A study of clinical profile and factors associated with the outcome in patients of dengue fever at tertiary health care centre

 

Eknath M Bamane

 

Abstract              Background: Incidence of dengue fever and dengue hemorrhagic fever increased thirty folds globally over the last few decades Aims and Objectives: To Study Clinical profile and Factors associated with the outcome in patients of dengue fever at tertiary health care centre. Methodology: This was a cross-sectional study carried out in the department of Medicine during the one year period in the suspected patients of Dengue so during the one year period all the suspected patients were screened by Dengue antigenic Kit those showing the positive results with clinical features with written and explained consent were included into the study hence in the study period 77 patients were enrolled. The data was entered into excel sheet and analyzed excel software’s for windows 10. Result: In our study we have seen that the majority of the patients were in the age group of 40-50 were 32.47%, followed by 50-60 Were 24.68%, 30-40 were 16.88%, >60 were 14.29%, 20-30 were 11.69%. The majority of the patients were Male i.e. 57.14% followed by Female were 42.86%. The most common clinical features were Fever in 94% followed by Myalgia in 92%, Headache in 80%, Retro-orbital pain in 79%, Arthralgia in 68%, Rash in 43%, Diarrhea in 24%, Mucosal bleeding in 5%, Spontaneous bleeding of skins in 4%. The majority of the patients improved i.e. 82% and 16% Improved with Complications, DAMA was given in 1% and Death occurred in only 1%. The most common factors associated were Old age (>50) in 69.23% followed by H/o Diabetes in 53.85%, H/o Hypertension in 53.85%, H/o CVD in 46.15%, H/o Smoking in 38.46%, Recurrent infection in 30.77%, Renal failure -23.08, H/o Immuno compromised disease - 15.38%. Conclusion: It can be concluded from our study that the majority of the patients were in the age group of 4th or 5th decade and male outnumbered than females, the most common clinical features were Fever and myalgia, the majority of the patients improved and the factors associated with poor outcome were Old age (>50), H/o Diabetes , H/o Hypertension , H/o CVD , H/o Smoking , Recurrent infection, Renal failure, H/o Immuno-compromised disease etc.

Key Word: dengue fever.

 

INTRODUCTION

Dengue fever is a viral infection caused by one of the four serotype of dengue viruses belongs to flaviviridiae family.¹ It has 4 serotypes DENV1, DENV2, DENV3 and DENV.⁴ Dengue virus believed to be originated in Africa about 300year ago.² Aedes aegypti is the principal vector dengue for fever. DENV is maintained in a humanmosquito-human cycle.³ Incidence of dengue fever and dengue hemorrhagic fever increased thirty folds globally over the last few decades. India first major outbreak was in 1996 at Delhi where more than 10,000 cases and 400 deaths were repored.^4,5 So we have studied the clinical profile and Factors associated with the outcome in patients of dengue fever at tertiary health care centre.

 

METHODOLOGY

this was a cross-sectional study carried out in the department of medicine during the one year period in the suspected patients of dengue so during the one year period all the suspected patients were screened by dengue antigenic kit those showing the positive results with clinical features with written and explained consent were included into the study hence in the study period 77 patients were enrolled. all details of the patients like age, sex, clinical features, Outcome and the factors if any associated with the poor outcome were included into the study. The data was entered into excel sheet and analyzed excel software’s for windows 10.

 

RESULT

Table 1: Distribution of the patients as per the Age

The majority of the patients were in the age group of 40-50 were 32.47%, followed by 50-60 Were 24.68%, 30-40 were 16.88%, >60 were 14.29%, 20-30 were 11.69%.

 

Table 2: Distribution of the patients as per the sex

The majority of the patients were Male i.e. 57.14% followed by Female were 42.86%

 

Table 3: Distribution of the patients as per the various clinical features

(*More than one symptoms were present in the patients so total may be more than 77) The most common clinical features were Fever in 94% followed by Myalgia in 92% Headache in 80%, Retro-orbital pain in 79%, Arthralgia in 68%, Rash in 43%, Diarrhea In 24%, Mucosal bleeding in 5%, Spontaneous bleeding of skins in 4%.

 

 

Table 4: Distribution of the patients as per the Outcome

The majority of the patients improved i.e. 82% and 16% Improved with Complications, DAMA was given in 1% and Death occurred in only 1%.

 

Table 5: Distribution of the factors associated with the poor outcome

(*More than one factors associated with patients so total may be >13) The most common factors associated were Old age (>50) in 69.23% followed by H/o Diabetes in 53.85%, H/o Hypertension in 53.85%, H/o CVD in 46.15%, H/o Smoking in 38.46%, Recurrent infection in 30.77%, Renal failure -23.08, H/o Immuno compromised disease - 15.38%

 

DISCUSSION

Dengue has recently become a major public health problem causing significant morbidity, mortality and economic loss. Dengue is endemic in more than 100 countries. Worldwide around 2.5 billion people live in dengue prone regions and about 100 million new cases are detected each year.⁶ The WHO 2009 classification divides dengue fever into two groups: uncomplicated and severe;⁷ though the 1997 WHO classification is still widely used, classifying dengue in to 3 groups: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS).^8,9 The resurgence of dengue has been observed in India and varied clinical presentations are being reported in the outbreaks reported from different geographical locations. ^10-16 Severity of dengue infection varies from influenza-like self-limiting illness to life-threatening complications like dengue hemorrhagic fever (DHF) and dengue shock syndrome. Thrombocytopenia in dengue is related to oxidative stress. ¹⁸ In our study we have seen that the majority of the patients were in the age group of 40-50 were 32.47%, followed by 50-60 Were 24.68%, 30-40 were 16.88%, >60 were 14.29%, 20-30 were 11.69%. The majority of the patients were Male i.e. 57.14% followed by Female were 42.86%. The most common clinical features were Fever in 94% followed by Myalgia in 92%, Headache in 80%, Retro-orbital pain in 79%, Arthralgia in 68%, Rash in 43%, Diarrhea in 24%, Mucosal bleeding in 5%, Spontaneous bleeding of skins in 4%. The majority of the patients improved i.e. 82% and 16% Improved with Complications, DAMA was given in 1% and Death occurred in only 1%. The most common factors associated were Old age (>50) in 69.23% followed by H/o Diabetes in 53.85%, H/o Hypertension in 53.85%, H/o CVD in 46.15%, H/o Smoking in 38.46%, Recurrent infection in 30.77%, Renal failure -23.08, H/o Immuno compromised disease - 15.38% These findings are similar to Frederico Figueiredo Amâncio et al¹⁹ they found A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death The mortality and other complications were more in this study this may be due to the fact that we have taken all patient but present study only taken the patients admitted to ICU hence the overall mortality and complications were more.

 

CONCLUSION

It can be concluded from our study that the majority of the patients were in the age group of 4^th or 5^th decade and male outnumbered than females, the most common clinical features were Fever and myalgia , the majority of the patients improved and the factors associated with poor outcome were Old age (>50), H/o Diabetes, H/o Hypertension, H/o CVD, H/o Smoking, Recurrent infection, Renal failure, H/o Immuno-compromised disease etc

 

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