Clinical Profile of Dengue Fever with Its Acute Complications in Rural Population of Jaipur District

Abstract

Dengue is the most important mosquito-borne viral infection in terms of morbidity and mortality. In recent years, it has become a major public health concern. The present study was conducted on hospitalized adult patients of NIMS Medical College & Hospital with the aim to study the clinical profile and usual presentations of dengue fever. During the study of 75 patients of dengue infection, 18 had dengue fever (DF), 19 had dengue fever with unusual bleeding (DFB), 28 had dengue hemorrhagic fever (DHF) and 10 had dengue shock syndrome (DSS). The mortality rate in the study was 1.33%. Maximum number of cases occurred in the month of September. Maximum number of cases occurs between the ages of 20 and 40 years and the median age of patients in this study was 25 years. The male: female ratio was 1.42:1. Fever was the universal symptom in 100% of the cases followed by bleeding in 53.33% of the cases, vomiting in 44% and myalgia in 40%. Vomiting and abdominal pain were commonly associated with the dengue shock syndrome group, i.e., in 80 and 70% of the cases respectively and hence regarded as alarm signals. Among the bleeding tendencies, epistaxis was the commonest in 32% of the cases. Tourniquet test was positive in only 16% of cases. Hepatomegaly was the commonest clinical finding in 38.6% of patients followed by bradycardia in 33.33% and petechiae in 21.33%. Haemoconcentration (HCT > 40) was present in 20% of the cases. The association of haemoconcentration with the dengue hemorrhagic fever/dengue shock syndrome (poor prognosis) group was statistically significant. The median hemoglobin concentration was 12.8 g/dL inspite of haemoconcentration. Thrombocytopenia (platelet count < 1 lakh) was present in 69 out of 75 patients (92%). Lower platelet counts (< 50,000) were significantly associated with more bleeding tendency and poor prognosis (dengue hemorrhagic fever/dengue shock syndrome) group. Deranged prothrombin time was found in 40% of patients, the common laboratory parameters being leucopenia and proteinuria. Deranged liver function tests (SGOT/SGPT values > 40) were found in 80% of the patients and the association of higher values of SGPT/SGOT (> 100) with poor prognosis, i.e., likelihood of falling in dengue hemorrhagic fever/dengue shock syndrome group was statistically significant. 100% patients in the dengue shock syndrome group had SGPT/SGOT > 40 of which 70% had SGPT/SGOT > 100. The ECG showed bradycardia in 37.5% of the patients. Three patients had ST-T changes suggestive of dengue myocarditis, also confirmed on Echo. Ultrasound examination showed gall bladder wall thickening due to edema in 79.2% of cases, it was a nonspecific, yet the commonest finding. Hepatomegaly was seen in 60.4% and pleural effusion in 16.7% of cases. Dengue was associated with neurological manifestations like encephalitis in two cases, of which one patient later had dengue-related myopathy, disseminated intravascular coagulation in two patients, renal failure in two patients, ST-T changes of myocarditis in three patients. Dengue was associated with other infections like plasmodium falciparum malaria (two cases), plasmodium vivax malaria (two cases) and viral hepatitis B (one case).

Keywords: Viral infection, dengue hemorrhagic fever, dengue shock syndrome, hepatomegaly, thrombocytopenia