Adult dengue deaths in Singapore

Background: Dengue haemorrhagic fever (DHF) is a leading cause of hospitalization of children in Southeast Asia and regarded mainly as a problem of childhood. In Singapore, however, both dengue fever (DF) and DHF now occur most frequently in those aged 16–25 years and case fatality rates are higher among adults than children. Objective: To describe adults who died from DHF in Singapore. Study design: The clinical, laboratory and, where performed, autopsy records of adults reported to the Ministry of the Environment to have died from DHF were reviewed. Results: Four of 10 adults had clinical, serological and/or virological evidence of acute dengue virus infection. All 4 patients, who were between 27 and 58 years old, had dengue IgM antibodies. Two of them had elevated dengue IgG antibodies consistent with a recent infection. Dengue type 2 virus was isolated from one of these two patients who had bled into the lungs, skin, pericardial and pleural surfaces and succumbed to shock. The other patient had no evidence of overt bleeding. A third patient, who suffered massive intractable retroperitoneal haemorrhage and shock, seroconverted in the haemagglutination inhibition test for dengue antibodies. The fourth patient had bleeding into her skin, urinary and gastrointestinal tracts, acute pulmonary oedema, ascites and hypotension. Her stillborn baby also had ascites. Conclusion: Deaths from DHF are not mainly a childhood occurrence. Adults do die from severe DHF, whether the infection be primary or secondary.