title: Early clinical and biological features of severe clinical manifestations of dengue in Vietnamese adults.
abstract: BACKGROUND
  Dengue is a major public health problem in both children and adults in Vietnam, but dengue severity in adults has been poorly investigated.
  
  
  OBJECTIVE
  To describe severe manifestations of dengue in Vietnamese adults and to identify early indicators of these manifestations.
  
  
  METHODS
  A prospective longitudinal study was carried out from July to October, 2007, in People's Hospital 115, Ho Chi Minh City, Vietnam.
  
  
  RESULTS
  One hundred ninety-five clinically suspected dengue patients were enrolled. 151 of these were laboratory-confirmed using serum samples on day 3 after onset of fever for RT-PCR and/or virus isolation. Dengue was associated with plasma leakage in 51 patients (33.8%), gallbladder thickening in 30 patients (20%), spontaneous bleeding in 127 patients (84.1%), and internal bleeding in 37 patients (24.5%). Several early indicators were associated with severe manifestations of dengue. Frequent vomiting (> or =3 times a day), marked lymphopenia, thrombocytopenia, and elevated liver enzymes on day 3 after onset of fever were significantly associated with plasma leakage and gallbladder thickening. Increased alanine aminotransferase level in plasma on day 3 was significantly associated with internal bleeding. Gallbladder thickening and internal bleeding were more common with specific serotypes.
  
  
  CONCLUSIONS
  Several severe manifestations of dengue were observed in Vietnamese adults. These manifestations were associated with early clinical and biological indicators. This information may be useful for clinicians to better monitor adult dengue patients, particularly in tropical areas where health resources may be limited.
authors.affiliation: Infectious Disease Department, People's Hospital 115 of Ho Chi Minh City, Viet Nam. ifmtbinh@yahoo.com
authors.forename: Pham Thai
authors.initials: PT
authors.lastname: Binh
authors.forename: Severine
authors.initials: S
authors.lastname: Matheus
authors.forename: Vu Thi Que
authors.initials: VT
authors.lastname: Huong
authors.forename: Xavier
authors.initials: X
authors.lastname: Deparis
authors.forename: Vincent
authors.initials: V
authors.lastname: Marechal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003715:Dengue / Q000473:pathology* / Q000503:physiopathology*; D003716:Dengue Virus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014744:Vietnam; D055815:Young Adult