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Clinical characteristics and management of dengue fever in Indian teaching hospital

      Keywords

      Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. Clinically dengue virus infection manifests in one of the three forms: Classical Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). The DF is characterized by high grade fever, musculoskeletal pains, retrobulbar headaches and morbilliform rash. Appearance of hemorrhagic rash or hemorrhagic manifestations in addition to classical DF characterizes the Dengue Hemorrhagic Fever (DHF), Dengue shock syndrome is characterized by hypotension, altered mental status and delayed capillary filling.
      Objective was to assess and compare the clinical symptoms, lab investigations and management pattern of dengue suspected and dengue proven. A prospective study was carried out for six months in the medicine department of Bharati Hospital and Research Centre, Pune.
      The study included 52 patients out of 39 (75%) males and 13 (25%) females were enrolled and analyzed for symptomatic of DF and DHF. According to Quader Ahmed et al. dengue fever occurs more in male patients than their female counterparts [
      • Quader Ahmed Jalily
      Screening for dengue infection in clinically suspected cases in a rural teaching hospital.
      ].
      The patients included in the study were between age group of 18–65 years. The highest number of patients admitted for dengue were among 18–25 years age group which consist 50% of the infected population. According to Mia et al. and Nurulla et al. their study on dengue cases also showed highest number of patients from the same age group.
      The patients were admitted with fever with cough, nausea, vomiting, headache, body ache, abdominal discomfort, bloody black colored stool and bleeding from gums. Among the suspected and proven cases, the majority of the population showed up with the manifestations of fever followed by cough and head ache. Mohan Kashinkunti et al. [
      • Mohan Kashinkunti
      • Shiddappa Dr.,
      • Dhananjaya Dr., M.
      A study of clinical profile of dengue fever in a tertiary care teaching hospital.
      ] suggests that fever was the most common presenting symptom (100%) in and around India.
      Most of the patients were hospitalized with the reason of headache, body ache, general weakness followed by fever with chills. According to Messer WB et al. [
      • Messer W.B.
      Clinical features of hospitalized dengue patients in Sri Lanka from 2004 to 2006.
      ] abdominal discomfort, fever with chills, headache, body ache and general weakness are the more prominent reasons for the hospitalization.
      3.8% patients which were dengue proven showed clinical manifestation of hepatomegaly and splenomegaly. Hemorrhagic petechia was also manifested in 1 dengue proven case. These manifestations were not observed in dengue suspected cases. A similar scenario was seen in the study done by Shahid Ahmed et al. [
      • Ahmed Shahid
      • Nadir Ali
      • Shahzad Ashraf
      • Mohammad Ilyas
      • Waheed-uz-Zaman Tariq
      • Chotani Rashid A.
      Dengue fever outbreak: a clinical management experience.
      ] in which both hepatomegaly and splenomegaly was manifested in dengue proven and none were found in dengue suspected cases.
      Diagnostic values of IgG, IgM, and NS1Ag tests have a significant role in assessment and confirmation of DF and DHF. In this study a total number of 38 patients were specified as dengue proven on the basis of their positive values for IgM and IgG. In the study done by Rupal M et al. [
      • Mehta Rupal P.
      • Vijapura T.Y.
      • Gandhi Darshan J.
      • Dipti Gajjar
      ], 52% cases were positive for NS1Ag while 41% and 26% were positive for IgG and IgM respectively.
      Thrombocytopenia was most common in all the infected patients. There is no specific medicine to treat Dengue. WHO recommends fluid therapy consisting oral fluids and electrolyte therapy along with bed rest for patients with DF. In patients with DHF the treatment option is IV fluids and platelet management in cases with blood loss along with complete rest. The therapy given to the patients in our hospital included treatment in patients receiving with fluids minimum 1 pint and maximum 2 pint of Ringer lactate, normal saline and dextrose normal saline was given. A total number of 32 patients required blood transfusion in which maximum 15 (30%) of them received 6 pints and only 1 (2%) was given 12 pints which is a maximum pint form of Random Donor Platelets. While medications including antibiotics and other drugs were given for symptomatic and prophylactic treatment of clinical manifestations and complaints of patients associated with dengue. Few mortality were observed in dengue proven and suspected patients with the reason of respiratory failure and multiple organs dysfunction.
      Accurate and early diagnosis of dengue is important to prevent the hemorrhagic form of dengue fever. Also there is need of awareness about preventive measure for dengue. Unnecessary use of antibiotic should be avoided, adequate and measured fluid therapy should be given to the patients.

      Conflict of interest

      None.

      Funding

      None.

      Provenance and peer review

      Not commissioned; externally peer reviewed.

      References

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        Screening for dengue infection in clinically suspected cases in a rural teaching hospital.
        J Microbiol Biotech Res. 2013; 3 (Scholars Research Library): 26-29
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        A study of clinical profile of dengue fever in a tertiary care teaching hospital.
        Sch J App Med Sci. 2013; 1 (Research Article): 280-282
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        Clinical features of hospitalized dengue patients in Sri Lanka from 2004 to 2006.
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        Dengue fever outbreak: a clinical management experience.
        J Coll Physicians Surg Pak. 2008; 18: 8-12
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        Comparative study of 112 cases of dengue fever out of which 8 cases of dengue mortality in outbreak of 2012, at tertiary care centre of Smt. N.H.L. Municipal Medical College, Ahmadabad, Gujarat, India. vol. 2(6). June 2013: 2277-8179