Profile of patients suffering from dengue: A cross sectional study

 

Khemchandra Dhanraj Borole^1*, Chandrayya Achanna Kante²

 

¹Associate Professor, ²Assistant Professor, Department of Medicine, Dr Ulhas Patil Medical College, Jalgaon, Maharashtra, INDIA.

Email: drkhem.b@gmail.com

 

Abstract              Background: India is one of the seven identified countries in the South-East Asia region regularly reporting incidence of DF and Dengue Hemorrhagic Fever outbreaks and may soon transform into a major niche for dengue infection. Aims and Objectives: To study the socio demographic characteristics, clinical and some laboratory profile of dengue patients admitted in Tertiary Care Hospital. Materials and Method: In the present cross sectional study all the cases of dengue diagnosed in the institute in the year 2014 were enrolled in the present study. All the patients suspected to be suffering from dengue were tested for rapid immune-chromatography (ICT) test. Thus total 92 cases of dengue were enrolled in the present study. Demographic data like age, gender, address and occupation was recorded on predesigned proforma. At admission detailed history was taken in every patient and thorough general and systemic examinations were carried out. Baseline investigations were done as per requirement at admission. The collected data was analyzed and presented with appropriate tables and graphs. Results: It was observed that majority of the patients suffering from dengue were young in the age group of 21-40 years of age. 52.17% of patients were male with 1.09:1 male to female ratio. The most common presenting symptom was fever which was observed in all the patients followed by headache (75%), arthalgia (68.48%) and bodyache (59.78%). myalgia (55.43%), retro-orbital pain (54.35%) and rash (53.26%) etc. were also observed. 51.09% patients were having platelet count more than one lakh/cmm whereas 31.52% were having count between 50000 to 1lakh. Majority of the patients (48.91%) were having total leukocyte count less than 4000cmm. Hematocrit was raised in 35.87%. Conclusion: The most commonly affected age group due to dengue was young and fever, headache, arthalgia, bodyache and myalgia were the common presenting symptoms. Leucopenia and raised hematocrit was the common laboratory finding.

Key Words: Dengue, epidemiology, laboratory investigation, symptoms.

 

INTRODUCTION

India is one of the seven identified countries in the South-East Asia region regularly reporting incidence of DF and Dengue Hemorrhagic Fever outbreaks and may soon transform into a major niche for dengue infection¹. Dengue infection presents with varied clinical manifestation ranging from asymptomatic or simple viral illness to circulatory shock (DSS). Dengue infection has the potential to cause severe bleeding, shock and death. So, early diagnosis and recognition of complication is cornerstone in management. Even though, Dengue infection admissions are common in pediatric age group, but adult patient admission have also increased in recent years. During the 19^th century, dengue was considered a sporadic disease, causing epidemics at long intervals. However, dramatic changes in this pattern have occurred and currently, dengue ranks as the most important mosquito borne viral disease in the world. In the past 50 years, its incidence has increased 30-fold with significant outbreaks occurring in five of six World Health Organization (WHO) regions. At present, dengue is endemic in 112 countries in the world.² Dengue fever is characterized by fever, headache, muscle and joint pains, rash, nausea and vomiting. It can lead to-“classical” dengue fever, dengue hemorrhagic fever without shock, dengue hemorrhagic fever with shock. It has become a major public health concerns. About 50 million infections occur worldwide annually³. In most cases of dengue fever, platelet counts and serum biochemistry are normal. However, leucopenia, thrombocytopenia, and raised liver enzymes may be seen.

