Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths.

The present study reviewed the clinical features of ten fatal cases of DHF/DSS seen at UMMC, a major teaching and referral hospital, during the period when Malaysia experienced dramatic increase in dengue cases. The dengue deaths were seen primarily in adult females and were associated with secondary dengue infection. Majority of the patients presented with common clinical and laboratory warning signs of severe dengue before death. Underlying co-morbidities may be the contributing factors towards the rapid deterioration in severe dengue. Other complications included involvement of other organs including the brain, heart, liver and kidneys. This is reflective of the shift in the demographics of dengue cases in Malaysia where more adults are affected.

The study was approved by the University Malaya Medical Center (UMMC) Medical Ethics Committee (ethics committee/IRB reference number: 611.10). Informed consents were not obtained from the patients as this was a retrospective study.

The medical records of ten patients at UMMC with dengue-related deaths during the period from June 2006–October 2007 were reviewed and notes were transcribed into standardized data entry forms. Disease severity was classified following the WHO 1997 guideline [2]. This was done as the clinical notes were all in accordance to the WHO 1997 guidelines.

In conclusion, our study demonstrates a case series of severe dengue leading to death seen primarily in adult females with secondary dengue infection in Malaysia. The possible contributing role of underlying co-morbidities commonly seen in adults especially diabetes mellitus is highlighted. While most patients with fatal outcomes presented with common clinical and laboratory warning signs of severe dengue seen in all ages, the manifestation of uncommon clinical presentations of dengue is most likely a reflection of a change in the demographic pattern of the population being infected with dengue.

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Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number...