title: Fatal dengue hemorrhagic fever in Cuba, 1997.
abstract: OBJECTIVE
  After more than 15 years without dengue activity, a dengue II epidemic was reported in Cuba in 1997. Three thousand and twelve serologically confirmed cases were reported, with 205 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) cases and 12 fatalities. This report presents the clinical, serologic, and virologic findings in the 12 fatal DHF/DSS cases.
  
  
  METHODS
  Serum and necropsy samples were studied by viral isolation in C636 cell line and polymerase chain reaction. Serum samples were tested by IgM capture enzyme-linked immunoassay (ELISA) and ELISA inhibition method (EIM).
  
  
  RESULTS
  All 12 cases were classified as DHF/DSS according to the Pan American Health Organization Guidelines for Control and Prevention of Dengue and Dengue Hemorrhagic Fever in the Americas. All patients were older than 15 years. Women were more frequently affected. The symptoms and signs presented by these patients were similar to those previously described in DHF/DSS cases. Clinical deterioration occurred on average at day 3.75. Abdominal pain and persistent vomiting were the earliest and most frequent warning signs. Dengue infection was confirmed in all cases. IgM antibodies were detected in 11 of 12 cases, all of them with a secondary infection. Dengue II virus was detected by viral isolation in 12 samples and by polymerase chain reaction in 17. Virus or RNA was detected in various tissues, including kidney, heart, lung, and brain.
  
  
  CONCLUSIONS
  The clinical, pathologic, and laboratory features of 12 cases of fatal dengue hemorrhagic fever were reviewed. The results obtained demonstrate that adults with a primary dengue infection are at risk of developing the severe disease (DHF) if they are infected with a different serotype.
authors.affiliation: Department of Virology, PAHO/WHO Collaborator Center for Viral Diseases, Tropical Medicine Institute of Havana, Havana, Cuba.
authors.forename: M G
authors.initials: MG
authors.lastname: Guzmán
authors.forename: M
authors.initials: M
authors.lastname: Alvarez
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez
authors.forename: D
authors.initials: D
authors.lastname: Rosario
authors.forename: S
authors.initials: S
authors.lastname: Vázquez
authors.forename: L
authors.initials: L
authors.lastname: Vald s
authors.forename: M V
authors.initials: MV
authors.lastname: Cabrera
authors.forename: G
authors.initials: G
authors.lastname: Kourí
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003462:Cuba / Q000453:epidemiology; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005416:Flavivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012703:Serotyping
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M