{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:36:01Z","timestamp":1790184961610,"version":"4.1.0"},"reference-count":120,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Dengue is a viral disease with a broad spectrum of clinical manifestations. Its severity is associated with risk factors such as periods of endemicity, although the extent of this contribution is unclear. In the present study, the characteristics of the clinical course and differences in the occurrence of severe and lethal outcomes were assessed by the degree of endemicity in patients with dengue treated in health institutions in Cali, Colombia, between 2019 and 2022. A longitudinal, observational-historical, single-cohort study was conducted. Analysis involved evaluating clinical complications during epidemic and endemic periods. Mortality, cumulative incidence of hospital or intensive care unit (ICU) admission, and survival time were estimated using the competing risks method. A total of 1,038 dengue cases were included. Patients with severe dengue and those with warning signs (WS) were consulted up to 6 or 5 days after symptom onset, respectively. A hospital stay of 2.0 days (Quartile [Q]1\u2013Q3: 2\u20134 days) and an ICU stay of 4.5 days (SD \u00b1 3.9 days) were estimated. A mortality rate of 5.5% was obtained for severe dengue, and a mortality rate of 0.4% was identified for patients with WS. In 2020 and 2021, the probability of hospitalization was 20% from initial contact. The likelihood of dying within 10 days after initial contact was 0% in 2019 and 11.2% (95% CI: 4.0\u201322.5%) in 2020. The incidence of hospitalization, number of hospital days, and ICU stays due to dengue varied by epidemiological year in a high-endemicity area. The probability of severe and lethal clinical outcomes was higher during 2020 and 2021.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0158","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:41:26Z","timestamp":1772131286000},"page":"724-737","source":"Crossref","is-referenced-by-count":1,"title":["Dengue\u2019s Clinical Course in One of Colombia\u2019s Most Endemic Areas: Impact of Endemic and Epidemic Periods"],"prefix":"10.4269","volume":"114","author":[{"given":"Gisel Viviana","family":"Osorio-Cu\u00e9llar","sequence":"first","affiliation":[{"name":"Research Center, Cl\u00ednica Imbanaco, Cali, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Quintero","sequence":"additional","affiliation":[{"name":"Population Health, Fundaci\u00f3n Santa Fe de Bogot\u00e1, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro Andres","family":"Gaitan","sequence":"additional","affiliation":[{"name":"Takeda Colombia, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Torres-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Universidad del Bosque, Bogot\u00e1, Colombia;"},{"name":"Cafettor M\u00e9dica S.A.S, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcela","family":"Daza","sequence":"additional","affiliation":[{"name":"Takeda Colombia, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Clemen","sequence":"additional","affiliation":[{"name":"Hospital Universitario Evaristo Garc\u00eda E.S.E, Cali, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz Elena","family":"Mu\u00f1oz Garz\u00f3n","sequence":"additional","affiliation":[{"name":"Red de Salud Ladera E.S.E, Cali, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"O\u00f1ate","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Imbanaco, Cali, Colombia;"},{"name":"Cl\u00ednica de Occidente, Cali, Colombia;"},{"name":"Cl\u00ednica Sebasti\u00e1n de Belalc\u00e1zar, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Bernal-Sanchez","sequence":"additional","affiliation":[{"name":"Takeda Colombia, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn","family":"Ca\u00f1\u00f3n Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Research Center, Cl\u00ednica Imbanaco, Cali, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Cienc e Innovaci\u00f3n en Salud","first-page":"1","article-title":"Adherencia de los pacientes a la Gu\u00eda de Pr\u00e1ctica Cl\u00ednica del Dengue (GPC_Dengue) en una Cl\u00ednica de Barranquilla (Atl, Col)","volume":"3","author":"Rodr","year":"2015"},{"key":"b2","series-title":"biomedica","first-page":"61","article-title":"Manifestaciones cl\u00ednicas inusuales del dengue hemorr\u00e1gico en ni\u00f1os","volume":"26","author":"M\u00e9ndez","year":"2006"},{"key":"b3","series-title":"Glob Heal J","first-page":"37","article-title":"Dengue epidemiology","volume":"3","author":"Jing","year":"2019"},{"key":"b4","article-title":"Protocolo Vigilancia En Salud P\u00fablica Dengue C\u00f3digo: 210 \u2013 220 \u2013 580.","year":"2024"},{"key":"b5","series-title":"Lancet Infect Dis","first-page":"e88","article-title":"Dengue: Knowledge gaps, unmet needs, and research priorities","volume":"17","author":"Katzelnick","year":"2017"},{"key":"b6","article-title":"Disease Outbreak News: Dengue \u2013 Global Situation.","year":"2024"},{"key":"b7","series-title":"Int