Wijewickrama Ananda, Kuruppu Heshan, Idampitiya Damayanthi, Wickramanayake Rivindu, Kottahachchi Anagi, Jayamali Jeewantha, Chathurangika Padukkage Harshani, Senatilleke Nushara, Warnakulasuriya Navanjana, Jeewandara Chandima, Malavige Gathsaurie Neelika
National Institute of Infectious Diseases, Angoda, Sri Lanka.
Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
medRxiv. 2024 Dec 26:2024.12.23.24319534. doi: 10.1101/2024.12.23.24319534.
Elderly individuals, those with comorbidities and pregnant women are at a higher risk of developing severe dengue and succumbing to their illness. However, an increased incidence of severe dengue and fatalities are seen in females of the reproductive age. As per vaginal (PV) bleeding is an important complication that has not been well characterized, we sought to determine the frequency, complications and disease outcomes in women who develop PV bleeding.
METHODOLOGY/PRINCIPAL FINDINGS: 288 adult female patients were recruited from the National Institute of Infectious Diseases Sri Lanka. All clinical features and laboratory investigations were recorded throughout the duration of hospital admission along with treatment received.28/288 (9.72%) reported PV bleeding, with 12/28 (42.85%) developing dengue haemorrhagic fever (DHF) compared to 65/260 (25%) of those who did not have bleeding.Women who developed PV bleeding were more likely to have developed DHF (OR 2.2, 95% CI 0.98 to 5.1, p=0.06), abdominal pain (OR=2.17, 95% CI = 0.99 to 4.69, p = 0.06), vomiting (OR= 2.0, 95% CI= 0.89 to 4.44, p= 0.10), diarhoea (OR= 4.35, 95% CI = 1.908 to 9.610, p= 0.0004) or evidence of any fluid leakage (OR= 1.98, 95% CI = 0.91 to 4.5, p = 0.11). Although not significant, those who had PV bleeding were more likely to have been given intravenous fluids, blood transfusions and colloids.
PV bleeding appears to associate with worse disease outcomes. The possible contribution of PV bleeding to higher incidence of severe dengue and fatality rates observed in many countries, should be further investigated.
老年人、患有合并症者及孕妇发生严重登革热并因此病死亡的风险更高。然而，育龄期女性中严重登革热的发病率及死亡率有所上升。阴道出血是一种尚未得到充分描述的重要并发症，我们试图确定发生阴道出血的女性的出血频率、并发症及疾病转归。
方法/主要发现：从斯里兰卡国家传染病研究所招募了288名成年女性患者。在整个住院期间记录所有临床特征、实验室检查结果以及接受的治疗。288名患者中有28名（9.72%）报告有阴道出血，其中12名（42.85%）发展为登革出血热（DHF），而未出血的260名患者中有65名（25%）发展为登革出血热。发生阴道出血的女性更有可能发展为登革出血热（比值比2.2，95%置信区间0.98至5.1，p = 0.06）、腹痛（比值比 = 2.17，95%置信区间 = 0.99至4.69，p = 0.06）、呕吐（比值比 = 2.0，95%置信区间 = 0.89至4.44，p = 0.10）、腹泻（比值比 = 4.35，95%置信区间 = 1.908至9.610，p = 0.0004）或有任何液体渗漏迹象（比值比 = 1.98，95%置信区间 = 0.91至4.5，p = 0.11）。虽然差异不显著，但发生阴道出血的患者更有可能接受静脉输液、输血和胶体治疗。
阴道出血似乎与更差的疾病转归相关。阴道出血对许多国家中观察到的严重登革热高发病率及死亡率的可能影响，应进一步研究。
