A Fatal Case of Dengue Hemorrhagic Fever in an American Child

This is the authors' abstract. We don't add key points for this paper.

DENGUE HEMORRHAGIC FEVER has occurred in yearly epidemics in Thailand since 1958. During the past 8 years, approximately 18,000 Thai children in Bangkok alone have been hospitalized; there have been over 1,000 deaths. Approximately 30% of the hospitalized hemorrhagic fever patients have a severe form of the disease, termed the dengue shock syndrome, which is manifested by hypoproteinemia, hemoconcentration, shock, hepatomegaly, and a bleeding tendency. In spite of the high incidence of this disease in the indigenous Thai and Chinese population, dengue hemorrhagic fever has not been observed in Caucasians of European descent, even though over 200 dengue virus infections have been serologically confirmed in Americans and Europeans living in Bangkok during the past 4 years. These persons, however, had mild undifferentiated febrile illnesses or classical dengue fever, and none of the studied patients exhibited the manifestations of hemorrhagic fever. The apparent lack of susceptibility of Americans or Europeans to dengue shock syndrome suggested theories that genetic or nutritional differences were responsible for the apparent difference in susceptibility. However, no substantial evidence has been presented to support these theories, and recent correlations of clinical, epidemiologic, and serologic observations indicate that the severe form of dengue hemorrhagic fever occurs in persons previously infected by dengue virus. The serologic observations reported on patients with dengue shock syndrome in Singapore also are indicative of previous dengue infections and tend to confirm the observations made in Bangkok. A third theory of the pathogensis of dengue hemorrhagic fever is that dengue virus strains of unusual virulence are the causative agents of the severe manifestations.