Dengue fever in a south Asian metropolis: a report on 219 cases
-
Shiv Sekhar Chatterjee
,
Ankush Sharma
,
Shilpee Chowdhury
,
Sushil Kumar Chumber
,
Ras Bage
,
Nittin Parkhe
,
Uma Khanduri
Abstract
Background and Objectives: Yearly epidemics of Dengue fever occur post-monsoon in India’s capital, Delhi. A prospective observational study was conducted during the outbreak months to understand the epidemiology and outcome of this infection and its economic impact.
Materials and Methods: Febrile hospitalized (n=219) patients with dengue fever diagnosed by a combination of MAC-ELISA, GAC-ELISA and NS1Antigen-ELISA were enrolled. Epidemiologic (including economic) parameters, clinical, radiological and laboratory manifestations were noted and patients followed up over the period of hospital stay. Patient management means and outcome were recorded and analysed.
Results: As per WHO-2009, 153 (69.9%) and 27 (12.3%) patients were classified as dengue with warning signs and Severe Dengue respectively while according to WHO-1997 guidelines 39 (17.8%) and 18 (8.2%) patients were classified as DHF and DSS respectively. 216 patients were from the city while three were travellers; hospitalization was more frequent among the young and male gender. Fever, vomiting, aches and abdominal pain were the most common troublesome manifestations; classical dengue triad was present in 55 (25.1%) patients; hemorrhagic, neurologic and mucocutaneous manifestations were present in 44 (20.1%), 8 (3.7%) and 70 (32%) patients. Ascitis, pleural effusion, and Gall bladder wall oedema was found in 53 (24.2%), 31 (14.1%) and 45 (20.5%) patients respectively. Mortality was 1.4% (3 deaths); in addition there was an intra-uterine fetal death; mean expenditure per patient during the illness was US$ 377.25.
Conclusion: Dengue virus infection results in immense morbidity and substantial mortality.
Guo RN, Lin JY, Li LH, Ke CW, He JF, Zhong HJ, et al. The prevalence and endemic nature of dengue infections in Guangdong, South China: an epidemiological, serological, and etiological study from 2005-2011. PLoS One 2014; 9: e85596.
World Health Organization (WHO) and the Special Programme for Research and Training in Tropical Diseases (TDR) (2009). Dengue guidelines for diagnosis, treatment, prevention and control. New Edition, Geneva, Switzerland.
Makroo RN, Raina V, Kumar P, Kanth RK. Role of platelet transfusion in the management of dengue patients in a tertiary care hospital. Asian J Transfus Sci 2007; 1: 4-7.
Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Gupta P, et al. Hematological observations as diagnostic markers in dengue hemorrhagic fever–a reappraisal. Indian Pediatr 2001; 38: 477-481.
Chaurasia R, Zaman S, Chatterjee K, Das B. Retrospective review of platelet transfusion practices during 2013 Dengue Epidemic of Delhi, India. Transfus Med Hemother 2015; 42: 227-231.
Daudé É, Mazumdar S, Solanki V. Widespread fear of dengue transmission but poor practices of dengue prevention: A study in the slums of Delhi, India. PLoS One 2017; 12: e0171543.
World Health Organization (1997). Dengue Hemorrhagic fever: Diagnosis, Treatment, Prevention and Control. 2nd edition, Geneva, Switzerland.
Balasubramanian S, Anandnathan K, Shivbalan S, Datta M, Amalraj E. Cut off Hematocrit for hemoconcentration in Dengue hemorrhagic fever. J Trop Pediatr 2004; 50: 123-124.
Benter T, Klühs L, Teichgräber U. Sonography of the spleen. J Ultrasound Med 2011; 30: 1281-1293.
Gosink BB, Leymaster CE. Ultrasonic determination of hepatomegaly. J Clin Ultrasound 1981; 9: 37-44.
Directorate of National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India (2008). Guidelines for clinical case management of dengue fever/ dengue hemorrhagic fever/ dengue shock syndrome, Delhi, India.
http://nvbdcp.gov.in/Doc/Clinical%20Guidelines.pdf (last accessed August 13, 2017).
World health Organisation: regional office for South-east Asia (2011). Comprehensive guidelines for prevention and control of dengue and dengue hemorrhagic fever. Revised and expanded edition, New Delhi, India. Available from: URL:
www.searo.who.int/entity/vector_borne_tropical_diseases/ (last accessed August 13, 2017).
Anand T, Kumar R, Saini V, Meena G, Ingle G. Knowledge and use of personal protective measures against mosquito borne diseases in a resettlement colony of delhi. Ann Med Health Sci Res 2014; 4: 227-232.
Shepard DS, Halasa YA, Tyagi BK, Adhish SV, Nandan D, Karthiga KS, et al. Economic and disease burden of dengue illness in India. Am J Trop Med Hyg 2014; 91: 1235-1242.
