{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:30:29Z","timestamp":1791052229116,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2004,10,13]],"date-time":"2004-10-13T00:00:00Z","timestamp":1097625600000},"content-version":"vor","delay-in-days":42,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2004,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objectives\u2002<\/jats:bold> Dengue haemorrhagic fever (DHF) is an important cause of morbidity in South\u2010east Asia and used to occur almost exclusively in young children. In recent years, there has been a progressive shift in age\u2010distribution towards older children and adults. We investigated an outbreak in 2001 in both children and adults, in an endemic area of Thailand.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Retrospective study of 347 patients with serologically confirmed dengue infection admitted to Chonburi Hospital during an epidemic in 2001.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> A total of 128 (37%) patients had dengue fever (DF) and 219 (63%) had DHF. Patients with DHF were significantly older than patients with DF (11\u2003years <jats:italic>vs.<\/jats:italic> 8\u2003years). Clinical bleeding was noted in 124 individuals, both with DF (<jats:italic>n<\/jats:italic>\u2003=\u200324) and DHF (<jats:italic>n<\/jats:italic>\u2003=\u2003100), and significantly more frequently in adults. Twenty\u2010nine (13.2%) of all DHF cases were caused by primary infection. Secondary dengue infection was associated significantly with the development of DHF in children, OR (95% CI)\u2003=\u20033.63 (1.94\u20136.82), <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.0001, but not in adults, OR (95% CI)\u2003=\u20030.6 (0.02\u20136.04), <jats:italic>P<\/jats:italic>\u2003=\u20031. Unusual clinical manifestations were observed in 23 patients: three presented with encephalopathy and 20 with highly elevated liver\u2010enzymes. In the latter group, four patients were icteric and nine had gastrointestinal bleeding.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> These results indicate that DHF in South\u2010east Asia is common in both children and adults. In dengue\u2010endemic countries, dengue should be considered as a differential diagnosis in patients with clinical gastrointestinal bleeding in association with increased liver enzymes.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2004.01295.x","type":"journal-article","created":{"date-parts":[[2004,10,13]],"date-time":"2004-10-13T13:18:32Z","timestamp":1097673512000},"page":"1022-1029","source":"Crossref","is-referenced-by-count":157,"title":["Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand"],"prefix":"10.1111","volume":"9","author":[{"given":"Ole","family":"Wichmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchat","family":"Hongsiriwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chureeratana","family":"Bowonwatanuwong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesinee","family":"Chotivanich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoawalark","family":"Sukthana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasithon","family":"Pukrittayakamee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,10,13]]},"reference":[{"key":"e_1_2_18_2_1","first-page":"595","article-title":"Fatal 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