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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 178-182

A study of clinical profile in different serological diagnostic parameters of dengue fever


Department of Medicine, JN Medical College, Belagavi, Karnataka, India

Date of Web Publication30-May-2017

Correspondence Address:
Rohit Morlawar
Department of Medicine, JN Medical College, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.ijhs_73_16

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  Abstract 

Background and Objectives: Dengue fever a mosquito borne viral infection poses an serious situation due to lack of antiviral drugs or vaccine.[1] Worldwide, an estimated 2.5 billion people are at risk of infection.[2] It is estimated that more than 50 million infections occur each year, of which 500,000 hospitalizations are of dengue haemorrhagic fever with the case fatality rate exceeding 5% in some areas. The objective of this research was to study the clinical profile in different serological diagnostic parameters of dengue fever.
Methodology: The present study was conducted in Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum In patients with dengue fever from January 2014 to December 2014.The study design was one year cross-sectional study. A total of 180 dengue fever patients were studied.
Results:

  • Out of 180 patients 72.22% of the patients were males and male to female ratio was 2.6: 1
  • In the study all the patients presented with fever (100%).
  • In this study 127 (70.56%) patients presented with melaena, the p value was 0.025
  • In the present study 113 (62.78%) patients presented with rash. p = 0.045.
  • Platelet count of 20000 to 49999/cumm was in 51 patients (28.33%) with a p = 0.010.
  • In this study serum creatinine levels were raised in 15% of the patients and the value was p = 0.029

Conclusion and Interpretation: The findings of this study highlight that clinical profile of dengue fever based on clinical features viz. rash, and laboratory parameters that is, platelet count, serum creatinine which showed significant variations in different dengue serological tests.

Keywords: Dengue, platelets, serum creatinine


How to cite this article:
Morlawar R, Kothiwale V A. A study of clinical profile in different serological diagnostic parameters of dengue fever. Indian J Health Sci Biomed Res 2017;10:178-82

How to cite this URL:
Morlawar R, Kothiwale V A. A study of clinical profile in different serological diagnostic parameters of dengue fever. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2019 Nov 15];10:178-82. Available from: http://www.ijournalhs.org/text.asp?2017/10/2/178/207269


  Introduction Top


Dengue fever (DF), a mosquito-borne viral infection, poses an serious situation due to lack of antiviral drugs or vaccine.[1] Worldwide, an estimated 2.5 billion people are at a risk of infection.[2] It is estimated that more than 50 million infections occur each year, of which 500,000 hospitalizations are of dengue hemorrhagic fever with the case fatality rate exceeding 5% in some areas.[1],[2],[3],[4]

India is one of the countries in the South-East Asian region regularly reporting the incidence of DF outbreaks and may soon transform into a major niche for dengue infection in the near future. The first confirmed report of dengue infection in India dates back to the 1940s.[5] Several fatal cases have been reported in India.[6],[7],[8],[9] Until the mid-1990s, dengue was reported from only three of the four South Indian states, Karnataka being one among them. All the four serotypes of the virus have been in circulation and documented.[10]

Dengue is transmitted by several species of mosquito within the genus Aedes, principally Aedes aegypti. The virus has four different types; infection with a given type usually confers lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications.[11]

The incubation period is 3–10 days, the illness starts with high fever, which is typically accompanied by headache, myalgia, arthralgia, and characteristic maculopapular skin rash. Mostly, the symptoms recover spontaneously. In a small proportion of cases, the disease progresses to a more severe life-threatening form which is characterized by hemorrhage, severe thrombocytopenia, and leakage of blood plasma, or to dengue shock syndrome.[11]


  Materials and Methods Top


  • The present study was conducted at the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, in patients with DF from January 2014 to December 2014
  • This was a 1-year cross-sectional study
  • Patients with DF admitted in the wards of Medicine Department were included in the study
  • A total of 180 DF patients were studied.


Inclusion criteria

  • Patients with confirmed dengue infection with either one of the following:
    • Isolated NS1 positive (IgM and IgG negative)
    • Isolated IgM positive (NS1 and IgG negative)
    • Isolated IgG positive (NS1 and IgM negative)
    • Both IgM and IgG positive (NS1 negative)
  • Patients' age more than 18 years with confirmed dengue infection.


Exclusion criteria

  • Patients with other coinfections, mixed infections, and known case of liver disease.


