Per vaginal bleeding-an important but ignored feature of dengue

BackgroundElderly individuals, those with comorbidities and pregnant women are at a higher risk of developing severe dengue and succumbing to their illness. However, an increased incidence of severe dengue and fatalities are seen in females of the reproductive age. As per vaginal (PV) bleeding is an important complication that has not been well characterized, we sought to determine the frequency, complications and disease outcomes in women who develop PV bleeding. Methodology/Principal findings288 adult female patients were recruited from the National Institute of Infectious Diseases Sri Lanka. All clinical features and laboratory investigations were recorded throughout the duration of hospital admission along with treatment received. 28/288 (9.72%) reported PV bleeding, with 12/28 (42.85%) developing dengue haemorrhagic fever (DHF) compared to 65/260 (25%) of those who did not have bleeding. Women who developed PV bleeding were more likely to have developed DHF (OR 2.2, 95% CI 0.98 to 5.1, p=0.06), abdominal pain (OR=2.17, 95% CI = 0.99 to 4.69, p = 0.06), vomiting (OR= 2.0, 95% CI= 0.89 to 4.44, p= 0.10), diarhoea (OR= 4.35, 95% CI = 1.908 to 9.610, p= 0.0004) or evidence of any fluid leakage (OR= 1.98, 95% CI = 0.91 to 4.5, p = 0.11). Although not significant, those who had PV bleeding were more likely to have been given intravenous fluids, blood transfusions and colloids. ConclusionsPV bleeding appears to associate with worse disease outcomes. The possible contribution of PV bleeding to higher incidence of severe dengue and fatality rates observed in many countries, should be further investigated. Author summaryElderly individuals, those with comorbidities and pregnant women are at a higher risk of developing severe dengue and succumbing to their illness. However, an increased incidence of severe dengue and fatalities are seen in females of the reproductive age. As per vaginal (PV) bleeding is an important complication that has not been well characterized, we investigated the complications and disease outcomes in women who developed PV bleeding, by studying clinical and laboratory characteristics of 288 women with acute dengue. 28 (9.72%) reported PV bleeding, with 42.85% developing dengue haemorrhagic fever (DHF). Women who developed PV bleeding were more likely to have developed DHF, abdominal pain, vomiting, diarhoea or evidence of any fluid leakage. They were more likely to have been given intravenous fluids, blood transfusions and colloids. Therefore, the possible contribution of PV bleeding to higher incidence of severe dengue and fatality rates in many countries should be further investigated.