title: Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital.
abstract: BACKGROUND
  Dengue shock syndrome (DSS) is a severe manifestation of dengue virus infection that particularly affects children and young adults. Despite its increasing global importance, there are no prospective studies describing the clinical characteristics, management, or outcomes of DSS.
  
  
  METHODS
  We describe the findings at onset of shock and the clinical evolution until discharge or death, from a comprehensive prospective dataset of 1719 Vietnamese children with laboratory-confirmed DSS managed on a single intensive care unit between 1999 and 2009.
  
  
  RESULTS
  The median age of patients was 10 years. Most cases had secondary immune responses, with only 6 clear primary infections, and all 4 dengue virus serotypes were represented during the 10-year study. Shock occurred commonly between days 4 and 6 of illness. Clinical signs and symptoms were generally consistent with empirical descriptions of DSS, although at presentation 153 (9%) were still febrile and almost one-third had no bleeding. Overall, 31 (2%) patients developed severe bleeding, primarily from the gastrointestinal tract, 26 of whom required blood transfusion. Only 8 patients died, although 123 of 1719 (7%) patients had unrecordable blood pressure at presentation and 417 of the remaining 1596 (26%) were hypotensive for age. The majority recovered well with standard crystalloid resuscitation or following a single colloid infusion. All cases were classified as severe dengue, while only 70% eventually fulfilled all 4 criteria for the 1997 World Health Organization classification of dengue hemorrhagic fever.
  
  
  CONCLUSIONS
  With prompt intervention and assiduous clinical care by experienced staff, the outcome of this potentially fatal condition can be excellent.
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases.
authors.forename: Phung Khanh
authors.initials: PK
authors.lastname: Lam
authors.forename: Dong Thi Hoai
authors.initials: DT
authors.lastname: Tam
authors.forename: Tran Vinh
authors.initials: TV
authors.lastname: Diet
authors.forename: Cao Thi
authors.initials: CT
authors.lastname: Tam
authors.forename: Nguyen Thi Hanh
authors.initials: NT
authors.lastname: Tien
authors.forename: Nguyen Tan Thanh
authors.initials: NT
authors.lastname: Kieu
authors.forename: Cameron
authors.initials: C
authors.lastname: Simmons
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Nguyen Thi Ngoc
authors.initials: NT
authors.lastname: Nga
authors.forename: Phan Tu
authors.initials: PT
authors.lastname: Qui
authors.forename: Nguyen Minh
authors.initials: NM
authors.lastname: Dung
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.forename: Bridget
authors.initials: B
authors.lastname: Wills
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D019595:Severe Dengue / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D014744:Vietnam / Q000453:epidemiology
keywords: Vietnam; dengue shock syndrome; pediatrics; prospective descriptive study
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