Review of dengue fever cases in Hong Kong during 1998 to 2005

Vivien WM Chuang, TY Wong, YH Leung, Edmond SK Ma, YL Law, Owen TY Tsang, KM Chan, Iris HL Tsang, TL Que, Raymond WH Yung, SH Liu
Infection Control Branch, Centre for Health Protection/Infectious Disease Control Training Centre, Hospital Authority, Hong Kong

OBJECTIVE. To describe the epidemiology, clinical and laboratory findings, and outcomes of patients presenting locally with dengue.

DESIGN. Retrospective review of case records.

SETTING. Public hospitals, Hong Kong.

PATIENTS. Medical records of all laboratory-confirmed dengue patients admitted to public hospitals during 1998 to 2005 were reviewed retrospectively.

RESULTS. A total of 126 cases were identified, 123 (98%) being dengue fever and three (2%) dengue haemorrhagic fever. One patient who had blood transfusion–acquired dengue fever was highlighted. A total of 116 (92%) cases were 'imported', while 10 (8%) were local. Among the 56 dengue cases confirmed by reverse transcription–polymerase chain reaction, dengue virus type 1 was the most common accounting for 48% of them, followed by type 2, type 3, and type 4 responsible for 23%, 16%, and 13%, respectively. Only type 1 and type 2 were present in locally acquired infections. The median age of the patients was 38 years and the mean duration of hospitalisation was 6 days. There was no mortality, and nearly all patients (98%) presented with fever. Other symptoms at presentation included: myalgia (83%), headache (65%), fatigue (59%), and skin rash (60%). More than one third of patients had gastro-intestinal and upper respiratory complaints. Maculopapular skin rash was the most common physical finding. Thrombocytopenia, neutropenia, and lymphopenia were present in 86%, 78%, and 69% of the patients, respectively. In only 29% of the patients was dengue fever included in the initial differential diagnosis. The demographic, clinical, and laboratory findings as well as outcomes did not differ significantly among the four dengue serotypes, but the lowest lymphocyte counts of type 3 was lower than the other serotypes (P=0.004).

CONCLUSION. When physicians encounter patients with a relevant travel history, presenting with fever and skin rash, and having compatible haematological findings, dengue fever should be included in the differential diagnosis.

Hong Kong Med J 2008;14:Epub 2008 Apr 3

Key words: Dengue; Dengue hemorrhagic fever; Serotyping