Review of Dengue hemorrhagic fever fatal cases seen among adults: a retrospective study

PLoS Negl Trop Dis. 2013 May 2;7(5):e2194. doi: 10.1371/journal.pntd.0002194. Print 2013.


Background: Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths.

Methodology/principal findings: We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if there have been changes in the presentation of severe to fatal dengue. Nine of ten fatal cases involved adult females with a median age of 32 years. All had secondary dengue infection. The mean duration of illness prior to hospitalization was 4.7 days and deaths occurred at an average of 2.4 days post-admission. Gastrointestinal pain, vomiting, diarrhea, intravascular leakages and bleeding occurred in the majority of cases. DSS complicated with severe bleeding, multi-organ failure and coagulopathy were the primary causes of deaths. Seven patients presented with thrombocytopenia and hypoalbuminemia, five of which had hemoconcentration and increased ALT and AST indicative of liver damage. Co-morbidities particularly diabetes mellitus was common in our cohort. Prominent unusual presentations included acute renal failure, acute respiratory distress syndrome, myocarditis with pericarditis, and hemorrhages over the brain and heart.

Conclusions: In our cohort, dengue fatalities are seen primarily in adult females with secondary dengue infection. The majority of the patients presented with common clinical and laboratory warning signs of severe dengue. Underlying co-morbidities may contribute to the rapid clinical deterioration in severe dengue. The uncommon presentations of dengue are likely a reflection of the changing demographics where adults are now more likely to contract dengue in dengue endemic regions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Cohort Studies
  • Comorbidity
  • Disease Outbreaks*
  • Female
  • Humans
  • Malaysia / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Severe Dengue / epidemiology*
  • Severe Dengue / mortality*
  • Sex Factors
  • Survival Analysis
  • Young Adult

Grant support

This study was partially funded by Malaysia Genome Institute initiative grant 07-05-MGI-GMB015 of the Ministry of Science, Technology, and Innovation of Malaysia (MOSTI), LRGS grant (LRGS/TD/2011/UM/Penyakit-Berjangkit) of the Ministry of Higher Education, Malaysia (MOHE), and Postgraduate Research Fund (PS148/2008C) of University of Malaya. The funders had no role in our study design, data collection and analysis, decision to publish, or preparation of the manuscript.