Published: 2019-05-24

Effect of co morbidities on the clinical outcome of Dengue fever

Dhivya P., Nagesh G. N., Jayaramachandran S.


Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).

Methods: A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.

Results: Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.

Conclusions: Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.


Comorbidities, Dengue fever, Dengue haemorrhagic fever, Diabetes mellitus, Dengue shock syndrome, Hypertension

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Gubler DJ. The global emergence/resurgence of arboviral diseases as public health problems. Arch Med Res. 2002 Aug;33(4):330-42.

Chaudhuri M. What can India do about dengue fever? BMJ. 2013 Feb 4;346:f643.

Malavige G, Fernando S, Fernando D, Seneviratne S. Dengue viral infections. Postgrad Med J. 2004 Oct;80(948):588-601.

Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013 Apr 25;496(7446):504-7.

Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Res. 2012 Sep 1;136(3):373-90.

Bhattacharya S. Why is dengue such an important public health problem in India? J Acad Clin Microbiol. 2018 Jan 1;20(1):3-4.

Castro MC, Wilson ME, Bloom DE. Disease and economic burdens of dengue. Lancet Infect Dis. 2017 Mar;17(3):e70-8.

Dunachie S, Chamnan P. The double burden of diabetes and global infection in low and middle-income countries. Trans R Soc Trop Med Hyg. 2019 Feb 1;113(2):56-64.

Htun NSN, Odermatt P, Eze IC, Boillat-Blanco N, D’Acremont V, Probst-Hensch N. Is Diabetes a Risk Factor for a Severe Clinical Presentation of Dengue? - Review and Meta-analysis. PLoS Negl Trop Dis. 2015 Apr 24;9(4):e0003741.

World Health Organization, editor. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Rev. and expanded. ed. New Delhi, India: World Health Organization Regional Office for South-East Asia; 2011:196. (SEARO Technical publication series).

Special Programme for Research and Training in Tropical Diseases, World Health Organization, editors. Dengue: guidelines for diagnosis, treatment, prevention, and control. New ed. Geneva: TDR : World Health Organization; 2009:147.

Pang J, Hsu JP, Yeo TW, Leo YS, Lye DC. Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study. Sci Rep. 2017 Jan 3;7:39872.

Agrawal VK, Prusty SK, Reddy CS, Krishna Mohan Reddy G, Agrawal RK, et al. Clinical profile and predictors of Severe Dengue disease : A study from South India. Casp J Intern Med [Internet]. 2018 Sep;9(4). (cited 2019 Apr 23).

Kalra S, Aggarwal S, Khandelwal D, Dutta D. Management of Glycemia in Acute Febrile Illness. Indian J Endocrinol Metab. 2017;21(3):460-3.

Lee IK, Hsieh CJ, Lee CT, Liu JW. Diabetic patients suffering dengue are at risk for development of dengue shock syndrome/severe dengue: Emphasizing the impacts of co-existing comorbidity(ies) and glycemic control on dengue severity. J Microbiol Immunol Infect [Internet]. 2018 Jan 31;pii:S1684-1182(18)30006-9. (cited 2019 Apr 23).

Werneck GL, Macias AE, Mascarenas C, Coudeville L, Morley D, Recamier V, et al. Comorbidities increase in-hospital mortality in dengue patients in Brazil. Mem Inst Oswaldo Cruz [Internet]. 2018;113(8). (cited 2019 Apr 23).

Chen C-Y, Lee M-Y, Lin K-D, Hsu W-H, Lee Y-J, Hsiao P-J, et al. Diabetes Mellitus Increases Severity of Thrombocytopenia in Dengue-Infected Patients. Int J Mol Sci. 2015 Feb;16(2):3820-30.

Pang J, Thein TL, Leo YS, Lye DC. Early clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore: a matched case-control study. BMC Infect Dis. 2014 Dec 5;14(1):649.

Badawi A, Velummailum R, Ryoo SG, Senthinathan A, Yaghoubi S, Vasileva D, et al. Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis. PLoS ONE [Internet]. 2018 Jul 10;13(7). (cited 2019 Apr 23).

Thein TL, Leo YS, Fisher DA, Low JG, Oh HML, Gan VC, et al. Risk Factors for Fatality among Confirmed Adult Dengue Inpatients in Singapore: A Matched Case-Control Study. PLoS ONE. 2013 Nov 22;8(11):e81060.

Kaur H, Kaur H, Kaur N, Kaur K. Study of nutritional status, comorbidities and other risk factors associated with dengue fever: data from a tertiary hospital in North India. Int J Adv Med. 2017 Jan 23;4(1):82-7.

Mahmood S, Hafeez S, Nabeel H, Zahra U, Nazeer H. Does Comorbidity Increase the Risk of Dengue Hemorrhagic Fever and Dengue Shock Syndrome? [Internet]. ISRN Trop Med. 2013;2013:5. (cited 2019 Apr 23).

Pang J, Salim A, Lee VJ, Hibberd ML, Chia KS, Leo YS, et al. Diabetes with Hypertension as Risk Factors for Adult Dengue Hemorrhagic Fever in a Predominantly Dengue Serotype 2 Epidemic: A Case Control Study. PLoS Negl Trop Dis [Internet].

May 1;6(5):e1641. (cited 2019 Apr 23).

Chaturvedi UC, Agarwal R, Elbishbishi EA, Mustafa AS. Cytokine cascade in dengue hemorrhagic fever: implications for pathogenesis. FEMS Immunol Med Microbiol. 2000 Jul 1;28(3):183-8.

Geerlings SE, Hoepelman AIM. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999 Dec 1;26(3-4):259-65.

Liu JW, Lee IK, Wang L, Chen RF, Yang KD. The Usefulness of Clinical-Practice-Based Laboratory Data in Facilitating the Diagnosis of Dengue Illness [Internet]. Biomed Res Int. 2013;2013:198797. (cited 2019 Apr 28).

Priyadarshini D, Gadia RR, Tripathy A, Gurukumar KR, Bhagat A, Patwardhan S, et al. Clinical findings and pro-inflammatory cytokines in dengue patients in Western India: a facility-based study. PLoS One. 2010 Jan 14;5(1):e8709. (cited 2019 Apr 28).

Mehta P, Hotez PJ. NTD and NCD Co-morbidities: The Example of Dengue Fever. Guzman MG, editor. PLoS Negl Trop Dis. 2016 Aug 25;10(8):e0004619.

Teixeira MG, Paixão ES, Costa M da CN, Cunha RV, Pamplona L, Dias JP, et al. Arterial Hypertension and Skin Allergy Are Risk Factors for Progression from Dengue to Dengue Hemorrhagic Fever: A Case Control Study. PLoS Negl Trop Dis [Internet]. 2015 May 21;9(5):e0003812..

Lee IK, Liu JW, Yang KD. Fatal Dengue Hemorrhagic Fever in Adults: Emphasizing the Evolutionary Pre-fatal Clinical and Laboratory Manifestations. PLoS Negl Trop Dis. 2012 Feb 21;6(2):e1532.

Sam SS, Omar SF, Teoh BT, Abd-Jamil J, AbuBakar S. Review of Dengue hemorrhagic fever fatal cases seen among adults: a retrospective study. PLoS Negl Trop Dis. 2013;7(5):e2194. (cited 2019 Apr 28).