Wulur H, Jahja E, Gubler D J, Suharyono W, Sorensen K
Bull World Health Organ. 1983;61(4):693-701.
Thirty virologically confirmed cases of dengue infection with a fatal outcome were studied clinically in Jakarta, Indonesia, from 1975 to 1978. All 4 dengue virus serotypes were isolated from fatal cases, but dengue type 3 was responsible for 21 (70%) of these isolates, compared to only 47% of isolates from all cases of dengue infection. The majority (60%) of these 30 cases were males in the 5-9-year age group. Nonspecific signs and symptoms in the fatal cases were no different from those in patients who survived dengue infection, but 70% of the patients with fatal outcome had one or more signs of encephalitis, primarily convulsions and somnolence; 3 of them developed spastic tetraparesis before death and 2 died of an illness clinically compatible with viral encephalitis. Other unexpected observations were that only 63% of the patients had classical dengue shock syndrome with haemoconcentration, thrombocytopenia and shock. A high percentage (80%) had gastrointestinal haemorrhage, and in 9 patients (30%) this was severe enough to cause shock and death. In these 9 cases, the gastrointestinal haemorrhage and haematemesis began before the onset of shock and there was no evidence of haemoconcentration or pleural effusion at any time during hospitalization. According to certain widely accepted criteria, these patients would not be diagnosed as dengue haemorrhagic fever (DHF). But as they made up nearly one-third of the confirmed fatal dengue infections in this study and had massive gastrointestinal haemorrhages with thrombocytopenia, the definition of DHF should be changed to include this type of patient. It is proposed that the disease should be more realistically classified as dengue fever with or without haemorrhage and dengue shock syndrome.
1975年至1978年期间，在印度尼西亚雅加达对30例经病毒学确诊的登革热感染致死病例进行了临床研究。所有4种登革热病毒血清型均从致死病例中分离出来，但3型登革热占这些分离株的21例（70%），而在所有登革热感染病例的分离株中仅占47%。这30例病例中的大多数（60%）为5至9岁年龄组的男性。致死病例的非特异性体征和症状与登革热感染存活患者无异，但70%的致死患者有一项或多项脑炎体征，主要为惊厥和嗜睡；其中3例在死亡前出现痉挛性四肢轻瘫，2例死于临床符合病毒性脑炎的疾病。其他意外发现是，只有63%的患者有典型的登革热休克综合征，伴有血液浓缩、血小板减少和休克。高比例（80%）的患者有胃肠道出血，9例（30%）患者的出血严重到足以导致休克和死亡。在这9例病例中，胃肠道出血和呕血在休克发作前就已开始，住院期间任何时候均无血液浓缩或胸腔积液的证据。根据某些广泛接受的标准，这些患者不会被诊断为登革出血热（DHF）。但由于他们在本研究确诊的致命登革热感染病例中占近三分之一，且有大量胃肠道出血伴血小板减少，DHF的定义应改变以纳入这类患者。建议将该疾病更实际地分类为有或无出血的登革热以及登革热休克综合征。
