Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection
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{"title"=>"Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection", "type"=>"journal", "authors"=>[{"first_name"=>"Emily K.", "last_name"=>"Rowe", "scopus_author_id"=>"56177086800"}, {"first_name"=>"Yee Sin", "last_name"=>"Leo", "scopus_author_id"=>"7004240142"}, {"first_name"=>"Joshua G X", "last_name"=>"Wong", "scopus_author_id"=>"56079420300"}, {"first_name"=>"Tun Linn", "last_name"=>"Thein", "scopus_author_id"=>"25722299500"}, {"first_name"=>"Victor C.", "last_name"=>"Gan", "scopus_author_id"=>"39761493600"}, {"first_name"=>"Linda K.", "last_name"=>"Lee", "scopus_author_id"=>"54881570100"}, {"first_name"=>"David C.", "last_name"=>"Lye", "scopus_author_id"=>"14016391200"}], "year"=>2014, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"issn"=>"19352735", "scopus"=>"2-s2.0-84901268760", "pmid"=>"24699282", "doi"=>"10.1371/journal.pntd.0002777", "pui"=>"373147050", "isbn"=>"1935-2727", "arxiv"=>"10.1155/2014/359308", "sgr"=>"84901268760"}, "id"=>"b3198132-173e-3685-9a10-fcbe1c8e7419", "abstract"=>"BACKGROUND/METHODS: To better understand dengue fever in the elderly, we compared clinical features, World Health Organization (WHO) dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients. We explored the impact of co-morbidity and hospital-acquired infection (HAI) on clinical outcomes in the elderly. All patients managed at the Communicable Disease Centre, Singapore, between 2005 and 2008 with positive dengue polymerase chain reaction (PCR) or who fulfilled WHO 1997 or 2009 probable dengue criteria with positive dengue IgM were included.\\n\\nRESULTS: Of the 6989 cases, 295 (4.4%) were elderly. PCR was positive in 29%. The elderly suffered more severe disease with more dengue haemorrhagic fever (DHF) (29.2% vs. 21.4%) and severe dengue (SD) (20.3% vs. 14.6%) (p<0.05). Classic dengue symptoms were more common in the adult group. The elderly were less likely to fulfill WHO 1997 (93.6% vs. 96.4%) (p = 0.014), but not WHO 2009 probable dengue (75.3% vs. 71.5%). Time to dengue diagnosis was similar. There was no significant difference in the frequency of warning signs between the two groups, but the elderly were more likely to have hepatomegaly (p = 0.006) and malaise/lethargy (p = 0.033) while the adults had significantly more mucosal bleeding (p<0.001). Intensive care admission occurred in 15 and death in three, with no age difference. Notably, the elderly stayed in hospital longer (median 5 vs. 4 days), and suffered more pneumonia (3.8% vs. 0.7%) and urinary infection (1.9% vs. 0.3%) (p = 0.003). Predictors of excess length of stay were age (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.37-2.88), critical illness (aOR 5.13, 95%CI 2.59-9.75), HAI (aOR 12.06, 95%CI 7.39-19.9), Charlson score (aOR 6.9, 95%CI 2.02-22.56) and severe dengue (DHF/dengue shock syndrome/SD) (aOR 2.24, 95%CI 1.83-2.74).\\n\\nCONCLUSION: Elderly dengue patients present atypically and are at higher risk of DHF, SD and HAI. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay.", "link"=>"http://www.mendeley.com/research/challenges-dengue-fever-elderly-atypical-presentation-risk-severe-dengue-hospitaacquired-infection", "reader_count"=>27, "reader_count_by_academic_status"=>{"Researcher"=>7, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>2, "Other"=>1, "Student > Master"=>5, "Student > Bachelor"=>8, "Lecturer"=>1}, "reader_count_by_user_role"=>{"Researcher"=>7, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>2, "Other"=>1, "Student > Master"=>5, "Student > Bachelor"=>8, "Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>2, "Medicine and Dentistry"=>19, "Agricultural and Biological Sciences"=>2, "Veterinary Science and Veterinary Medicine"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>19}, "Social Sciences"=>{"Social Sciences"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Unspecified"=>{"Unspecified"=>2}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Spain"=>1}, "group_count"=>5}

