重症登革热感染的死亡率是 0.8% 到 2.5%。[1]World Health Organization, Regional Office for South-East Asia. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever - revised and expanded edition. 2011 [internet publication].http://apps.searo.who.int/pds_docs/B4751.pdf?ua=1 与成人相比,儿童发生严重感染和死亡的风险较高;然而,关于成人严重感染的报告日益增多。[1]World Health Organization, Regional Office for South-East Asia. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever - revised and expanded edition. 2011 [internet publication].http://apps.searo.who.int/pds_docs/B4751.pdf?ua=1[8]Guzman MG, Kouri G. Dengue and dengue haemorrhagic fever in America: lessons and challenges. J Clin Virol. 2003 May;27(1):1-13.http://www.ncbi.nlm.nih.gov/pubmed/12727523?tool=bestpractice.com[9]Teixeira MG, Barreto M. Diagnosis and management of dengue: clinical review. BMJ. 2009 Nov 18;339:b4338.http://www.ncbi.nlm.nih.gov/pubmed/19923152?tool=bestpractice.com[33]Halstead SB. Dengue. Lancet. 2007 Nov 10;370(9599):1644-52.http://www.ncbi.nlm.nih.gov/pubmed/17993365?tool=bestpractice.com 1至5岁孩子死于登革热感染的危险性是11岁至15岁儿童的四倍。[34]Gamble J, Bethell D, Day NP, et al. Age-related changes in microvascular permeability: a significant factor in the susceptibility of children to shock? Clin Sci [Lond]. 2000 Feb;98(2):211-6.http://www.ncbi.nlm.nih.gov/pubmed/10657278?tool=bestpractice.com 尽管登革出血热 (DHF) 和登革热休克综合征在成年人中不常见,但据报告其并发症发生率和死亡率较高,尤其是在老年人中,这与其器官损伤风险增加有关。[1]World Health Organization, Regional Office for South-East Asia. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever - revised and expanded edition. 2011 [internet publication].http://apps.searo.who.int/pds_docs/B4751.pdf?ua=1[9]Teixeira MG, Barreto M. Diagnosis and management of dengue: clinical review. BMJ. 2009 Nov 18;339:b4338.http://www.ncbi.nlm.nih.gov/pubmed/19923152?tool=bestpractice.com[35]Kularatne SA, Patirage MM, Pathirage PV, et al. Cardiac complication of a dengue fever outbreak of Sri Lanka, 2005. Trans R Soc Trop Med Hyg. 2007 Aug;101(8):804-8.http://www.ncbi.nlm.nih.gov/pubmed/17428513?tool=bestpractice.com[36]Kularatne SA, Pathirage MM, Gunasena S. A case series of dengue fever with altered consciousness and electroencephalogram changes in Sri Lanka. Trans R Soc Trop Med Hyg. 2008 Oct;102(10):1053-4.http://www.ncbi.nlm.nih.gov/pubmed/18617208?tool=bestpractice.com[37]Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health. 2007 Sep;12(9):1087-95.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2007.01891.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17875019?tool=bestpractice.com
根据一项 Meta 分析,止血带试验阳性、腹水和休克分别为登革热感染、登革出血热 (DHF) 和死亡的最佳预测指标。[13]Guo C, Zhou Z, Wen Z, et al. Global epidemiology of dengue outbreaks in 1990-2015: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2017 Jul 12;7:317.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506197/http://www.ncbi.nlm.nih.gov/pubmed/28748176?tool=bestpractice.com
长期后遗症
一旦患者恢复,就不会发生与登革热感染相关的长期后遗症;然而,部分患者可能在康复后发生病毒感染后疲劳综合征。恢复期患者的血小板计数逐渐增加;然而,部分患者可在恢复期间发生暂时性血小板增多。肝功能完全正常可能需要长达 3 周或 4 周时间。
复发
复发可能与不同的登革热病毒血清型有关,导致继发感染登革热。 第三次和第四次的复发也可能发生,但临床上的影响还不是很清楚。 一旦诱导出所有4个血清型的免疫,将获得针对各血清型的终身免疫。