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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 128-131  

Demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital


Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

Date of Web Publication18-May-2018

Correspondence Address:
Tanvi Ajay Bafna
Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_131_17

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  Abstract 


Context: Dengue is an acute febrile disease transmitted by bite of Aedes aegypti mosquito. It leads to “classical” dengue fever, dengue hemorrhagic fever with/without shock. The disease is prevalent throughout India and Maharashtra recorded 5610 dengue cases in 2013 with 48 deaths and 3551 cases with 7 deaths until 29th October 2014. Aims: To study demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital in Pune. Settings and Design: This was a cross-sectional record-based study. Population of Inpatients of tertiary hospital, Pune, admitted during June 1, 2016–November 31, 2016. Materials and Methods: Records of indoor patients admitted used to fill prestructured pro forma. Data were entered into Microsoft Excel to calculate percentages. Results: A total of 299 patients' records were assessed. Patients belonging to age group of 0–30 years were 70.16% (210). Out of 299 patients, 63.21%were males. The common symptoms were fever with chills in 87% patients and headache/body ache in 89% of patients. Stay in hospital for 95.29% (285) was a week. Approximately 31% (92) patients had a platelet count of 10,000–40,000 and 99.6% (269) patients did not require platelet transfusion. Ns1Ag positive were 81% patients. The most common complication was thrombocytopenia (79%). Conclusion: Age group 21–40 years was affected. Ns1Ag positive were 81% patients, blood transfusion not required by majority.

Keywords: Dengue, inpatients, serological positive


How to cite this article:
Mehta SR, Bafna TA, Pokale AB. Demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital. Med J DY Patil Vidyapeeth 2018;11:128-31

How to cite this URL:
Mehta SR, Bafna TA, Pokale AB. Demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Nov 21];11:128-31. Available from: http://www.mjdrdypv.org/text.asp?2018/11/2/128/232637




  Introduction Top


Dengue or “bone breaking fever,” an acute febrile disease transmitted by the bite of an Aedes aegypti mosquito infected with any one of the four dengue viruses, is common in tropical and subtropical regions around the world.[1] Dengue fever (DF) is characterized by fever, headache, muscle and joint pains, rash, nausea, and vomiting.[1] It can lead to “classical” DF, dengue hemorrhagic fever (DHF) without shock, and DHF with shock.[1]

DF, with its severe manifestations, DHF and Dengue Shock Syndrome (DSS), has emerged as a great public health concern in the recent years.[2]

Over 2.5 billion people – over 40% of the world's population – are now at risk from dengue.[3] The WHO currently estimates there may be 50–100 million dengue infections worldwide every year.[3] It is of particular importance in South East Asia, which bears a high burden of dengue.[1] The disease is prevalent throughout India in most of the metropolitan cities and towns with outbreaks reported from rural areas of Haryana, Maharashtra, and Karnataka.[3] Maharashtra recorded 5610 dengue cases in the year 2013 with 48 deaths and 3551 cases with 7 deaths until October 29, 2014.[3]

The increase in number of dengue cases is due to uncontrolled population growth, urbanization, inappropriate water management, and other human habits.[4] Improper disposal of waste and sewage are responsible for high mosquito densities.[4] This is the cause for postmonsoon epidemics in country like India.[4]

With this background, we aimed to study the sociodemographic and clinical profile of dengue patients admitted in tertiary care hospital.


  Materials and Methods Top


Study area – Tertiary care hospital in Pune.

Study population - Inpatients of a tertiary care center in Pune.

Study sample - Inpatients who were serologically tested positive for NS1 antigen and/or IgM antibody for dengue virus.

Study type - Cross-sectional, record-based study.

Study duration - June 2016–November 2016.

The study was approved by Institution Ethics Committee. Records of in patients who tested positive for NS1 antigen and/or IgM antibody for dengue virus were obtained from the medical record department after taking permission from the medical director and in-charge records department.

Statistical analysis

Data were entered into Microsoft excel. Analysis was done using Microsoft excel and SPSS 21 (IBM, USA) to calculate percentages, median, and range.

Tools of data collection – Hospital records data were entered into a proforma. Information about patient's age, sex, area of residence, occupation, duration of hospital stay, clinical features of presenting illness, investigations, management, complications, and outcome were noted from the case files.

Inclusion criteria – inpatients who were serologically tested positive for NS1 antigen and/or IgM antibody for dengue virus.


  Results Top


A total of 299 patients' records were studied. There were 63% (180) male and 37% (110) female patients. Patients belonging to the age group of 21–40 years were 53% (159) and 2% (7) of patients and were above 61 years. It was observed that 25% (75) patients were residing in Ambegaon, Dhankawadi. About 66% (197) patients reside in different places of Pune which are outside 2 km radius from this hospital. Patients residing in nearby hostels were 3% (10) while 6% (17) were from areas outside Pune, namely, Bhor and Mulshi.

