Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of a steadily increasing yearly trend. The largest outbreak was seen in 1996, with 14,255 dengue cases reported and 32 deaths. The case-fatality rate varied from a high of 10.43% in 1985, when dengue serotype 3 was the predominant type, to a low of 1.29% when dengue serotype 1 predominated. Severe disease patterns have been observed with dengue serotypes 2 and 3 in the country.
The clinical spectrum has also been changing, and multisystem involvement with more severe manifestations has been observed. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye’s syndrome. Dengue serotype 3 has been isolated from liver biopsy specimens. Neurological manifestations can vary from irritability, convulsions and coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluid has recently provided strong evidence that dengue viruses can be neurovirulent. Acute respiratory distress syndrome (ARDS) was seen in three children admitted with shock. Deaths were more frequent in children in the early period, but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.
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The author(s) declare there are no affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript.
