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Clinical features of dengue in a large Vietnamese cohort: intrinsically lower platelet counts and greater risk for bleeding in adults than children.

Trung DT, Thao le TT, Dung NM, Ngoc TV, Hien TT, Chau NV, Wolbers M, Tam DT, Farrar J, Simmons C, Wills B - PLoS Negl Trop Dis (2012)

Bottom Line: Additionally, adults experienced significantly more severe thrombocytopenia.Secondary infection but not serotype was independently associated with greater thrombocytopenia, although with a smaller effect than age-group.The effect of age-group on platelet count was also apparent in the values obtained several weeks after recovery, indicating that healthy adults have intrinsically lower counts compared to children.

View Article: PubMed Central - PubMed

Affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. trungdt@oucru.org

ABSTRACT

Background: As dengue spreads to new geographical regions and the force of infection changes in existing endemic areas, a greater breadth of clinical presentations is being recognised. Clinical experience suggests that adults manifest a pattern of complications different from those observed in children, but few reports have described the age-related spectrum of disease in contemporaneous groups of patients recruited at the same geographical location.

Methodology/principal findings: Using detailed prospectively collected information from ongoing studies that encompass the full spectrum of hospitalised dengue cases admitted to a single hospital in southern Vietnam, we compared clinical and laboratory features, management, and outcome for 647 adults and 881 children with confirmed dengue. Signs of vascular leakage and shock were more frequent and more severe in children than adults, while bleeding manifestations and organ involvement were more common in adults. Additionally, adults experienced significantly more severe thrombocytopenia. Secondary infection but not serotype was independently associated with greater thrombocytopenia, although with a smaller effect than age-group. The effect of age-group on platelet count was also apparent in the values obtained several weeks after recovery, indicating that healthy adults have intrinsically lower counts compared to children.

Conclusions/significance: There are clear distinctions between adults and children in the pattern of complications seen in association with dengue infection, and these depend partly on intrinsic age-dependent physiological differences. Knowledge of such differences is important to inform research on disease pathogenesis, as well as to encourage development of management guidelines that are appropriate to the age-groups at risk.

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Related in: MedlinePlus

Platelet counts by day of illness for adults who did or did not develop mucosal bleeding.Box and whisker plots showing platelet counts on days 4, 5 and 6 of illness comparing adults who developed mucosal bleeding during the subsequent 24 hour period to adults who never developed mucosal bleeding throughout the illness course. Boxes represent the median and interquartile values. Open circles indicate outlying/extreme values. The total number of patients included in each group each day is indicated on the X axis. Patients in whom mucosal bleeding developed prior to admission to HTD are not included. The Mann-Whitney test was used to compare the platelet counts between the two groups on each day. *** p<0.001 and * p<0.05.
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pntd-0001679-g004: Platelet counts by day of illness for adults who did or did not develop mucosal bleeding.Box and whisker plots showing platelet counts on days 4, 5 and 6 of illness comparing adults who developed mucosal bleeding during the subsequent 24 hour period to adults who never developed mucosal bleeding throughout the illness course. Boxes represent the median and interquartile values. Open circles indicate outlying/extreme values. The total number of patients included in each group each day is indicated on the X axis. Patients in whom mucosal bleeding developed prior to admission to HTD are not included. The Mann-Whitney test was used to compare the platelet counts between the two groups on each day. *** p<0.001 and * p<0.05.

Mentions: We also found significant correlations between lower platelet counts and the overall severity of bleeding graded at discharge. Figure 3 presents the lowest platelet counts recorded during specified time-periods during the illness course according to bleeding severity, for the children and adults separately. The majority of patients who developed mucosal bleeding were adults, with the onset usually between days 4–6 of illness. To assess relationships between platelet counts and onset of mucosal bleeding in more detail in this group, we compared the most recent counts measured prior to development of any mucosal bleeding (≤24 hours) with counts measured at the same time in the disease evolution for patients who never developed mucosal bleeding (Figure 4); the counts were significantly lower in those who developed mucosal bleeding on days 5 and 6 of illness (p = 0.03 and p<0.001, respectively) and borderline significant for day 4 (p = 0.06, all Mann-Whitney test).