Himabindu BL, Arora R, Prashanth NS. Whose problem is it anyway? Crimes against women in India. Glob Health Action 2014; 7: 23718.
Shetty V, Sanil D, Shetty NJ. Insecticide susceptibility status in three medically important species of mosquitoes, Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus, from Bruhat Bengaluru Mahanagara Palike, Karnataka, India. Pest Manag Sci 2013; 69: 257-267.
Chatterjee N, Mukhopadhyay M, Ghosh S, Mondol M, Das C, Patar K. An observational study of dengue fever in a tertiary care hospital of eastern India. J Assoc Physicians India 2014; 62: 224-227.
Liu JW, Lee IK, Wang L, Chen RF, Yang KD. The usefulness of clinical-practice-based laboratory data in facilitating the diagnosis of dengue illness. Biomed Res Int 2013; 2013: 198797.
Thomas EA, John M, Bhatia M. Cutaneous manifestations of dengue viral infection in Punjab (north India). Int J Dermatol 2007; 46: 715-719.
Thomas EA, John M, Kanish B. Mucocutaneous manifestations of Dengue fever. Indian J Dermatol 2010; 55: 79-85.
Shukla V, Chandr A. A study of hepatic dysfunction in dengue. J Assoc Physicians India 2013; 61: 460-461.
Michels M, Sumardi U, de Mast Q, Jusuf H, Puspita M, Dewi IM, et al. The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. PLoS Negl Trop Dis 2013; 7: e2277.
Kittitrakul C, Silachamroon U, Phumratanaprapin W, Krudsood S, Wilairatana P, Treeprasertsuk S. Liver function tests abnormality and clinical severity of dengue infection in adult patients. J Med Assoc Thai 2015; 98 Suppl 1: S1-8.
Kularatne SA, Imbulpitiya IV, Abeysekera RA, Waduge RN, Rajapakse RP, Weerakoon KG. Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study. BMC Infect Dis 2014, 14: 141-150.
Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, et al. Evaluation of commercially available anti-dengue virus immunoglobulin M tests. Emerg Infect Dis 2009; 15: 436-440.
Blacksell SD, Jarman RG, Gibbons RV, Tanganuchitcharnchai A, Mammen MP Jr, Nisalak A, et al. Comparison of seven commercial antigen and antibody enzyme-linked immunosorbent assays for detection of acute dengue infection. Clin Vaccine Immunol 2012; 19: 804-810.
De Paula SO, Fonseca BA. Dengue: a review of the laboratory tests a clinician must know to achieve a correct diagnosis. Braz J Infect Dis 2004; 8: 390-398.
Andries AC, Duong V, Ngan C, Ong S, Huy R, Sroin KK, et al. Field evaluation and impact on clinical management of a rapid diagnostic kit that detects Dengue NS1, IgM and IgG. PLoS Negl Trop Dis 2012; 6: e1993.
Prince HE, Matud JL. Estimation of dengue virus IgM persistence using regression analysis. Clin Vaccine Immunol 2011; 18: 2183-2185.
Ngwe Tun MM, Muta Y, Inoue S, Morita K. Persistence of neutralizing antibody against dengue virus 2 after 70 years from infection in Nagasaki. Biores Open Access 2016; 5: 188-191.
Groen J, Koraka P, Velzing J, Copra C, Osterhaus AD. Evaluation of six immunoassays for detection of dengue virus-specific immunoglobulin M and G antibodies. Clin Diagn Lab Immunol 2000; 7: 867-871.
Hu D, Di B, Ding X, Wang Y, Chen Y, Pan Y, et al. Kinetics of non-structural protein 1, IgM and IgG antibodies in dengue type 1 primary infection. Virol J 2011; 8: 47.
Gyurech D, Schilling J, Schmidt-Chanasit J, Cassinotti P, Kaeppeli F, Dobec M. False positive dengue NS1 antigen test in a traveller with an acute Zika virus infection imported into Switzerland. Swiss Med Wkly 2016; 146: w14296.
Chung SJ, Krishnan PU, Leo YS. Two cases of false-positive dengue non-structural protein 1 (NS1) antigen in patients with hematological malignancies and a review of the literature on the use of NS1 for the detection of dengue infection. Am J Trop Med Hyg 2015; 92: 367-369.
Fry SR, Meyer M, Semple MG, Simmons CP, Sekaran SD, Huang JX, et al. The diagnostic sensitivity of dengue rapid test assays is significantly enhanced by using a combined antigen and antibody testing approach. PLoS Negl Trop Dis 2011; 5: e1199.
| Files | ||
| Issue | Vol 9 No 3 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Dengue fever Flavivirus Dengue Hemorrhagic fever Dengue shock syndrome | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
