Title: Typical and Atypical manifestation of Dengue Fever: A Prospective Observational Study
Authors: Kumar Rajesh, Rajak M., Bhattiprolu K Rahi
DOI: http://dx.doi.org/10.18535/jmscr/v4i1.33
Dengue is a major health problem in many parts of India and Jharkhand state has become one of the new endemic areas for dengue. Infection with dengue virus can cause a spectrum of clinical presentation, typical and atypical with altered haematological and coagulation parameters. Aims & Objectives: This study was undertaken to determine the typical and atypical manifestation and haematological profile of patients of dengue admitted in tertiary care teaching hospital in Jharkhand state ofIndia. The study was a hospital based descriptive study with prospective data collection. Material & Methods: One hundred and five patients were admitted with dengue fever as per WHO diagnostic criteria from June to December 2013 Results: Out of 105 cases, 75cases (71.4%) had dengue fever (DF), 27 cases (25.7%) dengue hemorrhagic fever (DF) and three cases (2.8%) had dengue shock syndrome (DSS). Fever and myalgia (100%) were the most common presentation. Among three cases of DSS (2.8 %), one case (0.95%) died of ARDS and one case died of multiorgan dysfunction (0.95%). Malena was the most common bleeding manifestation (44.4%). Low platelet count of less than 100,000/cu mm was present in 47 cases (44.7%) and had poor correlativity to bleeding manifestations. Atypical manifestations included 10 cases (9.5%) of elevated CPK levels&9 cases (8.5%) of elevated LDH levels and an isolated case of hemoglobinuria. Conclusion: Dengue fever has variable manifestations, sometimes puzzling to clinicians and is an important differential of fever in endemic region. Keywords: Dengue fever, Dengue hemorrhagic fever, Dengue shock syndrome, Hemoglobinuria, Thrombocytopenia 1. Dengue in Kerala: A critical review. ICMR Bulletin. 2006;36:13–22. 2. Fever in Chittagong, Bangladesh. ChattMaa Shi Hosp Med Coll J 2013; 12(1): 38–40. 3. Anuradha S, Singh NP, Rizvi SN, Agarwal SK, Gur R, MathurMD.The 1996 outbreak of dengue haemorrhagic fever in Delhi, India;Southeast Asian J Trop Med Public Health: 1998 Sep;29(3):503-6. 4. Sultana N, Biswas SK, Sultan T, Ahmed S, Hossain Z, Chowdhury R. Seroprevalence of dengue.,CMOS Hospital Medical College Journal,Jan 13,vol 12 issue1 5. BhaswatiBandyopadhyay, Indrani Bhattacharyya, SrimaAdhikary, et al., “A Comprehensive Study on the 2012 Dengue Fever Outbreak in Kolkata, India,” ISRN Virology,:2013;vol 2013 Article ID 207580, 5 pages. Available from http://www.hindawi.com/journals/isrn.virology/2013/207580/abs. 6. Rashmi KS, Jagadeesh, Ravikumar KL, PratibhaMalini J, GiridharUpadhyaya P, ArunKaushik R. Serological markers prevalence and trend of probable dengue infection at a tertiary care hospital in Bangalore. Journal of Evolution of Medical and Dental Sciences 2013 September 9 ;2(36); 6968-6976. 7. Mandal SK, Ganguly J, Sil K, Chatterjee S, Chatterjee K, Sarkar P, Hazra S, Sardar D. Clinical Profiles of Dengue Fever in a Teaching Hospital of Eastern India. Natl J Med Res. 2013; 3(2): 173-176. 8. Singh NP, Jhamb R, Agarwal SK, Gaiha M, Dewan R, Daga MK, Chakravarti A, Kumar S. 9. The 2003 outbreak of Dengue fever in Delhi, India.Southeast Asian J Trop Med Public Health. 2005 Sep;36(5):1174-8. 10. VK Singh, JM Haria, SK Jain. "Hospital Based Study of Dengue Hemorrhagic Fever in Western Uttar Pradesh Region". International Journal of Scientifi c Study. 2014;1(5):32-34 11. SHARMA, S. et al. Clinical profile of dengue haemorrhagic fever in adults during 1996: outbreak in Delhi, India. Dengue Bull., New Delhi, v.22, p.20-27, 1998. 12. SubhashGiri, Vishal Sharma, BijoyEasow, Mukul P. Agarwal, Alka Sharma. Low mortality during 2008 outbreak of dengue in Delhi, India: a clinico- biochemical study, Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital; 2GTB Hospital; Delhi, IndiaR. Ci. méd. biol. 2010; 9(1):10-12. 13. Aikat BK, Konar NR, Banerjee G. Haemorrhagic fever in Calcutta area. Indian J Med Res 1964;52:660-75. 14. RituKaroli, Jalees Fatima, Zeba Siddiqi, Khursheed I. Kazmi, Amit R. Sultania Department of Medicine, Era’s Lucknow Medical College,J Infect DevCtries 2012; 6(7):551-554. 15. Khan AH , Hayat AS , Massood N , Solangi , Shaikh TZ.Frequency and clinical presentation at tertiary care hospital of Hyderabad. JLUMHS May-Aug 2010;9(2):88-94 16. Lee et al.Clinical relevance and discriminative value of elevated transaminases for dengue severity .PLOS Ngl Trop dis ;6(6):e1676Abstract
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