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  • {"files"=>["https://ndownloader.figshare.com/files/1448231"], "description"=>"<p>Abbreviations: PCR = polymerase chain reaction, WHO = World Health Organization, COPD = chronic obstructive pulmonary disease.</p>", "links"=>[], "tags"=>["patients", "adults", "dengue"], "article_id"=>985765, "categories"=>["Biological Sciences"], "users"=>["Emily K. Rowe", "Yee-Sin Leo", "Joshua G. X. Wong", "Tun-Linn Thein", "Victor C. Gan", "Linda K. Lee", "David C. Lye"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0002777.t001", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Clinical_characteristics_of_elderly_patients_8805_60_and_adults_lt_60_with_dengue_fever_/985765", "title"=>"Clinical characteristics of elderly patients (≥60) and adults (<60) with dengue fever.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-03 02:54:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/1448232"], "description"=>"<div><p>Background/methods</p><p>To better understand dengue fever in the elderly, we compared clinical features, World Health Organization (WHO) dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients. We explored the impact of co-morbidity and hospital-acquired infection (HAI) on clinical outcomes in the elderly. All patients managed at the Communicable Disease Centre, Singapore, between 2005 and 2008 with positive dengue polymerase chain reaction (PCR) or who fulfilled WHO 1997 or 2009 probable dengue criteria with positive dengue IgM were included.</p><p>Results</p><p>Of the 6989 cases, 295 (4.4%) were elderly. PCR was positive in 29%. The elderly suffered more severe disease with more dengue haemorrhagic fever (DHF) (29.2% vs. 21.4%) and severe dengue (SD) (20.3% vs. 14.6%) (p<0.05). Classic dengue symptoms were more common in the adult group. The elderly were less likely to fulfill WHO 1997 (93.6% vs. 96.4%) (p = 0.014), but not WHO 2009 probable dengue (75.3% vs. 71.5%). Time to dengue diagnosis was similar. There was no significant difference in the frequency of warning signs between the two groups, but the elderly were more likely to have hepatomegaly (p = 0.006) and malaise/lethargy (p = 0.033) while the adults had significantly more mucosal bleeding (p<0.001). Intensive care admission occurred in 15 and death in three, with no age difference. Notably, the elderly stayed in hospital longer (median 5 vs. 4 days), and suffered more pneumonia (3.8% vs. 0.7%) and urinary infection (1.9% vs. 0.3%) (p = 0.003). Predictors of excess length of stay were age (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.37–2.88), critical illness (aOR 5.13, 95%CI 2.59–9.75), HAI (aOR 12.06, 95%CI 7.39–19.9), Charlson score (aOR 6.9, 95%CI 2.02–22.56) and severe dengue (DHF/dengue shock syndrome/SD) (aOR 2.24, 95%CI 1.83–2.74).</p><p>Conclusion</p><p>Elderly dengue patients present atypically and are at higher risk of DHF, SD and HAI. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay.</p></div>", "links"=>[], "tags"=>["dengue", "atypical", "hospita-acquired"], "article_id"=>985766, "categories"=>["Biological Sciences"], "users"=>["Emily K. Rowe", "Yee-Sin Leo", "Joshua G. X. Wong", "Tun-Linn Thein", "Victor C. Gan", "Linda K. Lee", "David C. Lye"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0002777", "stats"=>{"downloads"=>6, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Challenges_in_Dengue_Fever_in_the_Elderly_Atypical_Presentation_and_Risk_of_Severe_Dengue_and_Hospita_Acquired_Infection_/985766", "title"=>"Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-03 02:54:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/1448229"], "description"=>"<p>*All p-values <0.001.</p>∧<p>Dengue Severity – dengue hemorrhagic fever, dengue shock syndrome or severe dengue.</p>", "links"=>[], "tags"=>[], "article_id"=>985763, "categories"=>["Biological Sciences"], "users"=>["Emily K. Rowe", "Yee-Sin Leo", "Joshua G. X. Wong", "Tun-Linn Thein", "Victor C. Gan", "Linda K. Lee", "David C. Lye"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0002777.t003", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Excess_length_of_hospital_stay_/985763", "title"=>"Excess length of hospital stay.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-03 02:54:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/1448230"], "description"=>"<p>Abbreviations: DHF = dengue haemorrhagic fever, DSS = dengue shock syndrome, SD = severe dengue, SB = severe bleeding, SPL = severe plasma leakage, SOI = severe organ involvement, ICU = intensive care unit, HAI = hospital acquired infection, UTI = urinary tract infection.</p>", "links"=>[], "tags"=>["patients", "dengue"], "article_id"=>985764, "categories"=>["Biological Sciences"], "users"=>["Emily K. Rowe", "Yee-Sin Leo", "Joshua G. X. Wong", "Tun-Linn Thein", "Victor C. Gan", "Linda K. Lee", "David C. Lye"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0002777.t002", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Outcomes_for_elderly_8805_60_and_adult_lt_60_patients_with_dengue_fever_/985764", "title"=>"Outcomes for elderly (≥60) and adult (<60) patients with dengue fever.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-03 02:54:53"}

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