title: Dengue infection in children in Ratchaburi, Thailand: a cohort study. II. Clinical manifestations.
abstract: BACKGROUND
  Dengue infection is one of the most important mosquito-borne diseases. More data regarding the disease burden and the prevalence of each clinical spectrum among symptomatic infections and the clinical manifestations are needed. This study aims to describe the incidence and clinical manifestations of symptomatic dengue infection in Thai children during 2006 through 2008.
  
  
  METHODS
  This study is a school-based prospective open cohort study with a 9,448 person-year follow-up in children aged 3-14 years. Active surveillance for febrile illnesses was done in the studied subjects. Subjects who had febrile illness were asked to visit the study hospital for clinical and laboratory evaluation, treatment, and serological tests for dengue infection. The clinical data from medical records, diary cards, and data collection forms were collected and analyzed.
  
  
  RESULTS
  Dengue infections were the causes of 12.1% of febrile illnesses attending the hospital, including undifferentiated fever (UF) (49.8%), dengue fever (DF) (39.3%) and dengue hemorrhagic fever (DHF) (10.9%). Headache, anorexia, nausea/vomiting and myalgia were common symptoms occurring in more than half of the patients. The more severe dengue spectrum (i.e., DHF) had higher temperature, higher prevalence of nausea/vomiting, abdominal pain, rash, diarrhea, petechiae, hepatomegaly and lower platelet count. DHF cases also had significantly higher prevalence of anorexia, nausea/vomiting and abdominal pain during day 3-6 and diarrhea during day 4-6 of illness. The absence of nausea/vomiting, abdominal pain, diarrhea, petechiae, hepatomegaly and positive tourniquet test may predict non-DHF.
  
  
  CONCLUSIONS
  Among symptomatic dengue infection, UF is most common followed by DF and DHF. Some clinical manifestations may be useful to predict the more severe disease (i.e., DHF). This study presents additional information in the clinical spectra of symptomatic dengue infection.
authors.affiliation: Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. tmcsw@mahidol.ac.th
authors.forename: Chukiat
authors.initials: C
authors.lastname: Sirivichayakul
authors.forename: Kriengsak
authors.initials: K
authors.lastname: Limkittikul
authors.forename: Pornthep
authors.initials: P
authors.lastname: Chanthavanich
authors.forename: Vithaya
authors.initials: V
authors.lastname: Jiwariyavej
authors.forename: Watcharee
authors.initials: W
authors.lastname: Chokejindachai
authors.forename: Krisana
authors.initials: K
authors.lastname: Pengsaa
authors.forename: Saravudh
authors.initials: S
authors.lastname: Suvannadabba
authors.forename: Wut
authors.initials: W
authors.lastname: Dulyachai
authors.forename: G William
authors.initials: GW
authors.lastname: Letson
authors.forename: Arunee
authors.initials: A
authors.lastname: Sabchareon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003715:Dengue / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology