Printer Friendly

A study of clinical profile of dengue fever in a government general hospital, Nizamabad.

BACKGROUND

Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. [1] Symptoms typically begin three to fourteen days after infection. [2] This may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. [1,2]

Recovery generally takes two to seven days. [1] In a small proportion of cases, the disease develops into the life-threatening dengue haemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs. [2] Dengue has become a global problem since the Second World War and is common in more than 110 countries. [3,4] Each year between 50 and 528 million people are infected and approximately 10,000 to 20,000 die. [5-8] The earliest descriptions of an outbreak date from 1779. [4] Its viral cause and spread were understood by the early 20th century. [9]

Dengue Fever is a major health problem in our country. India is one of the seven countries in the South-East Asia region regularly reporting incidence of DF/DHF outbreaks due to its high incidence which constantly threatens the health care system. The first confirmed report of dengue infection in India dates back to 1940s, and since then more and more new states have been reporting the disease which mostly strikes in epidemic proportions often inflicting heavy morbidity and mortality. [10] The common signs and symptoms observed were fever, headache, myalgia, arthralgia, and bleeding manifestations have also been observed. The exact clinical profile is important for patient management and thus crucial for saving life. The present study is an attempt to describe the salient clinical as well as laboratory findings of serologically confirmed hospitalised cases of dengue fever during the study period. The study group represented the adult population.

Nizamabad district is one of the endemic area for dengue fever in Telangana state. There are very less studies in this district, this makes me to take up this study.

MATERIALS AND METHODS

Methodology

The study was undertaken as a hospital based descriptive study with prospective data collection at Government General Hospital, Nizamabad. The questionnaire was developed and based on a review of literature. The questionnaire was tested. The data was collected using a questionnaire. Hundred patients with confirmed dengue fever admitted to Government General Hospital during 5 months period from May 2016 to September 2016 were selected for this study. NS1 antigen and IgM dengue antibody-positive cases were included. These patients were admitted with fever, myalgia, headache, vomiting, abdominal pain or bleeding manifestations. NS1 antigen and IgM dengue antibody was estimated using capture ELISA. The diagnosis of dengue fever, dengue haemorrhagic fever and dengue shock syndrome was based on the WHO criteria. [11] Patients who had malaria and enteric fever were excluded from the study. Patients who did not give their consent was excluded.

Study Design

Hospital based descriptive study.

Study Setting

Government General Hospital, Nizamabad.

Study Population

Adults above 15 years of age who are confirmed having dengue fever.

Sample Size

100 patients.

Study Period

May 2016 to September 2016.

Data Collection

By using a pre-designed, pretested questionnaire.

Data Analysis

By Using MS office 2003. Epi info 2007.

Statistical Test

Rates, Ratios, Proportions and Chi-square tests.

Inclusion Criteria

Above 15 years age group who are confirmed having dengue fever.

Exclusion Criteria

Patients who had malaria and enteric fever and persons who are not willing to give consent.

RESULTS

A total of 100 cases admitted to the hospital in May 2016 to September 2016 were statistically analysed. Most of dengue cases occurred during the month of June to September which depicts the role of rainy season on clustering of cases. Majority of the cases, 62% were male and 38% were female. Maximum number of cases (25%) were in the age group of 21-30 years (as seen in Table 1). As seen in Table 2, fever was present in all cases and is the most common symptom followed by headache (93%), myalgia (90%), vomiting (62%), abdominal pain (39%). breathlessness (20%), skin rash (8%), and altered sensorium (13%). Haemorrhagic manifestations (5%) included petechiae, ecchymosis, gum bleeding, haematuria, melaena, hematemesis and epistaxis (as seen in Table 3). In the study, 43 patients had complications of which most common were hepatic dysfunction 23%, renal failure 14%, multiorgan failure 2%, encephalopathy 2% and ARDS in 2%.

DISCUSSION

Present study describes the clinical profile, laboratory features and outcome of DF/DHF/DSS in adult patients. Since the first confirmed case of dengue in India, during the 1940s, intermittent reports from Delhi, [12,13] Ludhiana, [14] Mangalore, [15] Vellore [16] and from other states have been published. The identification is by clinical features but they can present with varied manifestation. [12-13] There is a steady increase in the number of dengue patients over the past few years. This is due to the rapid urbanisation with unplanned construction activities and poor sanitation facilities contributing fertile breeding grounds for mosquitoes. A gradual increase in cases was noticed from June with a peak in September, during all the seven years of the study. These findings highlight that preventive measures against dengue infection should be taken during water stagnation periods after the initial bouts of rainfall and at the end of monsoon. The study revealed that majority of the cases were in the age group of 15-40 years. The clinical profile of dengue revealed that fever was the most common presenting symptom (100%). Similar studies in and around India have also substantiated fever as being the most common presenting symptom. Abdominal pain and vomiting were due to the liver injury caused by the dengue virus. An exclusive study on dengue shock syndrome conducted in Mumbai in 2003 reported hepatomegaly (97.4%), altered sensorium (58%), diarrhoea (50%), rash (42%), and cough (38%) in a significant number of cases. Headache was also seen less frequently compared to other studies. This has also been documented in our study. Retroorbital pain as a cardinal feature of dengue fever was seen in few of our patients. Haemorrhagic manifestations (5%) included petechiae, ecchymosis, gum bleeding, haematuria, melaena, hematemesis and epistaxis. In the study, 47 patients had complications of which most common were hepatic dysfunction 23%, renal failure 14%, multiorgan failure 2%, encephalopathy 2% and ARDS in 2%.

CONCLUSION

At present dengue infection is a major health problem in our country, especially in Telangana state. This study supports further studies on applying interventional measures to improve the diagnostic accuracy and precision at the primary healthcare level in dengue endemic regions. This study highlights the importance of dengue fever to the clinicians in the areas of epidemiology, manifestations, complications and outcome of the disease. This study may be helpful to conduct further studies.

REFERENCES

[1] Dengue and severe dengue. Fact sheet N[degrees]117. WHO 2016.

[2] Kularatne SA. Dengue fever. BMJ 2015;351:h4661.

[3] Ranjit S, Kissoon N. Dengue hemorrhagic fever and shock syndromes. Pediatr Crit Care Med 2011;12(1):90-100.

[4] Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 1998;11(3):480-96.

[5] Whitehorn J, Farrar J. Dengue. Br Med Bull 2010;95:161-73.

[6] Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature 2013;496(7446):504-7.

[7] Carabali M, Hernandez LM, Arauz MJ, et al. Why are people with dengue dying? A scoping review of determinants for dengue mortality. BMC infectious diseases 2015;15:301.

[8] Stanaway JD, Shepard DS, Undurraga EA, et al. The global burden of dengue: an analysis from the global burden of disease study 2013. Lancet Infectious diseases 2016;16(6):712-23.

[9] Henchal EA, Putnak JR. The dengue viruses. Clin Microbiol Rev 1990;3(4):376-96.

[10] Dengue in Kerala: a critical review. ICMR Bulletin 2006;36(4-5):13-22.

[11] World Health Organization. Dengue and dengue haemorrhagic fever. Fact Sheet No: 117, 2002. Available from: http//www.who.int/mediacentre/factsheets/fs117/e n/.

[12] Sulekha C, Kumar S, Philip J. Guillain-Barre syndrome following dengue fever. Indian Pediatr 2004;41(9):948-50.

[13] Prabhakar H, Mathew P, Marshalla R, et al. Dengue haemorrhagic fever outbreak in October-November 1996 in Ludhiana, Punjab, India. Indian J Med Res 1997;106:1-3.

[14] Faridi MM, Anju A, Kumar M, et al. Clinical and biochemical profile of dengue haemorrhagic fever in children in Delhi. Trop Doct 2008;38(1):28-30.

[15] Padibidri VS, Adhikari P, Thakare JP, et al. The 1993 epidemic of dengue fever in Mangalore, Karnataka state, India. Southeast Asian J Trop Med Public Health 1995;26(4):699-704.

[16] Cherian T, Ponnuraj E, Kuruvilla T, et al. An epidemic of dengue haemorrhagic fever & dengue shock syndrome in and around Vellore. Indian J Med Res 1994;100:51-6.

Thirupathi Rao J (1), Syam Sundar Junapudi (2)

(1) Assistant Professor, Department of General Medicine, GMC, Nizamabad.

(2) Assistant Professor, Department of Community Medicine, GMC, Nizamabad.

Financial or Other, Competing Interest: None.

Submission 16-03-2017, Peer Review 12-04-2017, Acceptance 17-04-2017, Published 24-04-2017.

Corresponding Author:

Thirupathi Rao J, Assistant Professor, Department of General Medicine, GMC, Nizamabad.

E-mail: drthirujalagam1234@gmail.com

DOI: 10.14260/jemds/2017/580
Table 1. Age Characteristics of Patients with Dengue Fever

Age       Male     Female   Total
(Years)   (N=62)   (N=38)   (N=100)

 16-20      14       6        20
 21-30      18       7        25
 31-40      12       8        20
 41-50      9        9        18
 51-60      6        7        13
  >60       3        1         4

Table 2. Symptoms of Dengue Fever

Symptoms                             Patients (N=100)

Fever                                      100
Headache                                    93
Myalgia                                     90
Vomitings                                   62
Abdominal pain                              39
Breathlessness                              20
Skin rash                                   8
Bleeding tendency                           5

Table 3. Complications of Dengue Fever

Complications                 Patients (N=100)

No associated Complications          57
Hepatic dysfunction                  23
Renal failure                        14
Multiorgan failure                   2
Encephalitis                         2
ARDS                                 2

Symptoms of Dengue Fever

Bleeding tendency     5
Skin rash             8
Breathlessness       20
Abdominal pain       39
Vomitings            62
Myalgia              90
Headache             93
Fever               100

Note: Table made from bar graph.

Complications of Dengue Fever

Patients (N=100)

ARDS                            2
Encephalitis                    2
Multi organ failure             2
Renal failure                  14
Hepatic dysfunction            23
No associated Commplications   57

Note: Table made from bar graph.
COPYRIGHT 2017 Akshantala Enterprises Private Limited
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Research Article; Nizamabad, India
Author:Thirupathi, Rao J.; Junapudi, Syam Sundar
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Apr 24, 2017
Words:1674
Previous Article:Thyroid dysfunction in SLE and association of thyroid antibody levels with disease activity in SLE.
Next Article:Comparison of ondansetron, granisetron and dexamethasone for prevention of postoperative nausea and vomiting in thyroidectomy patients in our rural...
Topics:

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters