Table 2.
Signs and Symptoms Associated With Severe Dengue Among Laboratory-Positive Dengue Patients, Sentinel Enhanced Dengue Surveillance System, Puerto Rico, 2012–2014
| Characteristic | Total, No. (%) (n = 1089) | Severe, No. (%) (n = 281) | Nonsevere, No. (%) (n = 808) | P aValue |
|---|---|---|---|---|
| Comorbidities | ||||
| Any chronic medical condition | 339 (31.1) | 81 (28.8) | 258 (31.9) | .37 |
| Asthma | 203 (18.6) | 50 (17.8) | 153 (18.9) | .7380 |
| Coronary heart disease | 37 (3.4) | 12 (4.3) | 25 (3.1) | .4554 |
| Diabetes | 70 (6.4) | 14 (5.0) | 56 (6.9) | .3144 |
| High blood pressure | 87 (8.0) | 19 (6.8) | 68 (8.4) | .4513 |
| High cholesterol | 44 (4.0) | 11 (3.9) | 33 (4.1) | 1.0000 |
| Cancer | 16 (1.5) | 3 (1.1) | 13 (1.6) | .7175 |
| Thyroid | 43 (3.9) | 8 (2.8) | 35 (4.3) | .3560 |
| Sickle cell disease | 7 (0.6) | 2 (0.7) | 5 (0.6) | 1.0000 |
| Other | 23 (2.1) | 7 (2.5) | 16 (2.0) | .7854 |
| Signs and symptoms | ||||
| Eye pain | 614 (57.2) | 165 (58.7) | 449 (56.6) | .59 |
| Headache | 915 (84.0) | 245 (87.2) | 670 (82.9) | .11 |
| Jaundice/icteric sclera | 57 (5.3) | 35 (12.5) | 22 (2.8) | <.001 |
| Red conjunctiva | 614 (57.2) | 165 (58.7) | 449 (56.6) | .59 |
| Skin rash | 613 (56.9) | 191 (68.0) | 422 (53.0) | <.001 |
| Petechia/purpura | 383 (35.4) | 137 (48.8) | 246 (30.7) | <.001 |
| Facial and/or neck erythema | 637 (59.3) | 190 (68.3) | 447 (56.2) | <.001 |
| Pruritic skin | 412 (38.3) | 132 (47.1) | 280 (35.2) | <.001 |
| Chills | 867 (80.2) | 245 (87.5) | 622 (77.7) | <.001 |
| Muscle/bone/back pain | 833 (77.5) | 237 (84.6) | 596 (75.0) | .001 |
| Joint pain | 667 (62.5) | 194 (69.3) | 473 (60.0) | .007 |
| Red/swollen joints | 177 (16.7) | 61 (22.0) | 116 (14.8) | .008 |
| Cough | 475 (44.1) | 136 (48.7) | 339 (42.5) | .08 |
| Rhinorrhea | 356 (33.1) | 105 (37.6) | 251 (31.5) | .07 |
| Sore throat | 410 (38.3) | 118 (42.1) | 292 (37.0) | .14 |
| Anorexia | 869 (80.8) | 250 (89.6) | 619 (77.7) | <.001 |
| Nausea | 744 (69.5) | 222 (79.9) | 522 (65.9) | <.001 |
| Diarrhea | 449 (41.9) | 148 (53.2) | 301 (37.9) | <.001 |
| Dizziness | 674 (62.5) | 205 (73.2) | 469 (58.8) | <.001 |
| Tiredness, lethargy | 953 (88.1) | 266 (95.3) | 687 (85.6) | <.001 |
| Irritability | 357 (33.2) | 127 (45.4) | 230 (28.9) | <.001 |
| Seizure | 19 (1.8) | 9 (3.2) | 10 (1.2) | .06 |
| Warning signs | ||||
| Mucosal bleeding | 140 (12.9) | 51 (18.1) | 89 (11.1) | .01 |
| Nose/gums | 100 (9.2) | 36 (12.8) | 64 (8.0) | .02 |
| Unusual vaginal | 26 (8.8) | 10 (11.0) | 16 (7.9) | .52 |
| Macroscopic blood in urine | 26 (2.4) | 13 (4.7) | 13 (1.6) | .009 |
| Abdominal pain | 679 (63.1) | 218 (77.9) | 461 (57.9) | <.001 |
| Vomiting (3 or more episodes in day) | 304 (28.1) | 115 (40.9) | 189 (23.6) | <.001 |
| Nervousness, anxiety | 410 (38.3) | 142 (51.1) | 268 (33.8) | <.001 |
| Hemoconcentration | 60 (5.6) | 30 (10.8) | 30 (3.8) | <.001 |
| Fluid accumulation | ||||
| Ascites | 2 (0.8) | 2 (1.3) | 0 (0) | .68 |
| Pleural effusion | 23 (4.0) | 21 (8.4) | 2 (0.6) | <.001 |
| Any fluid accumulation | 24 (4.2) | 22 (8.8) | 2 (0.6) | <.001 |
| Signs of respiratory distress | ||||
| Tachypnea | 491 (46.3) | 209 (75.5) | 282 (36.0) | <.001 |
| Signs of shock | ||||
| Any sign of poor circulation | 716 (65.7) | 219 (77.9) | 497 (61.5) | <.001 |
| At least 2 signs of poor circulation | 210 (19.3) | 69 (24.6) | 141 (17.5) | .0120 |
| Narrow pulse pressure | 21 (2.0) | 9 (3.2) | 12 (1.5) | .14 |
| Hypotension | 71 (15.0) | 47 (19.4) | 24 (10.4) | .009 |
| Drop systolic blood pressure | 15 (3.4) | 10 (5.3) | 5 (2.0) | .11 |
| Use of vasopressors | 4 (0.8) | 4 (1.7) | 0 (0) | .14 |
| Diagnoses of shock | 1 (0.1) | 1 (0.4) | 0 (0) | .58 |
| Severe dengue classification | ||||
| Severe bleeding | 99 (9.1) | 99 (35.2) | 0 (0) | |
| Vomit with blood | 28 (2.6) | 28 (10.0) | 0 (0) | |
| Feces with blood | 17 (1.6) | 17 (6.0) | 0 (0) | |
| Black tarry stools | 49 (4.5) | 49 (17.4) | 0 (0) | |
| Pulmonary hemorrhage | 2 (0.4) | 2 (0.9) | 0 (0) | |
| Any blood product received | 17 (3.6) | 17 (7.0) | 0 (0) | |
| Severe plasma leakage + shock | 200 (18.4) | 200 (71.2) | 0 (0) | |
| Severe plasma leakage | 187 (17.2) | 187 (66.5) | 0 (0) | |
| Fluid accumulation plus respiratory distress | 16 (2.7) | 16 (6.3) | 0 (0) | |
| Shock | 22 (2.0) | 22 (7.8) | 0 (0) | |
| Severe organ involvement | 24 (4.0) | 24 (9.3) | 0 (0) |
a
Calculated with the Mann-Whitney-Wilcoxon test to compare medians and χ2 test to estimate the difference in proportions.