Clinical features of dengue in a large Vietnamese cohort: intrinsically lower platelet counts and greater risk for bleeding in adults than children.

Trung DT, Thao le TT, Dung NM, Ngoc TV, Hien TT, Chau NV, Wolbers M, Tam DT, Farrar J, Simmons C, Wills B - PLoS Negl Trop Dis (2012)

Platelet counts by day of illness for adults who did or did not develop mucosal bleeding.Box and whisker plots showing platelet counts on days 4, 5 and 6 of illness comparing adults who developed mucosal bleeding during the subsequent 24 hour period to adults who never developed mucosal bleeding throughout the illness course. Boxes represent the median and interquartile values. Open circles indicate outlying/extreme values. The total number of patients included in each group each day is indicated on the X axis. Patients in whom mucosal bleeding developed prior to admission to HTD are not included. The Mann-Whitney test was used to compare the platelet counts between the two groups on each day. *** p<0.001 and * p<0.05.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3383761&req=5

pntd-0001679-g004: Platelet counts by day of illness for adults who did or did not develop mucosal bleeding.Box and whisker plots showing platelet counts on days 4, 5 and 6 of illness comparing adults who developed mucosal bleeding during the subsequent 24 hour period to adults who never developed mucosal bleeding throughout the illness course. Boxes represent the median and interquartile values. Open circles indicate outlying/extreme values. The total number of patients included in each group each day is indicated on the X axis. Patients in whom mucosal bleeding developed prior to admission to HTD are not included. The Mann-Whitney test was used to compare the platelet counts between the two groups on each day. *** p<0.001 and * p<0.05.
Mentions: We also found significant correlations between lower platelet counts and the overall severity of bleeding graded at discharge. Figure 3 presents the lowest platelet counts recorded during specified time-periods during the illness course according to bleeding severity, for the children and adults separately. The majority of patients who developed mucosal bleeding were adults, with the onset usually between days 4–6 of illness. To assess relationships between platelet counts and onset of mucosal bleeding in more detail in this group, we compared the most recent counts measured prior to development of any mucosal bleeding (≤24 hours) with counts measured at the same time in the disease evolution for patients who never developed mucosal bleeding (Figure 4); the counts were significantly lower in those who developed mucosal bleeding on days 5 and 6 of illness (p = 0.03 and p<0.001, respectively) and borderline significant for day 4 (p = 0.06, all Mann-Whitney test).

Bottom Line: Additionally, adults experienced significantly more severe thrombocytopenia.Secondary infection but not serotype was independently associated with greater thrombocytopenia, although with a smaller effect than age-group.The effect of age-group on platelet count was also apparent in the values obtained several weeks after recovery, indicating that healthy adults have intrinsically lower counts compared to children.

View Article: PubMed Central - PubMed

Affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. trungdt@oucru.org

ABSTRACT

Background: As dengue spreads to new geographical regions and the force of infection changes in existing endemic areas, a greater breadth of clinical presentations is being recognised. Clinical experience suggests that adults manifest a pattern of complications different from those observed in children, but few reports have described the age-related spectrum of disease in contemporaneous groups of patients recruited at the same geographical location.

Methodology/principal findings: Using detailed prospectively collected information from ongoing studies that encompass the full spectrum of hospitalised dengue cases admitted to a single hospital in southern Vietnam, we compared clinical and laboratory features, management, and outcome for 647 adults and 881 children with confirmed dengue. Signs of vascular leakage and shock were more frequent and more severe in children than adults, while bleeding manifestations and organ involvement were more common in adults. Additionally, adults experienced significantly more severe thrombocytopenia. Secondary infection but not serotype was independently associated with greater thrombocytopenia, although with a smaller effect than age-group. The effect of age-group on platelet count was also apparent in the values obtained several weeks after recovery, indicating that healthy adults have intrinsically lower counts compared to children.

Conclusions/significance: There are clear distinctions between adults and children in the pattern of complications seen in association with dengue infection, and these depend partly on intrinsic age-dependent physiological differences. Knowledge of such differences is important to inform research on disease pathogenesis, as well as to encourage development of management guidelines that are appropriate to the age-groups at risk.

Show MeSH
Related in: MedlinePlus