 

MATERIALS AND METHOD

The present cross sectional study was conducted in the department of community medicine of Dr Ulhas Patil Medical College, Jalgaon. All the cases of dengue diagnosed in the year 2014 were enrolled in the present study. All the patients suspected to be suffering from dengue were tested for rapid immune-chromatography (ICT) test including dengue NS1 Antigen and Dengue specific IgM and IgG antibodies. Patients showing test positive for NS1antigen with or without antibodies, patients with either IgM or IgG antibodies positive or those positive for both antibodies included in the study. Thus total 92 cases of dengue were enrolled in the present study. Demographic data like age, gender, address and occupation was recorded on predesigned proforma. At admission detailed history was taken in every patient and thorough general and systemic examinations were carried out with special attention to the symptoms of the patient, conscious level, temperature, pulse, blood pressure, pallor, icterus, skin lesion bleeding manifestations, hepatosplenomegaly, ascites and pleural effusion. Baseline investigations like complete blood count, platelet count, haematocrit, liver function test, kidney function test, coagulation profile like prothrombin time, activated partial thromboplastin time, bleeding time, clotting time, X-ray chest, ultrasound abdomen were done as per requirement at admission. The collected data was analyzed and presented with appropriate tables and graphs.

 

RESULTS

Table 1: Age and sex wise distribution of patients

		No. of patients	%
Age group	≤20	4	4.35
	21-40	44	47.83
	41-60	29	31.52
	>60	15	16.30
Sex	Male	48	52.17
	Female	44	47.83

It was observed that majority of the patients suffering from dengue were young in the age group of 21-40 years of age. 52.17% of patients were male with 1.09:1 male to female ratio.

 

Table 2: Distribution of patients according to presenting symptoms

*Multiple responses were obtained

The most common presenting symptom was fever which was observed in all the patients followed by headache (75%), arthalgia (68.48%) and bodyache (59.78%). myalgia (55.43%), retro-orbital pain (54.35%) and rash (53.26%) etc. were also observed.

 

Figure 1

 

Table 3: Distribution according to laboratory findings

It was observed that 51.09% patients were having platelet count more than one lakh/cmm whereas 31.52% were having count between 50000 to 1lakh. Majority of the patients (48.91%) were having total leukocyte count less than 4000cmm. Hematocrit was raised in 35.87%.

 

DISCUSSION

The present study was conducted in the department of medicine of Dr Ulahs Patil Medical College, Jalgaon to study the profile of patients suffering from dengue. It was seen that majority of the patients (47.83%) suffering from dengue were young in the age group of 21-40 years of age. Kendre Varsharani et al⁴ and S. Saini et al⁵ also observed similar finding in their studies. Children were predominantly affected, but in recent years clinicians have seen increasing numbers of adult dengue patients⁶, with both significant morbidity and mortality. This rise in incidence among adults adversely affects developing countries economy. It also affects health planning, and is further compounded by the general lack of systematically collected information on the natural history of dengue in such patients. This often leads health planners and clinicians to base their decisions regarding resource allocation and clinical management on personal experiences, rather than on tangible evidence. 52.17% of patients were male with 1.09:1 male to female ratio. As compared to present study higher male to female ratio was observed by Agarwal et al⁷ in which male to female ratio was 1.9:1. Another study conducted by Sharma et al⁸ showed that male to female ratio was 3:1. Dengue infections may present as asymptomatic or give rise to undifferentiated fever, dengue fever, DHF, or dengue shock syndrome. The most common presenting symptom was fever which was observed in all the patients followed by headache (75%), arthalgia (68.48%) and bodyache (59.78%). myalgia (55.43%), retro-orbital pain (54.35%) and rash (53.26%) etc. were also observed. Sharma et al⁸ also observed fever as the most common presenting symptom. The other symptoms reported by them were bodyache (98%), vomiting (28%) loose motion (12.7%), abdominal pain (10.5%), skin rash (43.1%) and altered sensorium (0.5%). In another study by Eva Harris et al⁹ also fever was the most common presenting symptom. 91% had bodyache, 83% had vomiting, 15% had loose motion 48% had abdominal pain and 56% had skin rash as presenting symptoms. It was observed that 51.09% patients were having platelet count more than one lakh/cmm whereas 31.52% were having count between 50000 to 1lakh. Ritu Karoli et al¹⁰, Rachel Daniel et al¹¹, Malavige et al¹² and NP Singh et al¹³ also observed thrombocytopenia in majority of the patients. Majority of the patients (48.91%) were having total leukocyte count less than 4000cmm. Similar findings were also reported by Krishnamurthy K et al¹⁴ and Fu-Xi Qiu et al^15. Thus leukocytopenia is associated with dengue. Hematocrit was raised in 35.87%. Malavige et al¹² and NP Singh et al¹³ also observed similar findings in their study.

