Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

Dengue is a neglected tropical disease that is increasingly affecting elderly patients; however, there is a paucity of data on clinical presentation and outcomes in this group. The limited data suggests that elderly dengue patients have the highest case-fatality rate but the pathogenesis of mortality in elderly dengue patients remains unclear. To better understand dengue fever in the elderly we compared clinical features, WHO dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients and explored the impact of co-morbidity and HAI on clinical outcomes in the elderly. We found that diagnosis in the elderly may be challenging due to atypical presentation. Elderly patients have worse outcomes compared with their younger counterparts with increased rates of DHF and SD. Elderly patients have higher rates of HAI placing them at risk of infection-related mortality. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay. This will place further burden on already stretched hospital systems.