(RS20) A Multi-Centre Hospital-Based Cohort Study Describing Occurrence of Febrile Severe Dengue

Introduction: Existing literature describes severe dengue manifests in the critical phase of dengue fever, and defervescence - the subsidence of fever to a temperature below 38°Celsius - delineates the beginning of this phase. It has been suggested that patients could develop severe dengue prior to defervescence. Thus, we hypothesised that severe dengue occurs in the febrile phase and conducted a study to describe this phenomenon. Results: The cohort of 786 severe dengue cases comprised 586 (74.7%) patients with febrile severe dengue and 199 (25.3%) with severe dengue during the critical phase. In patients with febrile severe dengue, the median (IQR) time of severe dengue onset was 3.8 (2.05) days and the median (IQR) time of defervescence was 5.31 (2.0) days. These times were reversed in patients with severe dengue in the critical phase, 4.57 (1.96) days and 4.02 (1.67) days, respectively. The proportions of patients in the febrile phase for each manifestation of severe dengue were 74.6% for decompensated shock, 77.3% compensated shock, 61% respiratory compromise, 47.5% severe bleeding, 80.3% acute kidney injury, 80% encephalopathy and 65.1% carditis. Discussion/Conclusion: Appreciation that severe dengue may manifest in the febrile phase provides clarity in the clinical management of patients