Duration of stay in hospital for 95.29% (285) patients was a week, more than 1 week but <2 weeks in 13 (4%) and more than 2 weeks in 1 (0.33%) patients [Table 1].
Table 1: Distribution according to duration of stay in hospital (n=299)

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The common symptoms were fever with chills in 87% patients and headache/body ache in 89% of patients. The most common complication was thrombocytopenia in 69% patients and hepatosplenomegaly in 65% patients [Table 2].
Table 2: Distribution according to clinical manifestations and complications (n=299)

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According to laboratory instigation, 80.6% patients tested NsA1 g positive, 11.7% patients tested positive for IgG, ad 5.68% positive for IgM [Table 3]. No considerable changes were found in hemoglobin and packed cell volume. The shift of total leucocyte count was directly proportional to the platelet count. Out of all, in 36% (106) of cases, the serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) level were increased considerably. Out of these 36% patients, 33% had both SGOT and SGPT level between 100 U/L to 400 U/L and 3% of cases had both levels above 1000. Highest found SGOT was 1458 U/L and SGPT was 1091 U/L. Other electrolytes such as alkaline phosphatase were disordered in 4% of the patients.
Table 3: Distribution according to laboratory investigations (n=299)

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Treatment outcome showed that 90% patients did not require platelet transfusion and 96.9% patients were cured [Table 4].
Table 4: Distribution according to treatment outcome of patients (n=299)

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  Discussion Top


Dengue is emerging as a serious public health problem globally, 50 million dengue infections occurring annually. The expanding geographical distribution of both the virus and the mosquito vector is leading to increased frequency of epidemics, and the emergence of DHF in new areas may be due to climatic changes and the failure to control the mosquito vector.[5],[6]

In our study, the age group most affected was 21–40 years. These findings are similar to the study of Kendre Varsharani done in Latur (Maharashtra, India)[1] and Deshwal et al.[7] while the findings differed from a study in Kolkata in which majority of the cases found were in the age group of 11–30 years.[4]

There was a male preponderance in our study as compared to findings of Gupta and Bansal [4] and Karoli et al.[8] in North India and similar to the study done in Karnataka by Kumar et al.,[9] Ukey et al.,[10] and Deshwal et al.[7] in central India.

Thrombocytopenia, the most common manifestation, was present in 69% cases and these findings are similar to the study done by Kumar et al.[9]

According to WHO and CDC guidelines, the classic DF is characterized by fever, headache, retro-orbital pain, and myalgia, and arthralgia, nausea, vomiting, and often rash. The features of more serious form of disease DHF are decline in fever, hemorrhagic manifestations and may develop hem concentration. These patients may progress to DSS with severe abdominal pain, protracted vomiting, and a notable change temperature from fever to hypothermia.[11] Fever was the most common manifestation in our study similar to other studies.[7],[12],[13],[14] In our study, the second common manifestation was headache in 89% patients similar to Deshwal et al.'s [7] study. The rarest symptom in our study was myalgia in 13% patients which differed from Deshwal et al.'s [7] study which showed 90.7% patients had myalgia. Bleeding manifestations were seen in 20% patients and were mainly in the form of gastrointestinal bleed. This is in contrast to 63% and 69% of bleeding manifestations reported by Horvath from Australia [15] and Sharma from India,[16] respectively, but similar to Jain et al.'s [17] study which reported bleeding manifestations in various forms in 22.8% patients. Vomiting, arthralgia, abdominal pain body ache, diarrhea, giddiness, and convulsions were other symptoms present.

The duration of stay in hospital was <8 days for 95% of patients same as found by Khan et al.[14] in their study (8 days).

The most consistent finding as a complication was hepatomegaly 65%, which was similar to Joshi and Baid's [13] study in which hepatomegaly accounted to 66.6%. In a Bangladesh-based study by Mia et al.,[18] 42% had pleural effusion similar to our study.

Our study reported thrombocytopenia in 69% of patients while Joshi and Baid [13] had 96.5% patients with thrombocytopenia (platelet <100,000/mm3).

NS1 antigen was positive in 88% of cases, dengue IgM antibodies in 21% of cases, and IgG in 20% of cases which was similar to Chakravarti and Kumaria's [19] study in Delhi where 57.36% were confirmed as serologically positive, out of which 22.28% cases were positive for dengue-specific IgM antibodies indicating primary infection, and IgG antibodies alone were also detected in 35.05% cases.[13],[19],[20]

In our study, only 10% patients required platelet transfusion whereas in the study of Khan et al.,[21] 31% patients required platelet transfusion.

The overall mortality in our study population was 0.33% which is in sync with fatality rates of Deshwal et al.'s [7] study which was 0.77%.


  Conclusion and Recommendations Top


Males were diagnosed more than females. Age group of 21–40 years was affected which is the productive age group. Blood transfusion was not required by majority of the patients. They were cured well beforehand and did not suffer major complications. Thrombocytopenia was reflected as a major investigating factor observed in the majority of the patients.

Considering the spread of the disease and its complications, it is recommended that special preventive strategies should be planned during the monsoon period. More attention should be given to patients with comorbid conditions. Parental health education about the fever warning signs and early referral may prevent complications and/or deaths. Early recognition, precise assessment with WHO revised classification, and appropriate treatment have reduced the mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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