016/j.trstmh.2008.06.005. Epub 2008 Jul 18.
In Singapore in 2005 there were 14,209 documented cases of dengue fever, including 25 deaths. The epidemiology of dengue in Singapore is changing, with increasingly severe infection in adults with chronic disease being recognised. We performed a retrospective review of nine adult patients who died of dengue-related illness from 1 December 2004 to 30 November 2005 at the National University Hospital. The diagnosis was initially missed in six of the nine patients due to an atypical presentation. All the patients had significant comorbid conditions; six of the nine had diabetes mellitus. Altered mental state preceded frank shock in eight of the nine patients. Secondary bacteraemia was a contributor to death in four. Derangement of laboratory features such as prothrombin time, activated partial thromboplastin time and serum albumin level was common on presentation. Transition countries such as Singapore have an increasingly advanced health system supporting an ageing population, yet are still at risk of community-acquired tropical infections. We have found that atypical presentations, comorbidities, secondary bacterial infection and abnormal serum markers at presentation may be predictors of death from dengue.
2005年，新加坡有14209例登革热确诊病例，其中25人死亡。新加坡登革热的流行病学正在发生变化，慢性病成年患者感染登革热后病情日益严重，这一点已得到认可。我们对2004年12月1日至2005年11月30日期间在国立大学医院死于登革热相关疾病的9名成年患者进行了回顾性研究。9名患者中有6名最初因表现不典型而漏诊。所有患者都有严重的合并症；9名患者中有6名患有糖尿病。9名患者中有8名在出现明显休克之前出现精神状态改变。继发性菌血症是4名患者死亡的一个原因。凝血酶原时间、活化部分凝血活酶时间和血清白蛋白水平等实验室指标紊乱在就诊时很常见。像新加坡这样的转型国家拥有日益先进的卫生系统来支持老龄化人口，但仍面临社区获得性热带感染的风险。我们发现，不典型表现、合并症、继发性细菌感染和就诊时血清标志物异常可能是登革热死亡的预测因素。