 

CONCLUSION

Thus we conclude that the most commonly affected age group was young and fever, headache, arthalgia, bodyache and myalgia were the common presenting symptoms. Leucopenia and raised hematocrit was the common laboratory finding.

 

REFERENCES

 

1. Kumar A, Rao CR, Pandit V et.al.: Clinical manifestations and trend of Dengue cases admitted in a tertiary care hospital, Udupi District, Karnataka. Indian J Commun Med 2010;55: 586-590.
2. N Malavige, S Fernando, D J Fernando, S L Seneviratne; Dengue viral infections; Postgrad Med J 2004;80:588–601.
3. Park K.: Park’s Textbook of Preventive and Social Medicine. 22nd Ed. Jabalpur. Banarasidas Bhanot; 2013: p224-232.
4. Kendre Varsharani, Shekde S. D., Chinte L. T. The Study of Clinico-epidemiological Features of Dengue Cases Admitted in Tertiary Care Hospital, Latur, Maharashtra. International Journal of Recent Trends in Science And Technology.2014; 10(2): 369-372.
5. S. Saini, Anagha G Kinikar: Epidemiology and seropositivity of dengue fever cases in a rural tertiary care hospital of western Maharashtra, India. International Journal of Biomedical And Advance Research 2013; 04 (07):743-749.
6. Wali JP, Biswas A, Handa R, et al. Dengue haemorrhagic fever in adults: a prospective study of 110 cases. Trop Doct 1999;29:27–30.
7. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, et al. A clinical study of the patients with dengue haemorrhagic fever during the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med Public Health. 1999; 30(4): 735-40.
8. Sharma S, Sharma SK, Mohan A. Clinical profile of Dengue haemorrhagic fever in Adults during - 1996 outbreaks in Delhi, India. Dengue Bull 1998; 22: 1-7.
9. Harris E, Videa E, Perez L, Sandoval E, Tellez Y, Perez ML, et al. Clinical, Epidemiological and Virologic Features of Dengue in the 1998 Epidemic in Nicaragua. Am J Trop Med Hyg 2000; 63(1,2): 5-11.
10. Ritu Karoli, Jalees Fatima, Zeba Siddiqi et.al.: Clinical profile of dengue infection at a teaching hospital in North India. J Infect Dev Ctries 2012; 6(7):551-554.
11. Rachel Daniel, Rajamohanan and Aby Zachariah Philip:A Study of Clinical Profile of Dengue Fever in Kollam, Kerala, India. Dengue Bulletin. 2005, Vol 29, 197-205.
12. G.N. Malavige, V.G.N.S. Velathanthiri et al; Patterns of disease among adults hospitalized with dengue infections; Srilanka; Q J Med 2006; 99:299–305.
13. Janak Kishore, Jagdeep Singh, T.N. Dhole and A. Ayyagari; Clinical and Serological Study of First Large Epidemic of Dengue in and around Lucknow, India, in 2003; Dengue Bulletin – Volume 30, 2006; 72-79.
14. Krishnamurthy K, Kasturi TE, Chittipantulu G. Clinical and pathological studies of an outbreak of Dengue like illness in Visakhapatanam. Ind J Med Res 1965; 53(8): 800-12.
15. Qui FX, Gubler DJ, Liu JC, Chen QQ. Dengue in China. A clinical review. Bull World Health Organ 1993; 71(3/4): 349-59.

 

 

 

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