title: Classical dengue hemorrhagic fever resulting from two dengue infections spaced 20 years or more apart: Havana, Dengue 3 epidemic, 2001-2002.
abstract: OBJECTIVE
  To report the clinical, laboratory and sonographic findings in 76 adult cases of dengue hemorrhagic fever (DHF).
  
  
  METHODS
  A dengue 3 epidemic occurred in Havana City from June 2001 to March 2002. 12,889 cases were reported, with 81 DHF cases. From this, 76 serologically confirmed cases were studied descriptively.
  
  
  RESULTS
  Bronchial asthma and white race were important risk factors for the severe form of the disease. Fever (100%), headache (92.1%), myalgia (76.3%), arthralgia (73.7%) and retro-orbital pain (57.7%) were the most frequent general symptoms. Vomiting and abdominal pain were observed in 59.2% and 48.6% of cases, respectively. The most common bleeding site was the vagina (64%), followed by the skin (55.2%). Eighteen patients (23.6%) had shock syndrome. Laboratory findings included thrombocytopenia (100%), hemoconcentration (93.4%), an increase in liver enzymes (82.8%), and leukopenia (71%). Ultrasound detected thickening of the gallbladder wall in 35.1%, pleural effusion in 20.3%, and splenomegaly in 12.9% of cases.
  
  
  CONCLUSIONS
  These findings contribute to a better understanding of the clinical aspects of DHF in adult patients due to the dengue 3 virus.
authors: Pedro Kouri Tropical Medicine Institute, Virology Department, Autopista Novia del Mediodía, La Lisa, Havana City, Cuba.
authors: Daniel
authors: D
authors: González
authors: Osvaldo E
authors: OE
authors: Castro
authors: Gustavo
authors: G
authors: Kourí
authors: Jorge
authors: J
authors: Perez
authors: Eric
authors: E
authors: Martinez
authors: Susana
authors: S
authors: Vazquez
authors: Delfina
authors: D
authors: Rosario
authors: Reynel
authors: R
authors: Cancio
authors: María G
authors: MG
authors: Guzman
mesh_terms: D015746:Abdominal Pain / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000473:pathology; D003462:Cuba / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D005334:Fever / Q000473:pathology; D006261:Headache / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D008107:Liver Diseases / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019595:Severe Dengue / Q000175:diagnosis* / Q000453:epidemiology*; D012867:Skin / Q000473:pathology; D013921:Thrombocytopenia / Q000473:pathology; D014621:Vagina / Q000473:pathology; D014839:Vomiting / Q000473:pathology