Research Article

Clinical profile of patient with dengue fever in a tertiary

care teaching hospital
Varsha Shah1, Uresh Jain2
1
Department of Medicine, GMERS Medical College, Gandhinagar, Gujarat, India.
2
Department of Medicine, GMERS Medical College, Sola, Ahmedabad, Gujarat, India.
Correspondence to: Varsha Shah, E-mail: dr.shahvarsha@gmail.com

Received August 3, 2016. Accepted August 24, 2016

Abstract

Background: Dengue fever is still evolving with involvement of newer areas, newer populations and is increasing in
magnitude, epidemic after epidemic. Dengue viral infection still remains challenge for the treating physician.
Objective: To study the clinical profile of patient with dengue fever in a tertiary care teaching hospital.
Materials and Methods: A retrospective, observational, single centre study was carried out on patients of dengue fever
attended to medicine ward of the period of 4 months (August–November 2015). The data of all the patients who came for
the treatment of dengue fever to the hospital in year 2015 was included for the analysis.
Result: Total 151 patients diagnosed as dengue fever based on detection of dengue non-structural protein 1 (NS1), anti-
dengue IgM in the blood samples. Majority of the patients were males (99, 65.56%). Maximum patients were in 18–30
years’ age group (70.86%). All the patient of dengue fever had fever as one of the presenting symptoms. Headache was
also found as presenting symptom in majority of patients (94.70%). It was found that thrombocytopenia (platelet count
<50,000/cumm) at presentation in 68 (45.03%) patients.
Conclusion: Dengue fever can have different clinical manifestations. Continuous sero-epidemiological surveillance and
timely interventions are needed to identify the cases, so that its complications, outbreak and mortality can be minimized.
KEYWORDS: Dengue fever, clinical profile, epidemiological surveillance

Introduction states are Delhi, West Bengal, Kerala, Tamil Nadu, Karnataka,
Maharashtra, Rajasthan, Gujarat, and Haryana.[4]
Dengue fever (DF) is a vector borne viral disease which The disease spectrum may vary with asymptomatic illness
occurs in tropical countries in urban and semi - urban areas.[1] to life threatening diseases like dengue haemorrhagic fever
Dengue fever is a major international public health problem.[2] (DHF) and dengue shock syndrome (DSS).[1] The patients with
It is caused by the 4 serotypes of the dengue virus belonging dengue fever typically present with the sudden onset of fever,
to arboviruses of the genus flaviviruses.[3] The vector for the frontal headache, retroorbital pain, and back pain along with
disease is the mosquito Aedes aegypti.[3] A majority of region severe myalgias—break-bone fever.[5] Additional signs and
of India is endemic for dengue fever.[1] The most affected symptoms including anorexia, nausea or vomiting, and cuta-
neous hypersensitivity may appear in illness.[5] Epistaxis and
scattered petechiae are often noted in uncomplicated dengue.[5]
The characteristic laboratory finding for the disease is leu-
Access this article online
kopenia.[6] Other laboratory findings include thrombocytopenia,
Website: http://www.ijmsph.com Quick Response Code: elevations of serum aminotransferase concentrations. The
DOI: 10.5455/ijmsph.2017.03082016595
diagnosis can be made by IgM ELISA or paired serology during
recovery or by antigen-detection ELISA or RT-PCR during the
acute phase.[6] There are no specific therapy management of
dengue, besides supportive care.[6] The principle of manage-
ment of disease include fluids, rest, and antipyretics.[6] Platelet
transfusions should be considered for severe thrombocytopenia

International Journal of Medical Science and Public Health Online 2017. © 2017 Varsha Shah. This is an Open Access article distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format
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International Journal of Medical Science and Public Health | 2017 | Vol 6 | Issue 1 165
 Shah and Jain: Clinical profile of patient with dengue fever

