Hematodepressive Virus Diseases of Thailand

Abstract

Six hundred and eighty-one (681) patients in Thailand with clinical findings of a hematodepressive viral disease were studied under hospital conditions. Serologic data revealed multiple types of virus infection[long dash]chikungunya, Thai hemorrhagic fever due to dengue Types III to VI (pediatric dengue), and classical dengue due to Types I and II in adults. A 4th group of patients with identical symptomatology (VHD) had no serologic evidence of current dengue or chikungunya infection. Thrombocytopenia was profound in the hemato-depressed patients and was due to early suppression of megakary-ocytopoiesis[long dash]possibly as the primary hematopoietic target. This was particularly so in the adult patients with classical dengue as well as in Thai hemorrhagic fever (pediatric dengue) and VHD. Chikungunya did not cause profound thrombocytopenia although it often caused a mild thrombocytopenia. A composite chronologic order of events was reconstructed from life spans of the platelet and PMN, indicating virus inoculation 8 days ([plus or minus]2) before the acute febrile clinical onset of these hematodepressive diseases. Dengue virus infections are not innocuous in children, the death rate averaging 8%. Abnormal megakaryocytic forms persisted in the marrow for weeks after the peripheral hemato-logic picture had returned to normal. Studies of patients with megakaryocytic and granulocytic mutants in these hematodepressive viral diseases are needed to determine possible predispositions to subsequent, more serious illnesses.