Nguyen Trong Lan, Nguyen
Thanh Hung, Nguyen Bach Hue, Nguyen Thi Khen,
Do Quang Ha, Vu Thi Que Huong, Vicent Deubel, Michel Huerre
Six fatal Dengue shock syndrome patients with fulminant hepatitis
and encephalopathy were observed during a 11-month
period from October 1996 to September 1997 at Children’s Hospital N01,
HoChiMinh city, Vietnam.
Five patients had marked elevation of liver transaminases
(aspartate and alanine aminotransferases); transaminase level measuring in one
case was not done, Histopathologic examination of post-morterm liver specimens revealed findings of acute hepatitis such as
hepatic necrosis, steatosis, appearance of Councilman bodies. Reverse
Transcription Polymerase Chain Reaction (RT-PCR) with blood samples and / or in
situ Polymerase Chain Reaction with liver specimens detected RNAS of serotype
DEN-3 in all 6 cases.
The result showed that liver involvement plays an important
role in the outcome of Dengue shock patients, and fulminant hepatitis in Dengue
hemorrhagic fever has been a real entity in Vietnam
as well as other countries worldwide.
Summary
Dengue viruses were prevalent in Southern Vietnam
in 1998 and 438.98 DHF cases/100,000 population with 342 deaths were recorded.
The number of DHF patients and deaths per 100,000 population have respectively
increased 152.41% and 151.80% compared with those of 1997 DHF outbreak. The
1998 DHF epidemic was the largest one since 1963 up to now. A total of 219
Dengue viruses were isolated from DHF patient sera, in which there were 26
DEN-1, 27 DEN-2, 162 DEN-3 and 4 DEN-4. 65.88% of isolates were recovered from
children under 14 years old. Comparing to 1997 DHF epidemic, the Dengue
serotype variations in 1998 were as follows: DEN-1 decreased from 14.06% to
11.87%. DEN-2 decreased from 42.18% to 12.32%, DEN-3 increased from 42.18% to
73.97% and there was re-emergence of DEN-4 after 5 years of its absence. The
re-emergence of DEN-3 since 1994 has provoked the largest DHF epidemics in
1998. This emerging trend will likely continue, therefore it is a reminder that
active surveillance and effective prevention program must be implemented
without delay in the first trimester of the year.