Prospective and descriptive study of adult dengue cases in an emergency department, in Martinique

• Published in: Médecine et maladies infectieuses 2010-08, Vol.40 (8), p.480-489
• Main Authors: Thomas, L., Brouste, Y., Najioullah, F., Hochedez, P., Hatchuel, Y., Moravie, V., Kaidomar, S., King, J.P., Besnier, F., Abel, S., Carmès, S., Schmitt, S., Brihier, P., Meunier, C., Cardoso, T., Rosine, J., Quenel, P., Césaire, R., Cabié, A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Arboviroses; Biological and medical sciences; Dengue; Dengue - complications; Dengue - diagnosis; Dengue - epidemiology; Dengue fevers; Emergency Service, Hospital; Female; Fièvre hémorragique; Hemorrhagic fever; Human viral diseases; Humans; Infectious diseases; Male; Martinique; Medical sciences; Middle Aged; Prospective Studies; Tropical viral diseases; Viral diseases; Young Adult
• ISSN: 0399-077X; 1769-6690
• DOI: 10.1016/j.medmal.2009.10.001

Knowing about the clinical aspects of dengue in endemic zones is essential to implementation of appropriate case management protocols and public health interventions. The authors made a 4-year prospective, observational study of dengue-infected patients admitted to the emergency department of the Fort-de-France University Hospital. Two hundred and sixty-three male and 297 female patients were included. The median age was 37 years (range: 14–91). The diagnosis was based on a positive RT-PCR (463 patients) or on the presence of specific IgM (97 patients). Two hundred and seventy-seven patients (49.5%) presented with dengue fever without complications. According to WHO criteria, 95 patients (17%) developed plasma leakage, including 39 patients (7%) diagnosed with DHF, and 10 (1.8%) diagnosed with DSS. Among the other patients without plasma leakage, 84 (15%) had isolated thrombocytopenia, 14 (2.5%) had internal bleeding, and 90 (16%) had unusual manifestations. Seven patients died (1.3%): fulminant hepatitis (two), myocarditis (one), encephalitis (one), acute respiratory failure (one), gangrenous cholecystitis (one), and post-traumatic intracranial hemorrhage (one). The other patients recovered. Seven patients were pregnant (1.3%) from 6 to 27 weeks of amenorrhea and carried their pregnancy to term without complications. With this experience, we were able to develop appropriate case management protocols for patients during dengue epidemics. La connaissance des aspects cliniques de la dengue dans les zones d’endémie est indispensable à la mise en place des protocoles de prise en charge et des actions de santé publique. Étude observationnelle prospective des patients adultes admis aux urgences et infectés par un virus de la dengue conduite au CHU de Fort-de-France pendant quatre ans. Deux cent soixante-trois hommes et 297 femmes ont été inclus. L’âge médian était 37 ans (extrêmes 14–91). Le diagnostic reposait sur un test RT-PCR positif (463 patients) ou sur la présence d’IgM spécifique (97 patients). Deux cent soixante-dix-sept patients (49,5 %) avaient une fièvre dengue non compliquée. Quatre-vingt-quinze patients (17 %) ont présenté un syndrome de type dengue hémorragique défini par l’apparition de signes de fuite plasmatique. Parmi les autres patients, 84 (15 %) ont eu une thrombopénie isolée, 14 (2,5 %) une hémorragie interne et 90 (16 %) des manifestations atypiques. Sept patients sont décédés : hépatite fulminate (deux), myocardite (un), encéphalite (un)