BACKGROUND: Dengue, although endemic in Puerto Rico, is often not mentioned in the death certificates of decedents with laboratory results positive for @entity779 . Because confirmatory results are usually not available during hospitalization, we examined the utility of 2 instruments for diagnosis on the basis of clinical findings: the definition of @entity7643 ( @entity7643 ) and the publicized (but unevaluated) clinical alarm signals for impending @entity7643 . METHODS: We studied data from all @entity1 with laboratory test results positive for @entity779 who died (23 @entity1 ) and from the 8 @entity1 whose death certificates listed @entity779 as a cause of death but whose laboratory test results were negative for @entity779 in Puerto Rico from 1992 through 1996. We examined hospital records to determine whether the clinical criteria for @entity7643 were fulfilled and evaluated the incidence and timing of clinical alarm signals (intense, sustained @entity490 ; persistent @entity391 ; sudden change from fever to @entity2332 ; and marked @entity7621 ) and the hematocrit/hemoglobin ratio as an indicator of hemoconcentration. RESULTS: A similar proportion of @entity1 with laboratory test results positive for @entity779 (18 [78%] of 23) and negative for @entity779 (6 [75%] of 8) fulfilled the criteria for @entity7643 . Clinical alarm signals were found only among @entity1 with laboratory test results positive for @entity779 and were usually noted on the day that the @entity1 's condition deteriorated. The hematocrit/hemoglobin ratio identified 1 (6%) of 16 @entity1 with @entity779 who had significant hemoconcentration. Important comorbidities were present in 16 (70%) of the @entity1 with laboratory test results positive for @entity779 and in 4 (50%) of the @entity1 with @entity204 with laboratory test results negative for @entity779 . CONCLUSIONS: @entity204 in Puerto Rico often occur in @entity1 with comorbidities. Among such @entity1 , the @entity7643 definition and the hematocrit/hemoglobin ratio were not useful in identifying @entity1 with laboratory test results positive for @entity779 . In contrast, the clinical alarm signals for shock supported the @entity779 diagnosis and should alert clinicians to the severity of the disease.

XXXX in Puerto Rico, 1992-1996: diagnosis and clinical alarm signals.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting'] @entity7621 :: ('MESH:D053609', 'Disease') :: ['restlessness or lethargy'] @entity490 :: ('MESH:D015746', 'Disease') :: ['abdominal pain'] @entity7643 :: ('MESH:D019595', 'Disease') :: ['dengue hemorrhagic fever', 'DHF', 'dengue shock'] @entity779 :: ('MESH:D003715', 'Disease') :: ['dengue'] @entity204 :: ('MESH:D003643', 'Disease') :: ['dengue-related deaths', 'Dengue-related deaths'] @entity2332 :: ('MESH:D007035', 'Disease') :: ['hypothermia']
@entity204 :: (MESH:D003643,Disease) :: ['Dengue-related deaths']
