Title: Breakbone Fever- Sonological Manifestations of Dengue
Authors: Dr Harini Bopaiah, Dr Chaitra Srinivas, Dr SC Sanjay, Ajit Kumar Reddy
Background: Dengue fever is a major cause of illness and death worldwide. The disease is caused by dengue virus which gets transmitted to humans by the bites of infected mosquitoes, Aedes (Ae.) aegypti and Ae. albopictus . The disease represents a global health issue as it is endemic in around 100 countries, most of which are in tropical and sub-tropical areas.
Objectives: To determine importance of ultrasonography in the early diagnosis, severity grading and prognostic management of patient suffering from dengue To evaluate the typical sonographic features seen in patients suffering from dengue fever. To correlate ultrasound findings with platelet counts and to predict severity of dengue fever based on these findings.
Materials and Methods: This is a retrospective study done in KIMS hospital Bangalore from June 2015 to January 2016 involving 140 patients with clinical suspicion of dengue fever. Ultrasound of abdomen, pelvis and thorax was done using GE Voluson Pro750 and Philips HD7 machines. The typical edematous GB wall thickening resembling onion peel was an important criteria in our Ultrasound study (Sachar and sunders sign). The serology markers were NS1Ag, IgG and IgM. Platelet count values were graded as severe (less than 50,000) and mild (50,000 – 100,000).
Results: Sonography was conducted on 140 patients of whom 110 were seropositive for dengue. With the exclusion of 30 seronegative cases the total number of patients included in our study was 110 cases ranging from 1-90 years of which 64(58%) were males and 46(42%) were female. The majority of patients in the study ranged from 20 to 40 years. All 110 (100%) patients presented with fever, 93 (85%) had generalized body ache, 68(62%) had nausea and vomiting and 25(23%) had generalized skin rash.
Sonographic correlation in 55 patients with platelet count less than 50000, demonstrated gall bladder wall thickening in 52 patients (94%), ascites in 48(87%), pleural effusion in 39 patients (71%), splenomegaly in 14(25%) and hepatomegaly in 11(20%). The 36 patients with platelet count 50000 to 100000/mL, demonstrated gall bladder wall thickening in 29(81%), ascites in 22(61%), pleural effusion in 15(42%), with sonography. In this study, platelet counts were reduced in all 140 cases and dengue serology was positive in 110. Platelet counts below 50000/mL was noted in 55(50%) and 50000 to 100000mL in 36(33%) patients.
Conclusion: In a dengue epidemic ultrasound findings of gall bladder edema with or without ascites, pleural effusion and ascites should definitely suggest a provisional diagnosis of dengue fever prior to confirmatory serology reports. This helps in early management of patients there by reducing morbidity and mortality associated with dengue fever.
Keywords: Dengue fever, gall bladder wall edema, ascites, pleural effusion, hepatomegaly, splenomegaly, platelet count.