Details
Category: Volume 07 Issue 04 April 2019
Hits: 1369

Title: Spectrum of Ophthalmic Manifestations of Dengue: Our Experience in a Tertiary Care Centre

Authors: Srikant Kumar Dhar, Swati Samant, Suchismita Mishra, Debasmita Tripathy, Rishit D. Shah, Ram Chandra Prasad

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.184

Abstract

Background: Dengue is a multisystem disease by a viral infection affecting all organs. Ophthalmic manifestation are not uncommon but mostly under observed. we evaluated cases of dengue fever with different ophthalmic manifestations.

Introduction: Dengue is a vector borne disease by four different serotypes of dengue virus transmitted by bite of female Aedes mosquito. It is an acute febrile illness characterised by myalgia, joint pain, gastrointestinal manifestations. Complications like dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS), Extended Dengue Syndrome (EDS) may be fatal for patients. Ophthalmic manifestations like conjuctival chemosis and bleeding manifestation like retnal hemorrage associated with low platelet count. We determine different clinical spectrum of of ophthalmic manifestations and correlation to platelet level.

Materials and Methods: This study conducted over one year from August 2017 to September 2018 comprising of 110 dengue patients in IMS & SUM Hospital. Complete ocular examination was carried out to establish ocular manifestations.

Result: Out of 110 hospitalised patients (Age >18 years) 85 were males (77.27%) and 25 were females (22.72%). Mean age of presentation was 38.53 years (18-65years).Ocular findings were present in 47 patients (42.72%), Subconjunctival haemorrhage (SCH) was the commonest ocular finding 29 patients (61.72%).Posterior segments finding was present in 11 patients (10%),7 patients(6.36% )had superficial retinal haemorrhage. Thrombocytopenia was noted in 47 patients (43.03%) of which 34 patients (72.34%) had ocular findings. All patients of DSS and EDS had ocular findings, 70% cases of DHF and 37.5 % cases of DF had ocular manifestations. Raised haematocrit is also associated with ocular manifestations.

Conclusion: The incidence of dengue fever is increasing so also ocular complications, hence all patients with dengue should be evaluated to prevent any sight-threatening complications.

Keywords: Dengue, Subconjunctival haemorrhage, Platelets, Packed cell volume.

