Research Article - International Journal of Medical Research & Health Sciences ( 2023) Volume 12, Issue 1
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.
References
- Guzman MG, et al. Dengue: a continuing global threat. Nature Reviews Microbiology, Vol. 8, No. 8, 2010, pp. 7-16. [Crossref] [Google Scholar] [PubMed]
- Guzman MG and Kouri G. Dengue: an update. The Lancet Infectious Disease, Vol. 2, No. 1, 2002, pp. 33-42. [Crossref] [Google Scholar] [PubMed]
- WHO. Dengue: guidelines for diagnosis, treatment, prevention and control, Geneva, 2009.
- Thomas SJ, Strickman D and Vaughn DW. Dengue epidemiology: virus epidemiology, ecology and emergence. Advances in Virus Research, Vol. 61, 2003, pp. 235-289. [Crossref] [Google Scholar] [PubMed]
- Giri S, et al. Acute hepatic failure due to dengue: A case report. Cases Journal, Vol. 1, No. 1, 2008, pp. 204. [Crossref] [Google Scholar] [PubMed]
- Karoli R, et al. Clinical profile of dengue infection at a teaching hospital in North India. Journal of Infection in Developing Countries, Vol. 6, No. 7, 2012, pp. 551-554. [Crossref] [Google Scholar] [PubMed]
- Saha AK, Maitra S and Hazra SCh. Spectrum of hepatic dysfunction in 2012 dengue epidemic in Kolkata, West Bengal. Indian Journal of Gastroenterology, Vol. 32, No. 6, 2013, pp. 400-403. [Crossref] [Google Scholar] [PubMed]
- Trung DT, et al. Liver involvement associated with dengue infection in adults in Vietnam. The American Journal of Tropical Medicine and Hygiene, Vol. 83, No. 4, 2010, pp. 774-780. [Crossref] [Google Scholar] [PubMed]
- Parkash O, et al. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia). BMC Gastroenterology, Vol. 10, 2010, pp. 43. [Crossref] [Google Scholar] [PubMed]
- Agarwal R, et al. A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. The Southeast Asian Journal of Tropical Medicine and Public Health, Vol. 30, No. 4, 1999, pp. 735-740. [Google Scholar] [PubMed]
- Sharma S, et al. Clinical profile of dengue hemorrhagic fever in adults during 1996-outbreak in Delhi, India. Dengue Bulletin, Vol. 22, 1998, pp. 20-30.[Google Scholar]
- Daniel R and Philip AZ. A Study of Clinical Profile of dengue fever in Kollam, Kerala, India. Dengue Bulletin, Vol. 29, 2005, pp. 197-202.
- Singh NP, Jhamb R and Agarwal SK. Outbreak of dengue fever in Delhi, India. The Southeast Asian Journal of Tropical Medicine and Public Health, Vol. 36, No. 5, 2003, pp. 1174-1178.
- Harris E, et al. Clinical, epidemiological and Virologic Features of Dengue in the 1998 Epidemic in Nicaragua. The American Journal of Tropical Medicine and Hygiene, Vol. 63, No. 1-2, 2000, pp. 5-11. [Crossref] [Google Scholar] [PubMed]
- Agarwal R, et al. A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. The Southeast Asian Journal of Tropical Medicine and Public Health, Vol. 30, No. 4, 1999, pp. 735-740. [Google Scholar] [PubMed]
- Krishnamurthy K, Kasturi TE and Chittipantulu G. Clinical and pathological studies of an outbreak of Dengue like illness in Visakhapatnam. Indian Journal of Medical Research, Vol. 53, No. 8, 1965, pp. 800-812. [Google Scholar] [PubMed]
- Kalayanarooj S, et al. Early clinical and laboratory indicators of acute dengue illness. The Journal of Infectious Disease, Vol. 176, No. 2, 1997, pp. 313-321. [Crossref] [Google Scholar] [PubMed]
- (WHO) World Health Organization. Dengue hemorrhagic fever: diagnosis, prevention and control, 2nd edition, Geneva, 1997.