Title: Clinical and Investigational Profile of Adult Patients Suggestive of Dengue Fever at Teritiary Care Mamata General Hospital
Authors: Dilip M Rampure, Rajhounsh V, Subash Dasarapu
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.59
Abstract
Introduction: Dengue fever epidemic s have been causing major concern in India, many parts of India are endemic for the dengue. Dengue is mosquito borne infection caused by 4 distinct serotypes deny-1, v-2, v-3, v-4.v-3 is most prevalent serotype in last few years. Dengue illness often confused with other febrile states, this difficulty is especially striking during early phase of illness, when non specific clinical symptoms accompany the febrile illness.
Objective: Objective of the study is to document various clinical manifestations and laboratory parameters of all dengue cases.
Materials And Methods: Study conducted at Mamata general hospital during june2014-july 2015.This is a prospective study conducted on 100 cases who were presented with fever and admitted in hospital. A detailed history and clinical examination findings were recorded and all cases were subjected to laboratory investigations. Which included complete heamogram, mean plc, mean hematocrit, mean hb. all the patients were treated symptomatically.
Results: Among 100 serologically confirmed dengue cases the male and female ratio was l:l. the most common age group affected was 21-30years and most common presenting complaint was fever seen in 98%.mean duration of fever was 6.1 day. Among the cases 56% developed thrombocytopenia. In them 2 patients were having plc of 20000. Among 56% 3 cases developed DHF and DSS, 4 cases developed bleeding manifestations. 39% developed leucopenia.
Conclusion: This study showed that most common presentation was fever and 56%patients presented with thrombocytopenia but rarely developed bleeding manifestations and complications. cases developed bleeding manifestations. 39% developed leucopenia.
Keywords: Dengue fever, thrombocytopenia, hemogram
References
1. Gibbons ,R.V, and D.W Vaughan .2002. Dengue; An escalating problem.BMJ 324;1563-1566
2. World Health Organisation .1997. Dengue heamorrhagic fever. Diagnosis ,treatment , prevention and control,2nd edition W.H.O
3. Gubler .1998.Dengueand Dengue Heamorrhagic fever Clin. Microbiol.Rev.11;480-496
4. Chambers, T.J.C.S.Hahn, R.Galler, and C.M.Rice.Flavi virus replication expression and genome organisationannu .Rev.Microobial44649-688
5. Deubel,V,R.M. Kidney and D.W Trent 1998. Virology 165;234-244
6. Lyssen. P,E.D Clereqand J.Neyts .2000.Clin Microbiol Rev.13;67-82
7. Rice ,C.M,E.M.Lenches 1985 . Science229;726-733
8. Burked,d.S.A..Nisalak, D.E.Jhonson ,1988 A Prospective study of Dengue infraction in bankok Trop .Med.Hyg.38;172-180
9. GuzmaM.G.G.Kouri1990.Dengue heamorrahagic fever in cuba 1981Trop .Med.Hyg.421;179- 184
10. Halstead ,S.B,.H.Shotwell1973 Inf.Dis.128;15-22
11. Halstead,S.B.1988.pathogensis of Dengue .Sicence239;476-481
12. Gubler,D.J.,D.Reed I.Rose and J.C.J.Hitchcock.1978 Epidemiological,Virological, Clinical observations on Dengue.Am.J. Trop.Med.Hyg.27;581-589
13. Rosen,11977 Pathogenesis of Dengue fever.Trop.Med.Hyg.26;337-343
14. Green.S.D.,W.Vaughn et al.,1999 Early immune activation in dengue related to plasma leakage and severity.J.Infect.Dis.179;755-762
15. Kurane,L,A, I.Rothman.et al 1994.Immunopathologic mechanism of dengue heamorrhagic fever and dengue shock syndrome .Arch.Virol.Suppl.9;59-64
16. Vaughn.d. w., et al Dengue Viremia titre , antibody response pattern and virus serotype correlate with disease severity .J.Infect.DIS.181;2-9
17. lei.H. Y., TM. Yeh., et al . immunopathogenesis of Dengue fever .J.Biomed.Science2001.8;377-388
18. Lin,C.F.,H.Y.Lei.et al . generation of IgM antiplatelet antibody in dengue patient .J.Med .Virol.63:143:-496
19. Gubler.D.J et al .1998 Dengue and Dengue heamorrhagic fever.Clin.Microbiol.Rev. 11;480-496
20. Guzman.M.G and Kouri et al., Dengue : an update .Lancet Infect.Dis.2:33-42
21. Nimmannitya,s.1987.Clinical spectrum and management of Dengue haemorrhagic fever J..Trop.Med.Public Health 18:392-397
22. Endy T.P. et al. Epidemilogy of inapparent and symptomatic acute Dengue virus infection .Am.Jj.Epidemiol. 156:40-51
23. Perez JGR, Clark GG, Gubler DJ, Reiter P,,SandersEJ, Vorndam AV.Dengue and Dengue haemorrhagic fever Lancet 1998;352:971-977
24. World health organisation , Dengue haemorrhagic fever :Diagnosis treatment and Control Geneva:WHO 1986
25. Carey DE. Chickngunya and Dengue :A case of mistaken identity ? J Hist Med 1971;26:243-62
26. Ehernkranz NJ, Ventura AK, Caudrado RR. Pond WL, Porter pandemic Dengue in caribean contries and southern united states ; past, present and potential problems. NEJM 1971;285:1460-69.