Ethical clearance

Prior to the commencement, the ethical clearance was obtained from the Institutional Ethics Committee, Jawaharlal Nehru Medical College, Belgaum.

Informed consent

Patients fulfilling the selection criteria were explained about the nature of the study, and a written informed consent was obtained.

Investigations

The data regarding the following investigations of the selected patients from case records done for the diagnosis and management of DF were documented in a predesigned pro forma dengue serology.

  • Platelet count
  • Serum creatinine.


Outcome variables

Dengue serology

The cases were isolated according to the positive dengue serology and were divided into four cohorts as follows:

  • NS1 positive
  • IgM positive
  • IgG positive
  • Both IgM and IgG positive.


Statistical analysis

The data obtained were coded and entered into Microsoft Excel Worksheet (Annexure III). The categorical data were expressed as rates, ratios, and proportions, and comparison was done using Chi-square test or Fisher's exact test. The continuous data were expressed as mean ± standard deviation. In case of more than three means, one-way ANOVA test was used for the comparison. A probability value (“P” value) of ≤0.05 at 95% confidence interval was considered statistically significant.


  Results Top


Distribution of patients according to the sex and dengue serology

In the present study, 72.22% of the patients were males. The male-to-female ratio was 2.6:1. Most of the males were IgG positive (80.33%) while most of the females were diagnosed IgM positive (50%). However, the difference was statistically insignificant (P = 0.182).

Distribution of patients according to the fever and dengue serology

In the present study, all the patients presented with fever (100%).

Distribution of patients according to the melena and dengue serology

In this study, 127 (70.56%) patients presented with melena, and of these, maximum patients were IgM and IgG positive (77.42%) and NS1 positive (74.47%) compared to IgG positive (67.21%) and IgM positive (30%). This difference was statistically significant (P = 0.025).

Distribution of patients according to the rash and dengue serology

In the present study, 113 (62.78%) patients presented with rash. Further, maximum patients with NS1 positive (74.47%), IgM positive (70%), and both IgM and IgG positive (66.13%) had rash compared to IgG positive (49.18%). This difference was statistically significant (P = 0.045).

Distribution of patients according to the platelet count and dengue serology

In this study, 32.26% of the patients with both IgM and IgG positive had a platelet count of <20,000/cumm compared to 21.18% of the patients with NS1 positive and 14.75% with IgG positive and no patients of IgM positive had platelet count <20,000/cumm (P = 0.010) [Graph 1].



Association of rash with platelet count

In the present study, significantly higher number of patients with platelet count of <20,000/cumm had rash (64.10%; P = 0.012).

Distribution of patients according to the serum creatinine levels and dengue serology

In this study, serum creatinine levels were raised in 26.23% of the patients with IgG positive compared to 8.51% of the patients with NS1 positive and 11.29% with both IgM and IgG positive, while none of the patients with IgM positive had raised serum creatinine levels (P = 0.029) [Graph 2].




  Discussion Top


To date, several studies [12],[13],[14],[15] have reported the clinical profile of DF using either IgM with IgG or NS1. Hence, the present study was an attempt to evaluate and correlate the clinical profile and laboratory parameters of DF patients with different serological diagnostic parameters.

The present 1-year cross-sectional study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, from January 2014 to December 2014. A total of 180 DF patients confirmed through dengue serology with either NS1 antigen or IgM and/or IgG antibody were studied.

Demographic data

In the present study, male preponderance was noted with 72.22% of the males. The male-to-female ratio was 2.6:1. Maximum males were IgG positive (80.33%) compared to females who were IgM positive (50%), but the difference was statistically insignificant (P = 0.182), suggesting that all the four tests were equally effective among both the genders despite male preponderance. An Indian study by Padbidri et al.[8] documented male:female ratio of 1.26:1.

In this study, the most common age group was 18–30 years comprising nearly half of the study population (50.56%). The mean age of the study population was 32.96 ± 12.79 years, and median age was 30 years with youngest patient being 18 years and oldest being 74 years. These findings were similar to that of the study from AIIMS by Sharma et al.[16] who reported a median age of 26.3 years and also similar to the Mexico study by Navarrete-Espinosa et al.,[17] that is, 26.9 years.

Clinical presentation

In the present study, fever was the universal symptom present in 100% of the cases. Similar findings were reported in other Indian studies by Sharma et al.[16] from AIIMS and V. S. Padbidri et al.[8] in Mangalore who found fever in all the patients.

