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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 × 109/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.
Financial support: This work was supported by the STOP Dengue Translational Clinical Research Programme funded by the National Research Foundation through the National Medical Research Council, Singapore (Grant NMRC/TCR/005/2008).
Authors' addresses: Tun-Linn Thein, Joshua G. X. Wong, and Ying Hao, Communicable Disease Center, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, E-mails: email@example.com, Joshua_Gx_Wong@ttsh.com.sg, and firstname.lastname@example.org. David C. Lye, Communicable Disease Center, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, E-mail: email@example.com. Yee-Sin Leo, Communicable Disease Center, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore, E-mail: firstname.lastname@example.org. Annelies Wilder-Smith, Communicable Disease Center, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, and Lee Kong Chian School of Medicine, Singapore, E-mail: email@example.com.