J Parasitol","first-page":"597","article-title":"Neglected tropical diseases in Central America and Panama: Review of their prevalence, populations at risk and impact on regional development","volume":"44","author":"Hotez","year":"2014"},{"key":"b8","series-title":"Med Interna M\u00e9xico","first-page":"287","article-title":"Tendencias epidemiol\u00f3gicas del dengue en Latinoam\u00e9rica: 2019\u20132024","volume":"40","author":"Alfaro","year":"2024"},{"key":"b9","article-title":"PLISA Health Information Platform for the Americas.","year":"2025"},{"key":"b10","article-title":"Informe de La Situaci\u00f3n Epidemiol\u00f3gica Del Dengue En Las Am\u00e9ricas.","year":"2025"},{"key":"b11","article-title":"Bolet\u00edn Epidemiol\u00f3gico Semanal - Semana Epidemiol\u00f3gica 52 de 2023.","year":"2023"},{"key":"b12","article-title":"Eventos de Inter\u00e9s en Salud P\u00fablica Santiago de Cali, 2021.","author":"Torres Agredo","year":"2021"},{"key":"b13","series-title":"Lancet Infect Dis","first-page":"e42","article-title":"Knowledge gaps in the epidemiology of severe dengue impede vaccine evaluation","volume":"22","author":"Sharp","year":"2022"},{"key":"b14","series-title":"Rev Peru Epidemiol","first-page":"17","article-title":"Factors associated to severe dengue during the dengue epidemic in Iquitos, 2010\u20132011","volume":"15","author":"Arrasco","year":"2011"},{"key":"b15","series-title":"Curr Probl Cardiol","first-page":"102346","article-title":"Association of cardiovascular disease with severe dengue: A systematic review and meta-analysis","volume":"49","author":"Padhi","year":"2024"},{"key":"b16","series-title":"Cureus","first-page":"e60655","article-title":"Lung manifestation of dengue fever: A retrospective study","volume":"16","author":"Keshav","year":"2024"},{"key":"b17","series-title":"Brain","first-page":"830","article-title":"Dengue virus infection and neurological manifestations: An update","volume":"147","author":"Fong","year":"2024"},{"key":"b18","series-title":"Bol Oficina Sanit Panam","first-page":"102","article-title":"Dengue en Nicaragua, 1994 reintroducci\u00f3n del serotipo 3 en las Am\u00e9ricas","volume":"121","author":"Guzm\u00e1n","year":"1996"},{"key":"b19","article-title":"Identificaci\u00f3n y An\u00e1lisis de las Variantes Gen\u00f3micas del Virus del Dengue y Su Asociaci\u00f3n con la Presentaci\u00f3n Cl\u00ednica en una Zona de Baja y Otra de Alta Endemicidad en M\u00e9xico.","author":"Gal\u00e1n-Huerta","year":"2013"},{"key":"b20","series-title":"Rev Nac","first-page":"17","article-title":"Mortalidad en pacientes con dengue en la epidemia 2012\u20132013","volume":"7","author":"Aldama-Negrete","year":"2015"},{"key":"b21","series-title":"Sci Transl Med","first-page":"eadi1734","article-title":"Effects of boosting and waning in highly exposed populations on dengue epidemic dynamics","volume":"15","author":"Aogo","year":"2023"},{"key":"b22","series-title":"Rev Ciencias Biom\u00e9dicas","first-page":"212","article-title":"Caracterizaci\u00f3n de dengue y dengue severo en adultos hospitalizados en una instituci\u00f3n de Cartagena-Colombia","volume":"7","author":"Vergara-Verbel","year":"2016"},{"key":"b23","series-title":"Pediatria (Asuncion)","first-page":"92","article-title":"Dengue, una historia inacaba","volume":"48","author":"De Cuellar","year":"2021"},{"key":"b24","series-title":"Trans R Soc Trop Med Hyg","first-page":"730","article-title":"Neglecting the effect of COVID-19 on neglected tropical diseases: The Ethiopian perspective","volume":"114","author":"Abdela","year":"2020"},{"key":"b25","series-title":"Muestreo Estad\u00edstico: M\u00e9todos B\u00e1sicos","author":"Klinger Angarita","year":"2011"},{"key":"b26","series-title":"Sci Rep","first-page":"5979","article-title":"On evaluation metrics for medical applications of artificial intelligence","volume":"12","author":"Hicks","year":"2022"},{"key":"b27","series-title":"Rev Espa\u00f1ola Cardiol","first-page":"599","article-title":"An\u00e1lisis de riesgos competitivos","volume":"64","author":"Pintilie","year":"2011"},{"key":"b28","series-title":"Acta Trop","first-page":"105134","article-title":"Unusual clinical manifestations of dengue disease\u2013Real or imagined?","volume":"199","author":"Estofolete","year":"2019"},{"key":"b29","series-title":"J Trop Pediatr","first-page":"fmab006","article-title":"Does malaria co-infection alter the clinical course in children infected with dengue? Analysis from 623 Indian children admitted with dengue infection","volume":"67","author":"Bhakhri","year":"2021"},{"key":"b30","series-title":"biomedica","first-page":"133","article-title":"Caracterizaci\u00f3n cl\u00ednica de pacientes que consultaron por dengue en un hospital de tercer nivel en Cali, Colombia, 2013","volume":"36","author":"Matta","year":"2016"},{"key":"b31","series-title":"Rev Cubana Pediatr","first-page":"1","article-title":"Descripci\u00f3n cl\u00ednica de ni\u00f1os fallecidos por dengue hemorr\u00e1gico durante la epidemia cubana de 