Further, patients with rash were significantly higher in number of NS1 positive (74.47%), compared to other serology with a final P = 0.045. These findings prompt the physician for further assessment to evaluate the risk of bleeding and treat accordingly in patients.

Laboratory parameters

Sharma et al.[16] studied an outbreak of dengue hemorrhagic fever in Delhi and observed that, out of 98 patients, 94 (95.91%) had platelet count <1,00,000/mm 3 and 43.8% had severe thrombocytopenia, i.e., platelet count <20,000/mm 3.

In this study, platelet count was studied in different serologies which showed that both IgM and IgG positive had significantly higher number of patients with severe thrombocytopenia (<20,000/cumm), that is, 32.26% compared to other serology as shown in results with significant P = 0.010.

These findings propose a strong association of severe thrombocytopenia with IgM and IgG and provide clue for the vigorous management to avoid further complication of bleeding. This was evident as there was a positive association between platelet count and rash (P = 0.012).

However, in patients with IgM positive, 40% had platelet count of >1,00,000/cumm compared to others. These findings provide a hint that patients presenting with NS1 positive and both IgM and IgG positive are more likely to develop severe thrombocytopenia compared to the other two serologies. These findings indicate the role of different serological tests in determining thrombocytopenia and risk of bleeding which will help the treating physician in early identification, confirmation, and initiation of treatment so as to avoid the further consequences and complications of the DF.

A study by Kulkarni et al.[18] from Karnataka tried to evaluate the association of platelet counts against NS1 and IgM/IgG in dengue infections. Of the 320 cases, thrombocytopenia was more consistently associated whenever NS1 was detected compared to antibody detection (P < 0.001).

Jyothi and Metri [19] studied 39 cases who were positive for NS1 alone and observed thrombocytopenia in 20 cases (51.2%).

DF cases having NS1 positive have a higher risk of developing thrombocytopenia.[20] The present study and various studies also concluded the same.

Renal profile

Deranged renal function was noted in 15% of the patients as measured by serum creatinine levels. The raised serum creatinine levels were noted maximum, that is, 26.23% of the patients with IgG positive compared to other serologies. This difference between all the four dengue serological tests was statistically significant (P = 0.029). These findings show that patients presenting with IgG-positive serology are at a risk of renal failure.


  Conclusion Top


The findings of this study highlight significant variations in the clinical profile of DF based on clinical features, clinical examination, and laboratory parameters. Clinical features, namely, melena, and laboratory parameters, that is, platelet count and serum creatinine showed significant variations in different dengue serological tests.

Overall, the present study confirms variation in the clinical profile of DF within the different serological tests which is presumed to be helpful for the treating physician in case management and identification of patients who should be closely monitored.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Chaturvedi UC, Kapoor AK, Mathur A, Chandra D, Khan AM, Mehrotra RM. A clinical and epidemiological study of an epidemic of febrile illness with haemorrhagic manifestations which occurred at Kanpur, India, in 1968. Bull World Health Organ 1970;43:281-7.  Back to cited text no. 12
    
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Gupta E, Dar L, Kapoor G, Broor S. The changing epidemiology of dengue in Delhi, India. Virol J 2006;3:92.  Back to cited text no. 13
    
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Chakravarti A, Matlani M, Kashyap B, Kumar A. Awareness of changing trends in epidemiology of dengue fever is essential for epidemiological surveillance. Indian J Med Microbiol 2012;30:222-6.  Back to cited text no. 14
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Sharma S, Sharma SK, Mohan A, Wadhwa J, Dar L, Thulkar S, et al. Clinical profile of dengue hemorrhagic fever in adults during 1996 – Outbreak in Delhi, India. Dengue Bull 1998;22:20-7.  Back to cited text no. 16
    
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Navarrete-Espinosa J, Gómez-Dantés H, Celis-Quintal JG, Vázquez-Martínez JL. Clinical profile of dengue hemorrhagic fever cases in Mexico. Salud Publica Mex 2005;47:193-200.  Back to cited text no. 17
    
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Kulkarni RD, Patil SS, Ajantha GS, Upadhya AK, Kalabhavi AS, Shubhada RM, et al. Association of platelet count and serological markers of dengue infection- importance of NS1 antigen. Indian J Med Microbiol 2011;29:359-62.  Back to cited text no. 18
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