Epidemic Dengue Hemorrhagic Fever in Rural Indonesia

II. Clinical Studies

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  • Directorate of Prevention and Control of Communicable Diseases, Ministry of Health, Bantul Regency, St. Elizabeth Hospital, Ganjuran Bantul, Pediatric Department, University Hospital, U.S. Naval Medical Research Unit No. 2, Jakarta Detachment, National Institute of Health Research and Development, Ministry of Health, Yogyakarta, Java, Indonesia

Clinical observations were made on 95 serologically or virologically confirmed dengue fever cases during an epidemic in a rural area of Indonesia in December 1976. The age distribution was similar to that observed in patients with dengue hemorrhagic fever in Jakarta, a highly endemic urban area. The observed disease ranged in severity from undifferentiated fever to shock and death. The majority of patients had acute onset of fever with nausea, vomiting, headache, and abdominal pain. Hepatomegaly was observed in only 19% of the patients. A positive tourniquet test was the most frequently observed hemorrhagic manifestation, but epistaxis was observed in 20% and hematemesis in 6% of the patients. Dengue shock syndrome was observed in 37% of the patients. There were four deaths, three of which were confirmed as due to dengue infection by virus isolation. The data suggest that one, and possibly two, of the fatal cases with virus isolation were primary infections, based on the results of hemagglutination-inhibition tests using all four dengue antigens.

Author Notes

Present address: University of Illinois, 320 Morrill Hall, Department of Entomology, Urbana, Illinois 61801.

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