1981","volume":"94","author":"Pereda","year":"2022"},{"key":"b32","series-title":"Horiz M\u00e9dico","first-page":"e2389","article-title":"Caso de dengue grave en un ni\u00f1o de 5 a\u00f1os de la ciudad de Lima","volume":"24","author":"Morales","year":"2024"},{"key":"b33","series-title":"PLoS Negl Trop Dis","first-page":"e0010297","article-title":"A retrospective study on the socio-demographic factors and clinical parameters of dengue disease and their effects on the clinical course and recovery of the patients in a tertiary care hospital of Bangladesh","volume":"16","author":"Prattay","year":"2022"},{"key":"b34","series-title":"Int J Microbiol","first-page":"6658445","article-title":"Correlation of clinical severity and laboratory parameters with various serotypes in dengue virus: A hospital-based study","volume":"2020","author":"Rao","year":"2020"},{"key":"b35","series-title":"J Trop Med","first-page":"8842799","article-title":"Effect of prior symptomatic dengue infection on dengue haemorrhagic fever (DHF) in children","volume":"2021","author":"Ranawaka","year":"2021"},{"key":"b36","series-title":"Bioessays","first-page":"791","article-title":"X-chromosome-located microRNAs in immunity: Might they explain male\/female differences? The X chromosome-genomic context may affect X-located miRNAs and downstream signaling, thereby contributing to the enhanced immune response of females","volume":"33","author":"Pinheiro","year":"2011"},{"key":"b37","series-title":"West Pac Surveill Response J","first-page":"17","article-title":"Male\u2013female differences in the number of reported incident dengue fever cases in six Asian countries","volume":"2","author":"Anker","year":"2011"},{"key":"b38","series-title":"Nat Commun","first-page":"3286","article-title":"Immune resilience despite inflammatory stress promotes longevity and favorable health outcomes including resistance to infection","volume":"14","author":"Ahuja","year":"2023"},{"key":"b39","series-title":"Trop Med Int Health","first-page":"173","article-title":"Risk factors associated with severe dengue in Latin America: A systematic review and meta\u2010analysis","volume":"29","author":"Paran\u00e1","year":"2024"},{"key":"b40","series-title":"Nephrology (Carlton)","first-page":"564","article-title":"Clinical course of dengue fever and its impact on renal function in renal transplant recipients and patients with chronic kidney disease","volume":"24","author":"Thomas","year":"2019"},{"key":"b41","series-title":"BMC Infect Dis","first-page":"681","article-title":"Heart and liver are infected in fatal cases of dengue: Three PCR based case studies","volume":"18","author":"Kularatne","year":"2018"},{"key":"b42","series-title":"Trop Dis Travel Med Vaccines","first-page":"12","article-title":"Dynamics of dengue and SARS-CoV-2 co-infection in an endemic area of Colombia","volume":"8","author":"Acosta-P\u00e9rez","year":"2022"},{"key":"b43","series-title":"Front Immunol","first-page":"941923","article-title":"Antibodies against the SARS-CoV-2 S1-RBD cross-react with dengue virus and hinder dengue pathogenesis","volume":"13","author":"Cheng","year":"2022"},{"key":"b44","article-title":"Informe Epidemiol\u00f3gico Anual de Eventos de Inter\u00e9s En Salud P\u00fablica Cali - A\u00f1o 2022.","year":"2022"},{"key":"b45","article-title":"Informe Epidemi\u00f3logico Anual de Eventos de Inter\u00e9s En Salud P\u00fablica Cali - A\u00f1o 2021.","year":"2021"},{"key":"b46","article-title":"Informe Epidemiol\u00f3gico Anual de Eventos de Inter\u00e9s En Salud P\u00fablica Cali - A\u00f1o 2020.","year":"2020"},{"key":"b47","series-title":"Vector Borne Zoonotic Dis","first-page":"549","article-title":"Admission clinicopathological factors associated with prolonged hospital stay among hospitalized patients with dengue viral infections","volume":"19","author":"Willeam Peter","year":"2019"},{"key":"b48","series-title":"Interdiscip Perspect Infect Dis","first-page":"4823791","article-title":"Predictors of major bleeding and mortality in dengue infection: A retrospective observational study in a tertiary care centre in South India","volume":"2019","author":"John","year":"2019"},{"key":"b49","series-title":"Drug Discov Ther","first-page":"313","article-title":"Leucocytosis and early organ involvement as risk factors of mortality in adults with dengue fever","volume":"14","author":"Baitha","year":"2021"},{"key":"b50","series-title":"BMC Infect Dis","first-page":"729","article-title":"Clinical features and outcomes of COVID-19 and dengue co-infection: A systematic review","volume":"21","author":"Tsheten","year":"2021"},{"key":"b51","series-title":"New Microbes New Infect","first-page":"101041","article-title":"COVID-19 and dengue coinfection in Latin America: A systematic review","volume":"49","author":"Le\u00f3n-Figueroa","year":"2022"},{"key":"b52","series-title":"Med Virol","first-page":"e2339","article-title":"Does dengue and COVID\u201019 co\u2010infection have worse outcomes? 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