1Senior Resident, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Vananasi, India
2Ex Junior Resident, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Vananasi, India
3Associate Professor, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Vananasi, India
Dengue fever is mosquito born seasonal viral illness. There is increasing burden of dengue in India. Seeing the increasing number of cases and epidemics worldwide, WHO reclassified dengue classification in 2009. There has been very few studies of dengue fever based on new classification system and especially from this part of country, so we did a study of clinical spectrum and laboratory profile of dengue fever patients according to WHO classification 2009.
A prospective observational study, was carried out in Sir Sundar Lal hospital, Institute of medical sciences, Banaras Hindu University, Varanasi, after ethical approval from ethical committee of institute and taking proper consent from patients. Patients with incomplete follow up and records were excluded. Daily evolution of sign and symptoms, warning signs, postural fall of blood pressure were recorded. Suspected cases were considered as case of dengue fever based on the result of rapid diagnostic kit method. Laboratory profile like complete blood count, haematocrit, liver and renal function test, PT/INR (prothrombin time), activated partial thromboplastin time (aPTT), chest x-ray, electrocardiography (ECG) and ultrasonography (USG) abdomen and chest were documented.
Out of 99 patients of dengue fever, 15.2% were of dengue without warning sign, 72.7% were of dengue with warning sign, and 12.1% were of severe dengue. Plasma leakage was clinically detectable in 10% case while on ultrasonography it was present in 40.4% cases. Postural fall of blood pressure was present in 30% cases and was present earlier than rise in haematocrit in all cases. Mucosal bleeding was present in 12% cases (n=12) and most of them were minor bleeding. In 97% cases serum glutamic oxaloacetic transaminase (SGOT) was elevated more than serum glutamic pyruvic transaminase (SGPT), PT/INR was normal in all and aPTT>41 seconds was associated with risk of bleeding. Some cases had atypical manifestations like relative bradycardia (3%), transient eosinophilia (3%), hypokalemic paralysis (2%).
Most cases of dengue fever are of non-severe dengue with mucosal bleeding present in small proportion of patients and that too of minor variety. There is no correlation between bleeding manifestation and platelet count. Fluid leakage is present in good number of patients which is more evident sonographically. Our study showed that measurement of postural fall of blood pressure has potential to become early and important bedside clinical surrogate marker for detection of fluid leakage. More studies with large sample size is required to validate it.
Dengue fever, WHO classification 2009, serositis, postural fall of blood pressure, mucosal bleeding