(less than 10,000/cmm) or when there is evidence of bleeding diagnosed as dengue fever based on detection of dengue non-­
in case of DF/DHF. Volume replacement by immediate admin- structural protein 1 (NS1), anti-dengue IgM in the blood samples.
istration of intravenous fluids to expand plasma volume is Out of 151 patients with dengue fever, majority of the
essential in DSS. patients were males (99, 65.56%). Females formed 34.44% of
Dengue fever still evolving with involvement of newer the cohort. Maximum patients were in 18–30 years’ age group
areas, newer populations and is increasing in magnitude, (70.86%) with mean age of 27.55 ± 10.00 years (Table 1).
­epidemic after epidemic. Dengue viral infection still remains All the patient of dengue fever had fever as one of the pre-
challenge for the treating physician. So this study was planned senting symptoms. Headache was also found as presenting
to study the clinical profile of disease in our hospital set-up. symptom in majority of patients (94.70%) followed by myalgia
(88.74%) and conjunctival suffusion (39.74%) (Table 2). On
clinical examination, hepatomegaly and splenomegaly was
Materials and Methods noted in 12 (7.95%) and 18 (11.92%) patients, respectively.
On laboratory investigations, it was found that thrombocy-
A retrospective, observational, single centre study was
topenia (platelet count <50,000/cumm) at presentation in 68
carried out on patients of dengue fever attended to medicine
(45.03%) patients. It kept on falling in some of the patients fur-
ward at Civil Hospital, Gandhinagar, a tertiary care teaching
ther during hospitalization with minimum platelet count found
hospital in western India during August–November 2015. The
was 9,000/cumm. Raised serum SGPT and SGOT was found
research protocol was presented to the institutional ethics
in 36 (23.84%) and 40 (26.49%) patients, respectively. S. total
committee (IEC) and approval was taken before commence-
bilirubin more than 2 mg/dL was found in 8 patients but clin-
ment of the study. Permission from medical superintendent
ical jaundice was found in only 3 patients. Leucopenia was
was obtained before conducting the study.
noticed in 15.23% of cases (Table 3).

Inclusion and Exclusion Criteria

Table 1: Distribution of the patient according to age and gender
All the patients of all age group and of either gender
came for screening at medicine department of dengue dur- Age (Years) Male Female Total
ing August–November 2015 period was included in the study. 18–30 68 39 107 (70.86%)
The patients with concomitant malaria, typhoid, leptospirosis 31–40 15 6 21 (13.91%)
etc. were excluded from the study. 41–50 10 7 17 (11.26%)
51–60 6 0 6 (3.97%)
Study Procedure Total 99 (65.56%) 52 (34.44%) 151 (100.00%)
The data of all the patients who came for the treatment of
dengue fever was included for the analysis. First, all the details
from the pathology department about cases of dengue fever Table 2: Distribution of the patient according to presenting symptoms
came for investigation was gathered as they were maintaining Symptoms N %
separate record for dengue fever patients. Then those case files
were collected from the medical record section for gathering Fever 151 100.00
detailed information. All necessary information like demographic Headache 143 94.70
data (age, gender, socioeconomic status etc.), clinical data (his- Myalgia 134 88.74
tory of illness, symptoms and signs, duration of stay), and drug Conjunctival suffusion 60 39.74
treatment (dosage regimen) was collected by reviewing the hos- Retro-orbital pain 43 28.48
pital case file and was recorded in the structured case record Skin rashes 43 28.48
form. All the gathered data was analyzed for demographic Abdominal pain 24 15.89
parameters, clinical presentation, and laboratory parameters. Nausea/Vomiting 12 7.95
Diarrhoea 8 5.30
Statistical Analysis Other 23 15.23
The data thus collected was subjected to statistical anal-
ysis using Microsoft excel. Data was expressed in actual Table 3: Laboratory parameters
­frequencies, percentage, mean, standard deviation as appropri-
ate. The difference in proportions was measured by chi-square Laboratory parameters N %
test and p value less than 0.05 was considered significant. Thrombocytopenia (<50,000/cumm) 68 45.03
Leucopenia (<4,000/cumm) 23 15.23
Result SGPT >55 IU/L 36 23.84
SGOT >45 IU/L 40 26.49
Based on this symptomatology, total 700 patients were S. Total bilirubin > 2 mg/dL 8 5.30
screened in the medicine department during the period of
Raised hematocrit (>45%) 35 23.18
August–November 2015. Out of this 700, total 151 patients

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 Shah and Jain: Clinical profile of patient with dengue fever

Discussion Conclusion

There is a steady increase in the number of dengue In conclusion, this study has revealed a varied clinical pro-
patients over the past few years was noted. India is one of file of dengue fever which is of important diagnostic value. In
the countries in the South-East Asia region regularly report- the recent few years, the world has seen varied clinical pres-
ing incidence of DF/DHF outbreaks due to its high incidence entation of the dengue fever in different epidemics, even in
which constantly threatens the health care system.[7] the same regions and even with the period of time. Where
This study describes the clinical profile, laboratory fea- some known features are still manifesting, few atypical fea-
tures, and outcome of dengue fever in adult patients. The tures are noted from several parts of the world. Continuous
identification of dengue fever is usually by clinical features seroepidemiological surveillance and timely interventions are
and they can present with varied manifestation.[8-13] Dengue is needed to indentify the cases, so that its complications, out-
an important emerging disease of the tropical and sub-tropi- break and mortality can be minimized.
cal regions. Since the first confirmed case of dengue in India,
during the 1940s, intermittent reports from Delhi, Ludhiana,
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