title: Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore.
abstract: BACKGROUND
  Dengue fever has seen a significant re-emergence in Southeast Asia. Associated with the rise of dengue has been the increase in dengue-associated mortality. To better understand the predictors of mortality, we conducted a review of hospitalized adult dengue infections within our institution.
  
  
  METHODS
  This was a retrospective case-control study of dengue-associated deaths at a large tertiary care hospital.
  
  
  RESULTS
  In 2004, of 3186 cases of dengue fever (DF)/hemorrhagic dengue fever (DHF) admitted to our institution, there were 130 cases of DHF and seven dengue-associated deaths (case-fatality rate 5.4%). At least three of the seven fatal cases had serological evidence of primary dengue infection. All dengue-mortality cases had rapidly progressive clinical deterioration at an average of day 4 of fever with intensive care admission occurring on a mean of 5.6 days of fever. Adult respiratory distress syndrome, disseminated intravascular coagulopathy, and multi-organ failure were the most common causes of death despite early hospitalization, intravenous fluid, and blood-product support.
  
  
  CONCLUSIONS
  Dengue is associated with severe disease, and deaths do occur despite current supportive management. Fatal DHF/dengue shock syndrome (DSS) does occur in adults and in primary dengue infection. Better early predictors of disease severity and clinical interventions are needed.
authors.affiliation: Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433 Singapore. aomailbox@gmail.com
authors.forename: Adrian
authors.initials: A
authors.lastname: Ong
authors.forename: Mya
authors.initials: M
authors.lastname: Sandar
authors.forename: Mark I
authors.initials: MI
authors.lastname: Chen
authors.forename: Leo Yee
authors.initials: LY
authors.lastname: Sin
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019595:Severe Dengue / Q000453:epidemiology / Q000401:mortality*; D012846:Singapore / Q000453:epidemiology