27. Halstead SB. Dengue hemorrhagic fever : a public health problem and a field for research. Bull WHO 1980 ;58:1-21
28. Cohen SN , Halstead SB. Shock associated with Dengue infection. J peditar 1966;68:448-56
29. Communicable disease surveillance and response, WHO 2002, http;//www.who.-int/entity/csr/disease/Dengue
30. Chandrakantha, Rashmi kumar ,Garima, Jyosthma Agarwal, Amitha jain , Rachana nagar. Changing clinical manifestation of Dengue in north india. Dengue bulletin 2008;32:118-126
31. Janak Kishore , Jagadeep Singh , T.N Dhole and A Ayyagari. Clinical and serological study of first large epidemic of Dengue in and around Luknow , India , Dengue bulletin, 2006;30;72-80
32. Carey DE, Myers RM , Ruben R,Rodrigues FM. Studies on Dengue in Vellore , south india. Am J Trop Med Hyg. 1996;15;580-7
33. Sabin AB. Research on Dengue during worls war 2. Am J Trop Med Hyg . 1952;1:30-49
34. Hammon WMcD. Dengue hemorrhagic fever, Do we know its cause? Trop Med Hyg 1973;22:82-91
35. Hammon WMcD. Runick A, Sather GE . Virus associated with epidemic hemorrhagic fever of the Philippines and Thailand . Sciences 1960;131:1102-3
36. World health organisation WHO. Dengue hemorrhagic fever . diagnosis prevention and control, 2nd . Geneva :WHO 1997AA
37. Harrigton LC , Edman JD, Scott TW. Why do female Aedes feed preferentially and frequently on human blood ? J Med Entemol 2001;38:411-422
38. Halstead SB . Selective primary health care : Strategies for control of disease in the developing world .XI. Dengue Rev infect Dis 1984;6:251-64
39. McBride WJ, Bielefeldt-Ohman H.Dengue viral infections: pathogenesis and epidmology.Microbes Infect 2000;2: 1041-1050
40. Cheong LL. The vectors of Dengue and Dengue hemorrhagic fever in Malasyia . In: Rundick A , Lin TW, Editors . Dengue fever studies in malasyia bulletin 23, Kaulalampur, malasyia: institute of Medical Research . 1986
41. World health organisation . Dengue and Dengue hemorrhagic fever .Fact sheet no. 117 www.who.int/inf-fs/en/fact117.html.
42. Kurane, Takasaki T ,Yamada K .Trends in Flavi virus Infection in Japan.Emerg Ifect Dis 2000;6:569-571.
43. From the centes for diseas control and prevention .Imported Dengue-united states , 1997 and 1998. JAMA 200;283:1953-1954.
44. Gubler DJ. Aedea aegypti and Aedes aegypti – borne disease control in the 1990s:top down or bottom up ?Charles franklin Craig lectures . Am J Trop Med Hyg.1989;40:571-578.
45. Burke DS, Nisalak A, Jhoonson DE.Scott RM. A Prospective of dengue infection in Bankok . Am J Trop Med Hyg 1988;38:172-180
46. Krishnamurthi C, Kalayanarooj S, Cutting MA , Peat RA ,Roathwell SW, Reid TJ et al. Mechanism of hemorrhage in dengue without circulatory collapse. Am J Trop Med Hyg 2001;65:840-847.
47. Wu SJ , Grouard-Vogel G, Sun W, Mascola JR, Brachtel E, Putuvatanaa R, et al. Human skin langerhanss cells are target of dengue virus infection . Nat Med 2000;6:816-820.
48. Halstead SB. Antibody , Macrophages, Dengue virus infection , shock, and hemorrhage ; a pathogenic cascade .Rev infect. Dis 1989;11:s830-9.
49. Rosen L. COmements on epidemiology , pathogensis, and control of dengue . Med Trop 1999;59:495-498.
50. Solomon T, Dung NM , Vaughn DW, et al . Neurological manifestations of Dengue infection . Lancet 2000;355:1053-1059.
51. Cam BV, Fonosmark L, Hue NB, et al. Prospective case control study of enchepalopathy in Dengue hemorrhagic fever in children. Am J Trop Med Hyg 2001;65:848-851.
52. Vaughn DW, Green S, kalayanarooj S, et al. Dengue viremia titer , antibody response pattern , and virus serotype correlate with disease severity . J Infect .Dis 2000;181:2-9.
53. Sullivan NJ. Antibody mediated enhasment of viral disease. Curr top microbial Immunol 2001;260
54. K urane I, Takasaki T. Dengue fever and Dengue hemorrhagic fever : challenges of controlling an enemy still at large. Rev Med Virol 2001;11;301-311.
