Volume 90, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Studies on severe neutropenia in dengue are scarce, and its clinical significance is uncertain. We analyzed a cohort of 1,921 reverse transcription polymerase chain reaction-confirmed adult dengue patients admitted to the Communicable Disease Center in Singapore between 2005 and 2008. Time trend analyses for daily absolute neutrophil counts (ANCs) were done using Bayesian hierarchical and Markov models. We found that severe neutropenia, defined as ANC ≤ 0.5 × 10/L, was found in 11.8% with a median duration of 1 day. ANC nadir occurred on illness day 5. Severe neutropenia was not predictive of more severe disease and not associated with secondary bacterial infections, prolonged hospital stay, prolonged fever, or fatal outcome. We concluded that prophylactic antibiotics are not indicated in patients with severe neutropenia without indication for bacterial infection.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Wilder-Smith A, Schwartz E, , 2005. Dengue in travelers. N Engl J Med 353: 924932.[Crossref] [Google Scholar]
  2. Simmons CP, Farrar JJ, Nguyen VV, Wills B, , 2012. Dengue. N Engl J Med 366: 14231432.[Crossref] [Google Scholar]
  3. Ali N, Usman M, Syed N, Khurshid M, , 2007. Haemorrhagic manifestations and utility of haematological parameters in dengue fever: a tertiary care centre experience at Karachi. Scand J Infect Dis 39: 10251028.[Crossref] [Google Scholar]
  4. Wilder-Smith A, Earnest A, Paton NI, , 2004. Use of simple laboratory features to distinguish the early stage of severe acute respiratory syndrome from dengue fever. Clin Infect Dis 39: 18181823.[Crossref] [Google Scholar]
  5. Chadwick D, Arch B, Wilder-Smith A, Paton N, , 2006. Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: application of logistic regression analysis. J Clin Virol 35: 147153.[Crossref] [Google Scholar]
  6. Nathan C, , 2006. Neutrophils and immunity: challenges and opportunities. Nat Rev Immunol 6: 173182.[Crossref] [Google Scholar]
  7. Beers MH, Berkow R, , 1999. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories. [Google Scholar]
  8. World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Geneva: World Health Organization. [Google Scholar]
  9. Lee VJ, Chow A, Zheng X, Carrasco LR, Cook AR, Lye DC, Ng LC, Leo YS, , 2012. Simple clinical and laboratory predictors of chikungunya versus dengue infections in adults. PLoS Negl Trop Dis 6: e1786.[Crossref] [Google Scholar]
  10. La Russa VF, Innis BL, , 1995. Mechanisms of dengue virus-induced bone marrow suppression. Baillieres Clin Haematol 8: 249270.[Crossref] [Google Scholar]
  11. Hoang LT, Lynn DJ, Henn M, Birren BW, Lennon NJ, Le PT, Duong KT, Nguyen TT, Mai LN, Farrar JJ, Hibberd ML, Simmons CP, , 2010. The early whole-blood transcriptional signature of dengue virus and features associated with progression to dengue shock syndrome in Vietnamese children and young adults. J Virol 84: 1298212994.[Crossref] [Google Scholar]
  12. Pancharoen C, Mekmullica J, Thisyakorn U, , 2001. Primary dengue infection: what are the clinical distinctions from secondary infection? Southeast Asian J Trop Med Public Health 32: 476480. [Google Scholar]
  13. Phan DT, Ha NT, Thuc LT, Diet NH, Phu LV, Ninh LY, An VT, , 1991. Some changes in immunity and blood in relation to clinical states of dengue hemorrhagic fever patients in Vietnam. Haematologia (Budap) 24: 1321. [Google Scholar]
  14. Murillo-Llanes J, Soto-Valenzuela H, Flores-Flores P, Peraza-Garay F, , 2007. Clinical and epidemiological characteristic of dengue. Rev Med Inst Mex Seguro Soc 45: 485491. [Google Scholar]
  15. Khan NA, Azhar EI, El-Fiky S, Madani HH, Abuljadial MA, Ashshi AM, Turkistani AM, Hamouh EA, , 2008. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Acta Trop 105: 3944.[Crossref] [Google Scholar]
  16. Lee IK, Liu JW, Yang KD, , 2012. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations. PLoS Negl Trop Dis 6: e1532.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 02 Jan 2014
  • Accepted : 07 Mar 2014
  • Published online : 04 Jun 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error