Table 4.
Clinical Characteristics of 86 Patients With Complicated Dengue* Reported to GeoSentinel, 2007–2022
| Characteristic | Available Data† | Missing Data, n (%) | Patients With Severe Disease‡ |
|---|---|---|---|
|
| |||
| Symptoms | |||
| Abdominal pain§ | 40/78 (51) | 8 (9) | 12 (30) |
| Vomiting§ | 39/83 (47) | 3 (3) | 13 (33) |
| Clinical findings | |||
| Evidence of plasma leakage | 15/75 (20) | 11 (13) | 15 (100) |
| Mild/moderate (pleural, pericardial, or peritoneal effusion but no hemodynamic instability or respiratory compromise)§|| | 9/75 (12) | – | 8 (89) |
| Severe (hemodynamic instability or respiratory compromise)||¶ | 6/75 (8) | – | 6 (100) |
| Bleeding manifestations | 44/85 (52) | 1 (1) | 17 (39) |
| Mild (submucosal or subcutaneous bleeding)§ | 18/85 (21) | – | 7 (39) |
| Moderate (required intervention but no hemodynamic instability)§ | 18/85 (21) | – | 6 (33) |
| Severe (hemodynamic instability, blood transfusion, ICU, bleeding involving a critical organ, or leading to death/ disability)¶ | 8/85 (9) | – | 8 (100) |
| Signs of neurologic disease | 5/80 (6) | 6 (7) | 5 (100) |
| Mild (lethargy, restlessness)§ | 3/80 (4) | – | 2 (67) |
| Moderate (Glasgow Coma Scale score <15 but ≥12 for <48 h)¶ | 1/80 (1) | – | 1 (100) |
| Severe (Glasgow Coma Scale score <11, ICU, death, or sequelae >48 h)¶ | 1/80 (1) | – | 1 (100) |
| Myocarditis¶ | 2/77 (3) | 9 (10) | 2 (100) |
| Hepatomegaly (>2 cm)§ | 8/73 (11) | 13 (15) | 5 (63) |
| Laboratory findings | |||
| Liver disease | 19/81 (23) | 5 (6) | NA |
| Moderate (alanine aminotransferase >10× upper limit of normal) | 16/81 (20) | – | 5 (31) |
| Severe (alanine aminotransferase >10× upper limit of normal and change in mental status or new onset coagulopathy)¶** | 3/81 (4) | – | 3 (100) |
| Other end organ damage/dengue eye disease¶†† | 3/27 (11) | – | 3 (100) |
| Other | |||
| Splenomegaly | 6/72 (8) | 14 (16) | 5 (83) |
| Thrombocytopenia | 63/81 (78) | 5 (6) | 24 (38) |
| Mild (platelet count 50–150 × 109 cells/L) | 2/81 (3) | – | 0 (0) |
| Moderate (platelet count 20–50 × 109 cells/L) | 44/81 (54) | – | 15 (34) |
| Severe (platelet count <20 × 109 cells/L) | 17/81 (21) | – | 9 (53) |
| Elevated alanine aminotransferase but <10 × upper limit of normal | 31/81 (38) | – | 0 (0) |
| Hospitalization | |||
| At any point in clinical course | 78/86 (91) | – | 26 (33) |
| During travel | 31/86 (36) | – | 14 (45) |
| Duration of hospitalization | Median, 5 d (IQR, 3–8 d) | 3 (4) | Median, 7 d (IQR, 5–10 d) |
| Intensive care admission | 13/77 (17) | 9 (10) | 10 (77) |
| Duration of ICU stay | Median, 3.5 d (IQR, 3–8 d) | 1 (8) | Median, 4.5 d (IQR, 2–8 d) |
| Presence of coinfections‡‡ | 6/75 (8) | 3 (4) | 3 (50) |
| Deaths | 1/86 (1) | – | 1 (100) |
ICU = intensive care unit; IQR = interquartile range; NA = not applicable.
Complicated dengue is defined as dengue with warning signs or severe dengue.
Values indicate the proportion of the count (n) and the number (N) of records available for analysis, with percentages in parentheses, except where indicated.
Values are numbers (percentages) except where indicated.
Warning sign (based on World Health Organization 2009 guidelines).
Respiratory compromise = increased respiratory rate for age, or signs of increased work of breathing, or need for additional support (including oxygen supplementation or intubation).
Severe disease.
Coagulopathy was defined as international normalized ratio ≥1.5.
Findings included maculopathy with acute vision loss (n = 2) and retinal hemorrhage (n = 1). Ophthalmologic examination was done at the discretion of the treating clinician.
Among 78 patients hospitalized at any time in their clinical course. Coinfections included Clostridium difficile colitis, COVID-19, Enterococcus faecalis urinary tract infection, E. faecalis and Staphylococcus epidermidis bacteremia with invasive candidiasis; pneumonia (unspecified) and urinary tract infection (unspecified), and strongyloidiasis.