title: Clinical presentation of dengue among patients admitted to the adult emergency department of a tertiary care hospital in Martinique: implications for triage, management, and reporting.
abstract: OBJECTIVE
  During dengue epidemics, emergency physicians face large numbers of patients with acute febrile illness. Triage algorithms and appropriate reporting systems are useful to manage patients and prioritize resources. We identify possible adaptations to these systems to improve the management of patients during epidemics.
  
  
  METHODS
  In a prospective observational study in the adult emergency department (ED) of a tertiary care hospital, we enrolled all patients with febrile illness and a confirmed diagnosis of dengue (ribonucleic acid identification). We then retrospectively classified cases according to the initial clinical presentation at the ED.
  
  
  RESULTS
  We enrolled 715 patients (332 male patients), aged 14 to 91 years (median 35 years). Severe illness was documented in 332 cases (46.4%) and was mostly caused by serotype 2, or a secondary infection of any serotype. Severe forms included dengue hemorrhagic fever or dengue shock syndrome (104/332; 31.3%), severe bleeding (9/332; 2.7%), and acute organ failure (56/332; 16.9%). The other patients with severe illness (171/332; 51.5%) presented with symptoms of presyncope, intense weakness, prolonged gastrointestinal symptoms, and hypotension. This presentation was common during epidemics and appeared to be associated with dehydration and electrolyte loss that improved markedly within 24 hours with saline solution infusion. This group did not have evidence of plasma leakage, although similar features were observed in patients with dengue hemorrhagic fever/dengue shock syndrome.
  
  
  CONCLUSIONS
  Dengue has a wide range of clinical presentations in the ED. Many patients who appear seriously ill on presentation will respond to intravenous fluids.
authors: Emergency and Intensive Care Department, University Hospital, Fort-de-France, Martinique. laurent.thomas@chu-fortdefrance.fr
authors: Laurent
authors: L
authors: Thomas
authors: Victor
authors: V
authors: Moravie
authors: François
authors: F
authors: Besnier
authors: Ruddy
authors: R
authors: Valentino
authors: Stéphane
authors: S
authors: Kaidomar
authors: Laurent Villain
authors: LV
authors: Coquet
authors: Fatiha
authors: F
authors: Najioullah
authors: François
authors: F
authors: Lengellé
authors: Raymond
authors: R
authors: Césaire
authors: André
authors: A
authors: Cabié
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D058872:Epidemics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008395:Martinique / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D014218:Triage; D055815:Young Adult