Clinical spectrum of dengue at a tertiary care hospital in Eastern India
Keywords:Dengue hemorrhagic fever, Dengue shock syndrome, NS1 Antigen, Petechie, Platelet Count
Background: Dengue is a vector borne disease by four different serotypes of dengue virus transmitted by bite of female Aedes mosquito. It is an acute febrile illness characterised by myalgia, joint pain, gastrointestinal manifestations. Complications like dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) , Extended Dengue Syndrome(EDS) may be fatal for patients. Authors analyse different clinical spectrum of of manifestations, complications and correlation bleeding to platelet level.
Methods: This study conducted from July 2017 to December 2018 comprising of 100 dengue patients of age more than 15 years in IMS & SUM Hospital.
Result: Out of 100 dengue patients’ males 73% and females 27%. From the patients 57% were NS1 Antigen positive, 29% IgM positive, 9% NS1 and IgM positive, 4% IgM and IgG positive and 2 % with all NS1, IgM, IgG positive. In our series in clinical manifestations, all cases (100%) presented with fever, myalgia (78%), headache (53%), rashes (14%), nausea, pain abdomen (21%) loose motion (17%), and Retro-orbital pain (6%). Bleeding manifestations in any form was seen in 39% cases like Purpura or Petechie (23%), malena (18%), hematemesis ( 2% ), epixtasis (6%), Gum bleeding (2%), Hematuria (1%), and Ophthalmic bleeding like sub conjunctival hemorrhage, intra-vitreal hemorrhage in 8% cases. Complications detected e.g. hepatopathy in 53%, nephropathy. 4%, ascites 8%, pneumonia 7%, DSS (4%), Multi Organ Dysfunction (MODS) (4%), DHF (8%) and EDS in 2% cases. It was observed that 95.8% of patients with platelet counts between 20,000-50,000/cu.mm and 61% of patients less than 25000 had bleeding manifestations.
Conclusion: Wide clinical spectrum of manifestations and complications makes it common differential diagnosis of acute febrile illnesses and bleeding manifestation does not always corelate with lower platelet count.
Halstead SB. Pathogenesis of dengue: challenges to molecular biology. Science. 1988 Jan 29;239(4839):476-81.
Kurane I. Dengue hemorrhagic fever with special emphasis on immunopathogenesis. Comp Immunol Microbiol Infect Dis. 2007;30(5-6):329-40.
Gubler DJ. Dengue and dengue Hemorrhagic fever. Clin Microbiol Rev. 1998;11(3):480-96.
World Health Organization Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. New Edition, World Health Organization, Geneva, Switzerland. - References – Scientific Research Publishing.Scirp.org. 2019. Available at: https://www.scirp.org/reference/ReferencesPapers.aspx?ReferenceID=1125148.
Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. Dengue: A continuing global threat. Nat Rev Microbiol. 2010;8(12):S7-16.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature 2013;496(7446):504-7.
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 2012;6(8):e1760.
Sharma S, Sharma SK, Mohan A, Wadhwa J, Dar L, Thulkar S, et al. Clinical profile of dengue haemorrhagic fever in adults during 1996 - outbreak in Delhi, India. Dengue Bull. 1998;22:20-7.
Acharya SK, Buch P, Irshad M, Gandhi BM, Joshi YK, Tandon BN. Outbreak of Dengue fever in Delhi. Lancet 1988;2(8626-8627):1485-6.
Singh NP, Jhamb R, Agarwal SK, Gaiha M, Dewan R, Daga MK, et al. The 2003 outbreak of Dengue fever in Delhi, India. Southeast Asian J Trop Med Public Health. 2005;36:1174-8.
Pandey A, Diddi K, Dar L, Bharaj P, Chahar HS, Guleria R, et al. The evolution of dengue over a decade in Delhi, India. J Clin Virol. 2007;40(1):87-8.
Sinha N, Gupta N, Jhamb R, Gulati S, Kulkarni AV. The 2006 dengue outbreak in Delhi, India. J Commun Dis 2008;40(4):243-8.
Gupta P, Khare V, Tripathi S, Nag V, Kumar R, Khan M, et al. Assessment of World Health Organization definition of dengue hemorrhagic fever in North India. The Journal of Infection in Developing Countries. 2010;4(03):150-5.
Srikant D, A Study on the Clinicopathological Profile and Outcome of a Dengue Epidemic in Western Odisha. Int J Med Science and Innovative Research. 2017;2(4):13- 20.
Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai-a study of clinical profile and outcome. Indian Pediatr. 2002;39(11):1027-33.
Waterman SH, Gubler DJ. Dengue fever. Clin Dermatol. 1989;7:117-22.
Itoda I, Masuda G, Suganuma A, Imamura A, Ajisawa A, Yamada K, et al. Clinical features of 62 imported cases of dengue fever in Japan. Am J Trop Med Hyg. 2006;75(3):470-4.
Yip VC, Sanjay S, Koh YT. Ophthalmic complications of dengue Fever: a systematic review. Ophthalmol Ther. 2012 Dec;1(1):2.
Kapoor H, Bhai S, John M, Xavier J. Ocular manifestations of dengue fever in an East Indian epidemic. Canadian Journal of Ophthalmology. 2006;41(6):741-6.
Mehta SR, Bafna TA, Pokale AB. Demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital. Med J DY Patil Vidyapeeth 2018;11(2):128-31.
Hussain I, Afzal F, Shabbir A, Adil A, Zahid A, Tayyib M. Ophthalmic manifestation of dengue fever. Ophthalmol Updte. 2012:10:93-6.
Chakravarti A, Kumaria R. Eco-epidemiological analysis of dengue infection during an outbreak of dengue fever, India. Virol J. 2005;2(1):32.
Sharp TW, Wallace MR, Hayes CG, Sanchez JL, DeFraites RF, Arthur RR, et al. Dengue fever in U.S. troops during Operation Restore Hope, Somalia, 1992-1993. Am J Trop Med Hyg. 1995 Jul;53(1):89-94.
Kumar A, Rao CR, Pandit V, Shetty S, Bammigatti C, Samarasinghe CM. Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka. Ind J Community Medicine: official publication of Indian Association of Preventive & Social Medicine. 2010 Jul;35(3):386.
Sreenivasa B, Manjunatha B, Nivil J. Bleeding manifestations in dengue and their correlation with the platelet count. Sri lanka journal of child health. 2017 Sep 5;46(3):218-21.
Joshi R, Baid V. Profile of dengue patients admitted to a tertiary hospital in Mumbai. Turkish J Pediatr. 2011;53:626-31.
Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Dewan DK. Haematological observations as diagnostic markers in dengue haemorrhagic fever: A reappraisal. Ind Pediatr. 2001;38:477-81.
Dhooria GS, Bhat D, Bains HS. Clinical profile and outcome in children of dengue fever in North India. Iranian J Pediatr. 2008;18(03):222
Kurane I, Ennis FA. Cytokines in dengue virus infections: role of cytokines in the pathogenesis of dengue hemorrhagic fever. In Seminars in virology. 1994 Dec 1:5(6):443-8.
Green S, Pichyangkul S, Vaughn DW, Kalayanarooj S, Nimmannitya S, Nisalak A, et al. Early CD69 expression on peripheral blood lymphocytes from children with dengue hemorrhagic fever. J infectious diseases. 1999 Nov 1;180(5):1429-35.