title: The differences of clinical manifestations and laboratory findings in children and adults with dengue virus infection.
abstract: BACKGROUND
  Dengue haemorrhagic fever is an important public health problem and mainly occurs in children less than 15 years of age. Recently, the incidence of the disease have increased in adults but data on clinical and laboratory presentations of those affected are limited.
  
  
  OBJECTIVE
  To assess and compare clinical manifestations and laboratory findings of dengue virus infected children and adults in Thailand.
  
  
  METHODS
  A 1-year study was conducted from September 2003 to August 2004 for dengue virus infected patients admitted to Phetchabun Provincial Hospital, Thailand. Physical signs, symptoms, and laboratory features were recorded. All dengue patients were confirmed using immunochromatographic test on convalescent sera.
  
  
  RESULTS
  Based on serology-confirmed dengue virus infection, there was 286 dengue patients including 15 (5.3%) dengue fever and 271 (94.7%) dengue haemorrhagic fever (DHF). Among DHF cases, clinical classifications were DHF I, 40.9%; DHF II, 43%; and DHF III or dengue shock syndrome (DSS), 10.8%. Of all dengue patients, 231 cases (80.8%) were children aged less than 15 years and 55 cases (19.2%) were adults. The highest proportion of child cases was DHF I (42.9%), whereas that of adults was DHF II (51%). Some clinical manifestations were more common in adult patients, such as petechiae, melena, headache, retro-orbital pain, joint pain, myalgia, nausea and vomiting (p-value<0.05). Signs found commonly in children were epistaxis, oliguria, and liver enlargement (p-value<0.05). Haemoconcentration, thrombocytopenia, increased alanine aminotransferase, and longer prothrombin time were found to be significantly higher in adults than in children (p-value<0.05).
  
  
  CONCLUSIONS
  Some clinical presentations of dengue disease and laboratory findings in adults are different from those in children. Therefore, adults as well as pediatric cases of DHF need appropriate and prompt case management to reduce the mortality rate of DHF.
authors.affiliation: Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand. phlkt@mahidol.ac.th
authors.forename: Leera
authors.initials: L
authors.lastname: Kittigul
authors.forename: Piyamard
authors.initials: P
authors.lastname: Pitakarnjanakul
authors.forename: Dusit
authors.initials: D
authors.lastname: Sujirarat
authors.forename: Kanokrat
authors.initials: K
authors.lastname: Siripanichgon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003715:Dengue / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D019595:Severe Dengue / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology*; D013785:Thailand / Q000453:epidemiology