Research Article - International Journal of Medical Research & Health Sciences ( 2024) Volume 13, Issue 3
Study of Haemodynamic Instability in Dengue Fever and its Correlation with Thrombocytopenia, Hematocrit and Deranged Lft at Tertiary Care Hospital, RIMS, Ranchi
Abhay Kumar1, Arif Tauheed1* and Bushra Afreen22Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
Arif Tauheed, Department of Medicine, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, Email: harrobins11@gmail.com
Received: 05-Sep-2022, Manuscript No. IJMRHS-22-73678; Editor assigned: 07-Sep-2022, Pre QC No. IJMRHS-22-73678; Reviewed: 21-Sep-2022, QC No. IJMRHS-22-73678; Revised: 04-Nov-2022, Manuscript No. IJMRHS-22-73678; Published: 11-Jan-2023
Abstract
Background: Dengue fever has been known for more than a century in the tropical countries. Dengue fever is now the most common cause of arboviral disease in the world, with an estimated annual occurrence of 100 million cases of dengue fever and 250,000 cases of dengue haemorrhagic fever and a mortality rate of 25,000 per year. Most cases of dengue haemorrhagic fever are reported from Asia, where it is a leading cause of hospitalization and death among children. The virus seems to have some hepatotoxic effects. Affliction of liver in form of derangements in the liver function tests is common and may include mild elevations in serum bilirubin, elevated transaminases and derangements in serum albumin. Although asymptomatic in most cases, clinical manifestations like jaundice and Acute Liver Failure (ALF) may occasionally complicate the clinical picture. Indeed, dengue has been implicated as an important cause of ALF in endemic countries. Dengue is diagnosed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) and detection of NS1 antigen with corresponding IgM, IgG antibodies by enzyme immunoassay and immune-chromatographic test. These tests may not be available in the periphery. So the haematological parameters like platelet count, haematocrit, leukocyte count and peripheral smear findings will aid in the diagnosis of dengue fever.
Materials and methods: 50 cases with proven diagnosis of dengue by serology were taken. Detailed history, physical examination and investigations including complete blood count, coagulation profile, and liver function tests were done. Their stay in hospital and outcome were observed.
Results: Dengue infection was more common in adult age group with slight male preponderance (38/50). It presented commonly as dengue fever with other constitutional symptoms. Petechial ecchymosis was the most common sign elicited clinically (19/50). Haematological findings like raised hemotocrit (30/50) with decreased platelet count (30/50) were seen in majority of the cases. Supportive treatment was the mainstay mode of management.
Conclusion: Raised hematocrit, thrombocytopenia, leucopenia and atypical lymphocytes in the peripheral smear will aid in early diagnosis of dengue infection. Early recognition and prevention rather than treatment of complications is most important for favourable outcome of the disease.
Keywords
Dengue, Viral hepatitis, Acute liver failure, Transaminases, Bilirubin
Introduction
Dengue or “break bone fever” has gradually evolved as one of the important causes of febrile illness in the tropical and subtropical region. Dengue must be considered as a differential in the evaluation of acute hepatic failure and as an acute precipitant in patients presenting with acute on chronic liver failure. It is the most common cause of arboviral disease globally. Around 2.5 billion people in 100 endemic countries are believed to be susceptible, so are the equally significant numbers of travellers to these tropical and subtropical regions [1,2]. Presenting with a wide range of severity, “severe” dengue (Group C) as categorized by World Health Organization (WHO) in 2009 includes the Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) [3]. Despite the inadequate surveillance of cases from the underdeveloped tropical countries, the average number being reported per year has increased drastically [4]. This disease has been found to have profound effect on multiple organ systems, the commonest being the liver. Starting from asymptomatic elevated transaminase levels to Acute Liver Failure (ALF), dengue has all the properties of a hepatic illness. Clinical features suggesting dengue related hepatic involvement are the presence of liver enlargement and elevated transaminases [5]. The frequency of hepatomegaly in the adult dengue patients ranges from 4%-52% [6-8]. Clinical jaundice has been detected in 1.7%-17% in various series [9] and hyperbilirubinemia has been found to be as high as 48%.
Materials and Methods
50 cases with proven diagnosis of dengue by serology were taken. Detailed history, physical examination and investigations including complete blood count, coagulation profile, liver function tests were done [10]. Their stay in hospital and outcome were observed.
Results
The male: Female ratio was 3:1, majority of the patients were in the age group of 15 to 35 years and only few patients were more than 55 years of age [11]. Fever was the most common presenting symptom followed by vomiting, backache and myalgia. Out of 50 patients, 60% had increased hematocrit level, 40% had normal hematocrit. Thrombocytopenia was seen in 60% of patients as shown in supplementary Table. Leukocyte count was normal in majority of the cases as shown in table. Majority of the patients with deranged LFT had greater rise in SGOT as compared to SGPT in the present study [12-14].
Discussion
In the present study, the sex ratio was comparable to the studies done by Agarwal and Sharma with males being affected the most [15,16]. Fever was the most common mode of presentation as was also seen in studies done by Sharma Rachel Daniel, SK Agarwal and Eva Harris [17,18]. Petechial/ecchymosis was the most common sign seen in our study as well as study done by Sharma S, while the studies done by Rachel Daniel and Krishnamurthy K showed hepatomegaly as the most common sign of presentation. Dengue viral infection presents most commonly as dengue fever as seen in our study as well as studies done by Eva Harris and Kalayanarooj S. Hemoconcentration with an increase in the hematocrit of 20% or more is considered to be definitive evidence of increased vascular permeability and plasma leakage. In the present study, Hct >20% was present in 30 (60%) of cases.
Conclusion
Thrombocytopenia is a better marker of hemodynamic instability rather than higher grades of liver enzyme rise in dengue patients.
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