Singh Vishal, Mishra Satish Chandra, Agarwal Nikesh Ashok, Mallikarjuna Pradeepa Adgoor, Raut Binod Biswajeet
Senior Advisor (Medicine) & Nephrologist, 7 Air Force Hospital, Kanpur Cantt, UP, India.
Consultant (Medicine) & Cardiologist, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India.
Med J Armed Forces India. 2022 Apr;78(2):140-146. doi: 10.1016/j.mjafi.2020.06.009. Epub 2020 Jul 27.
Dengue is a common arthropod-borne viral disease with a variable clinical spectrum, course, and outcome.
We conducted a prospective observational study describing the clinical profile of patients hospitalized for dengue with warning signs during the 2019 epidemic.
A total of 1349 patients with dengue, including 459 with warning signs, were seen. It predominantly affects the younger subset of both sexes. A higher proportion of females presented with either a platelet count less than 20,000/mm or a rapid fall in platelets. Bleeding manifestations of varying severity were observed in one-fifth of them. Severe bleeding was universal at a platelet count less than 10,000/mm. Platelet transfusion was indicated in 17 (7.3%) males and 25 (11%) females, with females requiring it at a higher platelet count. While hepatic involvement was frequent, others such as myocarditis, encephalitis, and pancreatitis were infrequent. Coinfections observed included malaria, scrub typhus, and enteric fever. The case fatality rate for the patients with dengue and those with warning manifestations was 0.4% and 1.3%, respectively.
Dengue epidemics often overwhelm health-care resources. Such epidemics can be successfully managed using a protocolized approach, modified as per the available resources. Platelet transfusions are lifesaving at a count less than 10,000/mm. With meticulous supportive care, the case fatality rate can be reduced to less than 0.5%.
登革热是一种常见的节肢动物传播的病毒性疾病，临床症状、病程和预后各不相同。
我们进行了一项前瞻性观察性研究，描述了2019年疫情期间因登革热伴有警示体征而住院患者的临床特征。
共观察了1349例登革热患者，其中459例伴有警示体征。该病主要影响年轻人群体。女性患者中血小板计数低于20,000/mm或血小板迅速下降的比例更高。五分之一的患者出现了不同严重程度的出血表现。血小板计数低于10,000/mm时普遍出现严重出血。17名（7.3%）男性和25名（11%）女性需要输注血小板，女性在血小板计数较高时就需要输注。虽然肝脏受累很常见，但心肌炎、脑炎和胰腺炎等其他情况并不常见。观察到的合并感染包括疟疾、恙虫病和伤寒。登革热患者和有警示表现患者的病死率分别为0.4%和1.3%。
登革热疫情常常使医疗资源不堪重负。采用规范化方法并根据可用资源进行调整，此类疫情能够得到成功管控。血小板计数低于10,000/mm时，输注血小板可挽救生命。通过精心的支持治疗，病死率可降至0.5%以下。