References

  1. Halstead SB. Pathogenesis of dengue: Challenges to molecular biology. Science. 1988;239:476–81. [PubMed]
  2. Kurane I. Dengue hemorrhagic fever with special emphasis on immunopathogenesis. Comp Immunol Microbiol Infect Dis. 2007;30:329–40. [PubMed]
  3. Gubler DJ. Dengue and dengue Hemorrhagic fever. Clin Microbiol Rev. 1998;11:480–96. [PMC free article PubMed
  4. New ed. Geneva, Switzerland: World Health Organization; 2009. World Health Organization (WHO). Dengue- Guidelines for Diagnosis, Treatment, Prevention and Control.
  5. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. Dengue: A continuing global threat. Nat Rev Microbiol. 2010;8(Suppl):S7–16. [PMC free article][PubMed]
  6. Bhatt S, Gething PW, Brady OJ et al. The global distribution and burden of dengue. Nature 2013; 496: 504–507. [PMC free article][PubMed]
  7. Brady OJ, Gething PW, Bhatt S et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 2012; 6: e1760. [PMC free article] [PubMed
  8. Aguiar M, Rocha F, Pessanha JEM et al. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons? Sci Rep 2015; 5: 8462. [PMC free article][PubMed
  9. Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India.Indian J Med Res. 2012;136:373–90. [PMC free article] [PubMed]
  10. Chakravarti A, Arora R, Luxemburger C. Fifty years of dengue in India. Trans R Soc Trop Med Hyg 2012; 106: 273–282. [PubMed]
  11. Arunachalam N, Murty US, Kabilan L et al. Studies on dengue in rural areas of Kurnool District, Andhra Pradesh, India. J Am Mosq Control Assoc 2004; 20: 87–90. [PubMed[
  12. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 1998; 11: 480–496.
  13. Whitehorn J, Simmons CP. The pathogenesis of dengue. Vaccine. 2011;29:7221–8. [PubMed]
  14. Dhar srikant.,A Study on the Clinicopathological Profile and Outcome of a Dengue Epidemic in Western Odisha. International Journal of Medical Science and Innovative Research. 2017;2(4):13- 20. 
  15. Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai-a study of clinical profile and outcome. Indian Pediatr. 2002;39:1027–33. [PubMed]
  16. Waterman SH, Gubler DJ. Dengue fever. Clin Dermatol. 1989;7:117–22. [PubMed]
  17. Itoda I, Masuda G, Suganuma A, Imamura A, Ajisawa A, Yamada K, et al. Clinical features of 62 imported cases of dengue fever in Japan. Am J Trop Med Hyg. 2006;75:470–4. [PubMed]
  18. Chadwick D, Arch B, Wilder-Smith A, Paton N. Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: Application of logistic regression analysis. J Clin Virol. 2006;35:147–53.
  19. Climate Change 2013: The Physical Science Basis. InStocker TF, Qin D, Plattner GK et aleds. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press: Cambridge, UK and New York, NY, USA. 2013, 1535.
  20. Patz JA, Martens WJ, Focks DA et al. Dengue fever epidemic potential as projected by general circulation models of global climate change. Environ Health Perspect 1998; 106: 147–153
  21. Haritoglou C, Scholz F, Bialasiewicz A, Klauss V. [Ocular manifestation in dengue fever]. Ophthalmologe. 2000 Jun; 97(6):433-6. German. PubMed PMID: 10916388.
  22. Yip VC, Sanjay S, Koh YT. Ophthalmic complications of dengue Fever: asystematic review. Ophthalmol Ther. 2012 Dec;1(1):2. doi:10.1007/s40123-012-0002-z. Epub 2012 Aug 23. PubMed PMID: 25135582; PubMed
  23. Kapoor HK, Bhai S, John M, Xavier J. Ocular manifestations of dengue fever in an East Indian epidemic. Can J Ophthalmol. 2006 Dec;41(6):741-6. PubMed PMID:17224957.
  24. Hussain I, Afzal F, Shabbir A, Adil A, Zahid A,Tayyib M. Ophthalmic manifestation of dengue fever. Ophthalmol Updte 2012:10:93-6
  25. Sharp TW, Wallace MR, Hayes CG, Sanchez JL, DeFraites RF, Arthur RR, Thornton SA, Batchelor RA, Rozmajzl PJ, Hanson RK, et al. Dengue fever in U.S. troops during Operation Restore Hope, Somalia, 1992-1993. Am J Trop Med Hyg. 1995 Jul;53(1):89-94. PubMed PMID: 7625541.
  26. Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai--a study of clinical profile and outcome. Indian Pediatr. 2002 Nov;39(11):1027-33. PubMed PMID: 12466573.
  27. Kumar V, Ghosh B, Raina UK, Goel N. Bilateral periorbital ecchymosis in a casewith dengue fever. Indian J Ophthalmol. 2009 May-Jun;57(3):242-3. doi:10.4103/0301-4738.49407.
  28. Chan DP, Teoh SC, Tan CS, Nah GK, Rajagopalan R, Prabhakaragupta MK, Chee CK, Lim TH, Goh KY; Eye Institute Dengue-Related Ophthalmic Complications Workgroup. Ophthalmic complications of dengue. Emerg Infect Dis. 2006 Feb;12(2):285-9.
  29. Sanjay S, Wagle AM, Au Eong KG. Optic neuropathy associated with dengue fever.Eye (Lond). 2008 May;22(5):722-4.
  30. Lim WK,Mathur R,Koh A,Yeoh R,Chee SP. Ocular manifestrations of dengue fever. Ophthalmology 2004;111:2057-64.
  31. Sanjay S, Au Eong KG. Bilateral vitreous haemorrhage associated with dengue fever. Eye (Lond). 2007 Jan;21(1):144-5.
  32. Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral choroidal effusions associated with dengue fever. Retina. 2003 Aug;23(4):576-8.
  33. Sujatha R, Nousheen S, Nazlin A, Prakash S. Ocular manifestations of dengue fever. Int J Med Sci Public Health 2015;4:690-693
  34. Haritoglou C, Dotse SD, Rudolph G, Stephan CM, Thurau SR, Klauss V. A tourist with dengue fever and visual loss. Lancet. 2002 Oct 5;360(9339):1070.
  35. Kurane and E.A.Ennis,”Cytokines in dengue virus infection : role of cytokines in pathogenesis of dengue haemorrhagic fever,” Seminars in Virology,vol 5,no.6,pp.443-448,1994.
  36. Green, S. Pichyangkul, D.W. Vaughn et al.”Early CD69 expression on peripheral blood lymphocytes from children with dengue haemorragic fever”, Journal of infectious isease,vol.180,no.5,pp.1429-1435,1999.
  37. Halstead, ”Pathophysiology and pathogenesis of dengue haemorrhagic fever.” in Monograph on Dengue/Dengue Haemorrhagic Fever, P.T Hongcharoen, Ed., Regional Publication,SEARO no.22,pp.80-103,WHO,1993.
  38. M. Morens,” Antibody-dependent enhancement of infection and the pathogenesis of viral disease, ”Clinical Infections Disease,vol.19,pp.500-512,1994
  39. A. Wills, N.M.Dung, H.T.Loan et al.” Comparision of three fluid solutions for resuscitation in dengue shock syndrome”, The New England Journal of Medicine, vol.353,no.,pp.877-889,2005.
  40. Gomber S, Ramachandran VG, Kumar S,et al. Haematological observations and diagnostic markers in dengue haemorrhagic fever-a reappraisal. Indian Pediatr 2001;38:477-81.

Corresponding Author

Suchismita Mishra

Assistant Professor, PG Department of Ophthalmology, IMS and SUM hospital, Siksha “O” Anusandhan University, K8, Kalinganagar,Bhubaneswar-751003, Odisha, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.