Title: Role of Abdominal and Thoracic Ultrasonography in Dengue Fever

Authors: Dr Shilpa Hegde*, Dr Nita R Sutay, Dr Mohammed Ashfaque Tinmaswala

 DOI:  http://dx.doi.org/10.18535/jmscr/v3i9.39

Abstract

Aims and Objectives: 1) To Determine role of ultrasonography in early diagnosis of dengue fever.

2) To draw a co-relation between ultrasonography findings and the severity of dengue fever.

Study Design: A prospective study was conducted in Tertiary care centre in metropolitan during a period of 2 years.

Materials and Methods:All suspected cases of dengue based on clinical features and confirmed by laboratory profile between 2 months to 12 years were subjected to ultrasonography of abdomen & thorax within 1st 5 days of fever spike. Dengue cases were classified according to the recent WHO classification 2011.

Results: Among the 100 cases studied it was found that dengue fever is common in male with a male to female ratio of 2.1:1.According to the Revised WHO dengue case classification 2011- 43 patients (43%) had Non-severe dengue without warning signs, 16 patients (16%) had Non-severe dengue with warning signs & 41 patients (41%) had Severe dengue fever. In this study all the 100 patients were subjected to Ultrasonography of abdomen & thorax within 1st 5 days of onset of fever or symptoms. Among them most common ultrasonography finding was Thickened gall bladder wall which was seen in 97 patients (97%), hepatomegaly was present in 66 patients (66%), Ascites in 55 patients (55%), pleural effusion in 47 patients (47%), Pericholecystic fluid in 25 patients (25%) & splenomegaly in 14 patients (14%). Presence of pleural effusion & as cites among the patients co-related with the severity of disease with p<0.05 showing significant association.

Conclusion: Abdominal & thoracic ultrasonography in suspected dengue patients can be used in early diagnosis as it is easily available, non invasive & cheap compared to serological studies. Findings can suggest the severity of the disease.

Key words: Dengue, Ultrasonography, Revised WHO classification.

References

1.      Keng-Liang Wu, Chi-Sin Changchien, Chung-Huang Kuo, King-Wah Chiu, Sheng-Nan Lu, Chung-MouKuo, Yi-Chun Chiu, Yeh-Pin Chou. Early Abdominal Sonographic Findings In Patients With Dengue Fever. Journal ofclinical ultrasound October-2004,32:386-388.

2.      Weekly epidemiological record. No. 6, 8th February 2002:41–3.

3.      Gould EA, Solomon T (February 2008). “Pathogenic flaviviruses”.Thelancet 371 (9611):500–9

4.      H.J.Litz, H.A.Gharbi (2006). “Manual of diagnostic ultrasound in infectious Andtropical diseases”3.2.3 (89-92).

5.      Chen LH, Wilson ME (October 2010). “Dengue and chikungunya infections intravelers”.Curr.Opin. Infect. Dis. 23 (5): 438–44.

6.      Rahman M, Rahman K, Siddique AK et al.First outbreak of dengue haemorrhagic fever, Bangladesh. Emerg Infect Dis 2002; 8(7):738-40

7.      Bhamarapravti N. Pathology of dengue haemorrhagic fever. In:Thongcharoen P (ed) Denge/dengue haemorrhagic fever. WHO, Geneva1993;pp.72-3

8.      Fernanezlj. Dengue fever. In: lutzht & Charbi ha (ed) Manual Of Diagnostic Ultrasound In Infectious Tropical Diseases, Springer-verlag, berlag, berlin 2006; pp.89-93.

9.      Wu KL, Changchien CS, Kuo CH etal. Early abdominal sonographic findings in patients with dengue fever. Clin Ultrasound 2004; 32(8): 386-8.

10.  Sai PMV, Dev B, Krishnan R. Role of ultrasound in dengue fever. BritishJournal of Radiology 2005, 78:416-418.

11.  Bharath Kumar Reddy KR, Laksmana RR, Veerappa BG, Shivananda. Ultrasono-graphy as a tool in predicting the severity of dengue fever in children--a useful aid ina developing country. PediatrRadiol. 2013 Aug;43(8):971-7

12.  Narvaez F, Gutierrez G, Pérez MA, et al. Evaluation of the Traditional and Revised WHO Classifications of Dengue Disease Severity. Hirayama K, ed.PLoS Neglected Tropical Diseases. 2011;5(11):e1397.

13.  Singh B. Dengue outbreak in 2006: Failure of public health system? Indian J Community Med.2007;32:99–100.

14.  Ukey P, Bondade S, Paunipagar P, Powar R, Akulwar S. Study of seroprevalence of dengue Fever in central India. Indian J Community Med. 2010;35:517–9.

15.  Jawetz, Melwick .24th ed. McGraw Hill, Lange Publications; 2007.Adelberg's Medical Microbiology; pp. 350–5.

16.  Lal M, Aggarwal A, Oberoi A. Dengue fever – An emerging viral fever in Ludhiana, North India. Indian J Public Health. 2007;51:198–9

17.  Anders KL, Nguyet NM, Van VinhChau N, et al. Epidemiological Factors Associated with Dengue Shock Syndrome and Mortality in Hospitalized Dengue Patients in Ho Chi Minh City, Vietnam. The American Journal of Tropical Medicine and Hygiene. 2011;84(1):127-134.

18.  Balasubramanian S, Janakiraman L, Kumar SS, Muralinath S, Shivbalan S. A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever. Indian Pediatr. 2006;43:334–9.

19.  VenkataSai PM, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol. 2005;78:416–8.

20.  Zaki SA. Pleural Effusion and Ultrasonography in Dengue Fever. Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine. 2011;36(2):163. 

Corresponding Author

Dr Shilpa Hegde

Senior Resident

Department of Pediatrics, Grant Government Medical College and JJ Hospital Mumbai