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Introduction

00000000Dengue infections have been one of the major diseases affecting children in Thailand for more than 40 years. First dengue epidemic was recorded with 2,158 cases in 1958 and reached a peak in 1987 when there were 174,285 cases reported. The last two epidemics occurred in two consecutive years, 1997 and 1998, when 101,689 cases and 127,189 cases, respectively, were reported. Although the case-fatality rate has been reduced from 14% (1958) to 0.34% (1998), the number of deaths was higher, from 300 deaths in 1958 to 464 deaths in 1998. Adults were affected more than expected, and their share of deaths was to about 20% in 1998(1).

00000000 During the last two epidemics, one of the major reasons for not taking control measures was the delay in case reporting(2). This delay in reporting was due to clinicians being reluctant to report dengue haemorrhagic fever (DHF) cases without serological confirmation. The disease control authorities were doubtful about the clinical diagnosis as most of the criteria used was non-specific(3). They preferred to wait for confirmed cases before taking control actions.

00000000 This study is a part of the collaborative dengue pathophysiology studies and was planned to find simple clinical and/or laboratory indicators for the early diagnosis of dengue infections that would help speed up the reporting system so that control actions would start early and be effective to arrest the spread of the outbreak.

Materials and methods

00000000 Twelve febrile patients were enrolled each week between 1994 and 1997 from the outpatient department of two hospitals, Children's Hospital in Bangkok and Kampangpet Provincial Hospital. The patients met the following criteria: age 6 months to 15 years, had temperature > 38.5o Celsius for < 72 hours, had facial flushing and no obvious source of infection. Parents or guardians of all patients had to sign an informed consent before participating in this project. Patients who has signs of shock or had underlying diseases were excluded from the study.

00000000 All the patients were admitted to hospital for close observation. Study physicians did the history-taking and physical ezamination, including tourniquet test (TT), everyday, Daily phlebotomy was done every morning for CBC, dengue serological (ELISA and Haemagglutination Ingibition test), virollogical (mosquito inoculation technique) and immunological study for five days or until one day after defervescence (whichever came first). Right lateral decubitus chest films to detect pleural effusion were done one day after defervescence. Blood studies were repeated on study day 9 when the patients came for a follow up. Liver function test and coagulogram were studied on the first study day, on the day of defervescence or one day after and at the time of follow-up(2,3,4,5).