[Hemorrhagic dengue without hemorrhaging: a novel diagnostic category?]

Compare the clinical course of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF).

Cross-sectional study among seropositive cases reported by the Northern Veracruz District IMSS Office in 2004. We analyzed the epidemiology, symptomology, clinical findings and disease progression. We calculated frequencies, proportions and averages. Clinical data and disease progression were compared.

We studied 404 patients, divided into three groups: 75 with CD, 120 DHF and 212 cases with no hemorrhagic data although displaying Dengue with Thrombocytopenia (DwT). General symptoms were much less common among Dengue cases. Abdominal pain, hepatomegaly and splenomegaly were more frequent among patients with DHF. Fluid leakage and hemorrhaging were observed in 75% and 46%, respectively, of the latter group. The history of prior infection was proportional. All patients presenting DHF showed thrombocytopenia, though only 3% showed hemoconcentration. The mean value for hematocrit was low (p=0.02) and the platelet count greater (p<0.001) among Dengue cases. Hemoglobin concentration showed no difference. The average time between disease onset and appearance of thrombocytopenia was similar in DHF cases (4.3+/- 1.6 days) and Dengue with Thrombocytopenia (4.3+/-1.6); even though, contrary to these, in the first group fluid leakage (3.7+/-1.8) and hemorrhaging (3.4+/-1.7) were previously identified.

Our results confirm the presence of cases showing atypical disease course, without external hemorrhaging data but showing significant thrombocytopenia that may go unnoticed and worsen disease progression.