55. Sumarmo . The role of steroids in Dengue shock syndrome . South East Asian J Trop Med Public Health 1987;18:383-389.
56. Nimmantiya S. Dengue Hemorrhagic fever with unusal clinical presentations. South East Asian J Trop Med Public Health 1987 ;18:398-406
57. Halstead SB . The pathogenesis of Dengue ; The Alexander D.Langmuir Lecture. Am J Trop Med Hyg 1981;114:632-48
58. Sangkawahbia N, Rojanasuphot S , Ahandrik S et al.Risk factor in Dengue shock syndrome . A prospective epidemic-ological study in Rayong , Thailand Am J Epidemol 1984;120:653-69
59. Gubier DJ. Dengue In: Monath TP ed.The arbovirus :Epidemology and ecology . Bocca Raton , FLA:CRC Press , 1988:223-60.
60. Sumarmo WH, Jaha E, Gubler DJ , et al . Clinical observations in vipologically confirmed fetal dengue in Djakartha , Indonasia .Bull WHO 1983;61:693-701.
61. Sharp TW , WallaceMR, Hayes CG, Sanchez JL, DeFraites RF, Arthur RR, et al. Dengue fever in US troops during operation Restore Hope , Somalia, 1992-1993 Am J Trop Med Hyg 1995;53:89-94.
62. Waterman SH, Gubler DJ. Dengue fever. Clin Dermatol 1989;7:117-122.
63. Dietz VJ, Gubler DJ, Rigau-perez JG, Pinheiro P, Schatzmayr HG, Baily R et al.Epidemic Dengue 1 in Brazil, 1986: evalution of a clinically based Dengue surveillance system. Am J Epidemiol 1990;131:4.
64. World health organisation Technical Guides for diagnosis treatment , surveillance , prevention and control of Dengue hemorrhagic fever.Geneva;WHO , 1975.
65. George R, Liann CK, chua CT , Lam SK , Pang T, Geethan R, Foo LS. Unusal clinical manifestations of Dengue virus infection . Southeast Asian J Trop Med Public Health. 1998;19:585-590.
66. Lum LCS, Lam SK, Choy YS, George R , Harun F. Dengue Enchepalitis: a true entity? Am J Trop Med Hyg. 1996;54:256-259.
67. Lum LCS, Thong MK, Cheah YK and Lam SK Dengue –associated adult respiratory distress syndrome .Ann Trop Paediatrics . 1995;15:335-339.
68. Lum LCS, Lam SK, George R and Devi S. Fluminant hepatitis in Dengue infection. Southeast Asian J Trop Med Public Health 1993;24;467-471
69. Chye JK, Lim CT, Ng KB, Lim JMH, George R , Lam SK. Vertical transmission of Dengue Clin Inf Dis. 1997;25:1374-1377.
70. Liu CC, Haung KJ , Lin YS, Yeh TM, Liu HS, Lei HY. Transient CD4/CD8 ratio inversion and abeerant immune activation during Dengue virus infrction. J Med Virol. 2002 Oct;68(2):241-52.
71. Rueda E, Mendez A ,Gonzalez G. Hemophagocytic syndrome associated with Dengue hemorrhagic fever . Biomedica (Bogota). 2002;22:160-6.
72. Nhan NT, Cao XT, Kneen R, Wills B, Nguyen VM, Nguyen TQ et al. Acute management of Dengue shock syndrome ; a randomized double- blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis 2001;32:204-213
73. Goh KT, Ler, Teck Siang:Epidemilogical characteristics of the 2005 and 2007 Dengue epidemics in Singapore. West pacific survie J;Oct 2011;2:4-24.
74. Anuradha S, Singh NP, Rizvi SN, Agarwal SK, Gur R, Mathur MD. The 1996 outbreak of dengue hemorrhagic fever in delhi, India;Southeast Asian J Trop Med Public Health. 1998;29:503-6.
75. Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam Rex CS et al. Dengue fever Epidemic in Chennai – A Study of clinical profile and Outcome . Indian pediatr 2002;39:1027-1033.
76. Mahboob M, Iqbal Z, Javed R, Taj A, Mumir A, Akthar SM. Clinical characteristics of the patient with dengue fever ; Report of 48 patients in 2010 J Ayub Med col Abbottabad 2010;22(4).
77. Ahmed , F.U., B.C. Mahmood , J.D. Sharma, S.M. Hoque et al. Dengue and Dengue hemorrhagic fever in Chittagong, Bangladesh, Dengue Bull.25:33-39
78. Malavig, G.N., P.K Ranatunga, S.D jayaratne et al. 2007. Dengue viral infection as a cause of encephalopathy . Indian .J.Med. Microbiol.25(2):143-5
79. Arif , Y.Yahya, Ahmed and Akram, D.S 2008. Dengue fever out break in Karachi2006- Astudy of profile and outcome of children under 15 years of age JPMA.58(1):4-8.
80. Itoda I, Masuda G, Suganuma A, Imamura A, Ajisawa A, et al. Clinical features of 62 imported cases of Dengue fever in Japan . Am J Trop Med Hyg.2006 Sep;75(3);470-4.