A Study of Clinico--Haematological Profile of Patients with Dengue Fever

Abstract

INTRODUCTION Dengue fever is an infection that has been prevalent in India for more than 2 centuries. The number of reported cases of dengue are on the rise globally and South-east Asia region has a large population which is at risk and susceptible to dengue. Dengue epidemics have a significant economic and health toll. Epidemic dengue fever (DF) and dengue hemorrhagic fever (DHF) have emerged as a global public health problem in recent decades. In fact, the problem has become hyperendemic in many urban, peri-urban and rural areas, with frequent epidemics. The South-East Asia Region is one of the regions at highest risk of DF/DHF. Dengue has shown a wide clinico haematological profile from symptomatically mild disease to extreme fatal disease with multi organ dysfunctions Clinically. AIMS AND OBJECTIVES The aim and objective of the studies are to study the various clinical and haematological manifestations of patients with Dengue fever, to understand better the risk factors that lead to Dengue Hemorrhagic fever and Dengue Shock Syndrome and also to understand the various haematological and biochemical investigation findings in cases with dengue fever METHODS Written informed consent was taken from each patient and study was explained to each patient. Patients were selected based on inclusion/exclusion criteria. Patients of Dengue fever were enrolled from OPD patients or patients admitted to the wards/ICU. xv Appropriate history was taken and clinical examination of these patients was carried out. Routine investigations like Hb, CBC, RFT’s, LFT’s, RBS, Serum electrolytes were carried out for each patient from the Central Laboratory. Radiological investigations like Chest X-ray, Ultrasound of the abdomen or thorax, were carried out as per the routine standard followed, based on presentation of the patient. There was no extra cost for these investigations incurred by the patient for being in the study. Invasive investigations like Pleural fluid tapping and Analysis of the fluids were carried out where-ever necessary. Written informed consent of the patient was taken prior to any such investigation. All the data accumulated was compiled properly and conclusions were drawn from the same. RESULTS There is high incidence of dengue fever than dengue hemorrhagic fever or dengue shock syndrome. Males are slight more commonly affected than females in the ratio 1.27:1. Fever associated with myalgia, headache and retro-orbital pain was the most common presentation present in all the patients in our study. Rash and positive tourniquet test were the most common bleeding manifestations (34%) followed by haematuria (19%) and epistaxis (13%). NS1 antigen was the most common to be positive in 31 patients (62%), IgM and IgG were positive in 11 and 1 patient respectively Mean platelet counts were 94000 per cu ml, with lowest count was 10000 per cubic ml. Among all the patients in the study, 56% had normal total wbc counts, with 10% had leucocytosis and 34% had leukopenia Mean haematocrit was 38.19 ±1.92 %, increased levels were found in 20 of patients ( 40%). Acute kidney injury ( S. Creatinine ≥1.5) was present in 24% of the study patients. Hypokalaemia was present in 16 % of the patients. Abnormal SGPT was found in 28% of total patients in xvi this study, with 100% in dengue shock syndrome and 42.9% in dengue hemorrhagic fever patients. SGOT was found to be raised in 31 patients with 100% in dengue hemorrhagic and shock syndrome patients. Direct hyperbilirubinemia was found in 6% of patients, with 0% in patients with dengue fever while 75% in patients with dengue shock syndrome. APTT was raised in 28% of total patients with being 75% of dengue shock syndrome patients. Total bilirubin was raised in 7 patients in our study (14%), 1 patient in dengue fever group , 3 patients with dengue hemorrhagic fever. Ascites was present in 4 patients (8%) which were all patients with dengue shock syndrome. Pleural Effusion was present all of DSS patients with 6 patients with dengue hemorrhagic fever patients and overall in 10 patients (20%). Hepatomegaly and splenomegaly was present in 18 patients (36%) in our study , being all the patients of dengue hemorrhagic fever and dengue shock syndrome patients, while 7 patients (17.9%) with dengue fever patients. CONCLUSION In summary, young adults are at risk of dengue the most. Diagnosis of this vector borne disease is usually straight forward and no advanced clinical skill required, this disease has variety of clinical and haematological presentation, with early diagnosis and treatment we can reduce the burden of this disease especially in the endemic countries like India. Further studies will be needed to keep track of the changing epidemiological and clinical trends of dengue. More extensive studies to assess DHF are needed. Also a look into the differences of primary and secondary dengue and their profile is essential.