title: Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia.
abstract: OBJECTIVE
  To describe clinical profile of patients with dengue virus infection hospitalized at a single center during the first outbreak of dengue in Makkah, Saudi Arabia from April to July 2004.
  
  
  METHODS
  Clinical information and laboratory abnormalities of patients with suspected dengue infection were collected by a standardized data collection sheet and review of medical records. Dengue virus infection was confirmed by a positive IgM capture ELISA or RT-PCR.
  
  
  RESULTS
  Of the 160 clinically suspected patients, 91 were confirmed (64 by IgM ELISA, 14 by RT-PCR and 13 by both) to have dengue virus infection. Dengue serotypes 2 and 3 were identified in 19 and 4 patients respectively. Most patients were young adults with median age of 26 (range=6-94) years and male:female ratio of 1.5:1. The common symptoms were fever (100%), malaise (83%), musculoskeletal pain (81%), headache (75%), nausea (69%), vomiting (65%) and abdominal pain (48%). According to World Health Organization (WHO) classification (10 patients were excluded due to lack of serial hematocrits), 75 (93%) had dengue fever (DF) and 6 (7%) had dengue hemorrhagic fever (DHF). Only one patient with DHF was in pediatric age group. Twenty-one patients (5 with DHF and 16 with DF) developed one or more clinical complications that included bleeding (14), shock (4), seizures (3), acute renal failure (2), meningo-encephalitis (1), and secondary bacterial infection (1). Only one patient with shock had dengue shock syndrome (DSS) by WHO classification. Development of clinical complications was significantly associated with absence of musculoskeletal pain (p-value=0.03), lower platelet counts (p-value=0.03) and higher serum aspartate aminotransferase levels (p-value=0.04). The median duration of symptoms and hospitalization was 8 days (range=3-18) and 4 days (range=1-10) respectively. No mortality was noted.
  
  
  CONCLUSIONS
  Occurrence of dengue virus infection in Makkah, Saudi Arabia is documented. Continued surveillance and effective vector control programs are warranted due to unique population dynamics of Makkah that receives millions of pilgrims annually from all over the world.
authors.affiliation: Division of Rheumatology, University of Arkansas for Medical Sciences, Mail Slot - 509, 4301 West Markham, Little Rock, AR 72205, USA. nakhan99@yahoo.com
authors.forename: Nasim A
authors.initials: NA
authors.lastname: Khan
authors.forename: Esam I
authors.initials: EI
authors.lastname: Azhar
authors.forename: Suzan
authors.initials: S
authors.lastname: El-Fiky
authors.forename: Hosam H
authors.initials: HH
authors.lastname: Madani
authors.forename: Maha A
authors.initials: MA
authors.lastname: Abuljadial
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ashshi
authors.forename: Abdulhafis M
authors.initials: AM
authors.lastname: Turkistani
authors.forename: Esam A
authors.initials: EA
authors.lastname: Hamouh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D003715:Dengue / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D003716:Dengue Virus / Q000145:classification; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006760:Hospitalization; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012529:Saudi Arabia / Q000453:epidemiology; D012703:Serotyping; D019595:Severe Dengue / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral