Abstract

Dengue infection is a major health problem worldwide including our country. Dengue, one of the most rapidly spreading mosquito-borne viral diseases in the world, is an acute infection caused by an arbovirus in the Flavivirus genus, and the mosquito Aedes aegypti is the vector. Epidemic dengue is a major public health problem in South East Asia, especially in India where there is a reported case fatality ratio of 3–5%. One of the most prominent clinical characteristics of dengue patients is increased aspartate and alanine aminotransferase liver enzyme levels. The significance of this is uncertain, as it is transient in the majority of cases, and most patients recover uneventfully without liver damage.

Methods and Material: This study included 42 patients of dengue positive cases admitted in RL Jalappa hospital, Tamaka Kolar, Karnataka. We included all patients diagnosed dengue positive in this study.  Excluded based on exclusion criteria.

Results: Among 42 patients enrolled, males comprised 71% (30), females 29% (22) of the study population and median age of study population was 32 years (25-45 years). 21% (9) had dengue fever without warning signs, 62% (26) had dengue with warning signs and 17% (7) had severe dengue.  The main presenting symptoms were fever (100%) followed by myalgia (54.2%), arthralgia (53%), hemorrhagic manifestations (46.4%), vomiting (40.4%) and abdominal pain (27.1%). Hepatomegaly was observed in 11.4% patients in this study. Among 42 patients 90.4% (38)  patients were positive for NS1Ag, IgM 71.4% (30), 33.3 %  (14) and IgG and  NS1Ag 59.52 % (25). In our study 12 patients had normal level of serum transaminases (grade A, 28.5%), 30 (71.4%) had elevated enzymes in which 17 falling into the grade B (40.4%), 10 in grade C (23.3%) and 3 in the group D (7.1%). Among  30 patients with raised serum transaminases all had elevated AST whereas only 24 (80%) had elevated ALT. Mean AST value was 396 ± 746 IU/L and mean ALT was  285 ± 460 IU/L. The characteristics of ALT and AST among study population is as shown below in the table.

Conclusion: In conclusion, all serologically confirmed dengue infection patients, liver involvement in the form of elevation of transaminases levels occurred in almost all patients. However, association with the severity of the disease could not be sought due to the small sample size. Most of our patient developed jaundice and acute hepatitis but most patient had mild to moderate effect and recovered with supportive treatment. Care must be taken not to make a mistaken diagnosis of viral hepatitis.