title: Clinical and epidemiological characterization of dengue hemorrhagic fever cases in northeastern, Brazil.
abstract: BACKGROUND
  The dengue hemorrhagic dengue (DHF) remains an important public health problem in Brazil. The objective of this study was to analyze the epidemiological characteristics of DHF cases during the 2003 epidemic in Ceará.
  
  
  METHODS
  Suspected DHF cases with onset of symptoms between January and December 2003 were investigated.
  
  
  RESULTS
  37,964 classic dengue cases and 291 DHF cases were reported. Among the cases discarded, 75.5% were serologically positive but did not meet the criteria recommended by the World Health Organization (WHO). The DHF patients' median age was 30 years (2 - 88). Among the hemorrhagic manifestations, petechiae were the most (32.6%) frequent. Cases of gastrointestinal bleeding, ascites, pericardial pleural effusion, hepatomegaly, hypotension and shock showed higher risk of progression to death (p <0.05).
  
  
  CONCLUSIONS
  The introduction of a new serotype (DENV-3) in Ceará, which encountered a susceptible population and high vector density, may have been the primary agent responsible for the magnitude of the epidemic. Timely and appropriate medical care, along with an organized care structure are essential for reducing its lethality.
authors.affiliation: Graduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, CE, Brazil. pamplona.luciano@gmail.com; lucianoc@saude.ce.gov.br
authors.forename: Luciano Pamplona de Góes
authors.initials: LP
authors.lastname: Cavalcanti
authors.forename: Ivo Castelo Branco
authors.initials: IC
authors.lastname: Coelho
authors.forename: Dina Cortez Lima Feitosa
authors.initials: DC
authors.lastname: Vilar
authors.forename: Susana Glória Silveira
authors.initials: SG
authors.lastname: Holanda
authors.forename: Kiliana Nogueira Farias da
authors.initials: KN
authors.lastname: Escóssia
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Souza-Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019595:Severe Dengue / Q000401:mortality*; D012720:Severity of Illness Index; D055815:Young Adult