0053

PRIMARY DENGUE INFECTION: WHAT ARE CLINICAL

DISTINCTIONS FROM SECONDARY INFECTION?

Pancharoen C¹, Mekmullica J², Thisyakorn U¹

¹Chulalongkorn Hospital, Bangkok, Thailand

²Bhumibol Adulyadej Hospital, Bangkok, Thailand

Objective: To determine the magnitude of the problem posed by primary dengue infection in children and the distinctive clinical clues that may differ from those with secondary infection

Methods: Prospectively recorded dengue medical charts of 996 children who were clinically and serologically diagnosed as dengue infection and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand between 1988 and 1995 were reviewed.

Results: One hundred and thirty-nine cases (14.0%) were serologically proved to be primary dengue infection. Of these, 72 were males and 67 were females, with a mean age of 4.8 years. Common manifestations by order of frequency included fever (100%), hepatomegaly (71.9%), vomiting (59.0%), decreased appetite (55.4%), coryza (52.5%), drowsiness (39.6%), diarrhea (34.5%), rash (33.8%), abdominal pain (23.0%) and seizure (15.8%). Common sites of bleeding were skin (41.7%), mucous membranes (14.4%) and gastrointestinal system (12.2%). Three patients (2.2%) died. Compared with children with secondary dengue infection (n=139), the children with primary dengue infections tended to be younger, presented more commonly with coryza, diarrhea, rash and seizure; and less commonly with vomiting, headache and abdominal pain (p < 0.05). The hematocrit level and percentage of neutrophils were significantly lower in the study group whereas the percentage of lymphocytes was significantly higher.

Conclusions: This study has emphasized that primary dengue infection is not uncommon. Clinical presentations and laboratory findings are somewhat different from those in children with secondary infection.