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Am. J. Trop. Med. Hyg., 76(4), 2007, pp. 752-756
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


DIFFICULTY IN DIAGNOSIS AND TREATMENT OF DENGUE HEMORRHAGIC FEVER IN PATIENTS WITH CHRONIC RENAL FAILURE: REPORT OF THREE CASES OF MORTALITY

MEI-CHUAN KUO, JER-MING CHANG, PO-LIANG LU, YI-WEN CHIU, HUNG-CHUN CHEN, AND SHANG-JYH HWANG*
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Infection, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

 

ABSTRACT

In 2002, an outbreak of dengue fever (DF) in Taiwan caused mortality in some patients with chronic renal failure (CRF). We report three cases of CRF who died of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) despite an intensive care process. The difficulty in diagnosis and the treatment dilemma attributable to ambiguity in symptoms and signs between CRF and DF may delay the diagnosis, contributing to a high risk of mortality. The narrow window of fluid tolerance in patients with CRF further hampers the success of resuscitation in DHF and DSS. Continuous venous to venous hemodialysis (CVVHD) is helpful in managing a condition with unstable hemodynamics. However, to decrease mortality, the physician must pay great attention to ensure an early awareness of DHF/DSS and deliver a prompt and aggressive treatment of patients of dengue viral infections with chronic renal failure.

Received August 7, 2006. Accepted for publication December 18, 2006.

* Address correspondence to Shang-Jyh Hwang, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. E-mail: sjhwang{at}kmu.edu.tw

Authors’ addresses: Mei-Chuan Kuo, Jer-Ming Chang, Yi-Wen Chiu, Hung-Chun Chen, and Shang-Jyh Hwang, Division of Nephrology; Po-Liang Lu, Division of Infection, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San-Ming, District, Kaohsiung City 807, Taiwan, Telephone: 886-7-3121101-7901, Fax: 886-7-3165706.

Reprint requests: Shang-Jyh Hwang, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan, E-mail: sjhwang{at}kmu.edu.tw.




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Copyright © 2007 by the American Society of Tropical Medicine and Hygiene.