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COMMENTARY
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 132  

Clinical spectrum and demographic of dengue


Department of Community Medicine, Dr. DY Patil University, Mumbai, Maharashtra, India; Department of Tropical Medicine, Hainan Medical University, Haikou Shi, Hainan Sheng, China; Department of Laboratory Medicine, Chulalongkorn University, Bangkok, Thailand

Date of Web Publication18-May-2018

Correspondence Address:
Viroj Wiwanitkit
Wiwnaitkit House, Bangkhae, Bangkok

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_179_17

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How to cite this article:
Wiwanitkit V. Clinical spectrum and demographic of dengue. Med J DY Patil Vidyapeeth 2018;11:132

How to cite this URL:
Wiwanitkit V. Clinical spectrum and demographic of dengue. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2020 Jul 2];11:132. Available from: http://www.mjdrdypv.org/text.asp?2018/11/2/132/232645



The publication entitled “demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital [1]” in the journal is an interesting report on dengue. Indeed, dengue is a common problem in tropical Asia, and the disease causes high mortality each year. During dengue outbreak, the influx of patients admitted to the hospital can be expected and it usually becomes the local public health problem. In tertiary hospital, the clinical management of dengue uses the same principle according to standard guidelines for fluid replacement therapy.[2] Nevertheless, the problem in case management can be expected since most hospitalized dengue cases in tertiary hospital are usually referred from primary or secondary hospitals and most cases are serious and might have atypical complications. Indeed, dengue can affect anyone (any sex or age group), but the hospitalized case is usually an adult case because dengue infection at the first time is usually mild and the patient might have mild febrile illness. The serious dengue infection usually occurs when there is a second infection. The underlying immunopathological process will induce the serious dengue manifestation called “dengue hemorrhagic fever”. In the most severe case, the most serious form of dengue, dengue shock syndrome, can be seen. In the tropical endemic area, the mosquito vector is common and usually carries the disease. The first-time infection at childhood is not uncommon. Focusing on a second infection that might result in severe dengue, the most affected group is adult population, and this group, with a serious hemorrhagic fever, is the main group admitted to the hospital during any dengue outbreak.

Focusing on clinical spectrum of dengue, the data from records of tertiary hospital usually represent serious cases. In fact, the mild dengue, the case of the first time infection, is not uncommon and might be underdiagnosed in the community. Focusing on hospitalized case, it is no doubt that fever is the common presentation. Nevertheless, it should be noted that there is also atypical afebrile dengue infection.[3] The classical triad of dengue, hemoconcentration, atypical lymphocytosis, and thrombocytopenia is usually a useful clinical observation that can be a clue for presumptive clinical diagnosis of dengue.[2] Nevertheless, the hemorrhagic complication of dengue might be the leading symptom of the patient.[4] The skin petechiae is very common, but it is hard to differentiate from other common tropical infections. The more rare hemorrhagic presentation might be possible which the practitioner should not forget.[4] The examples of uncommon hemorrhagic presentations are bleeding per gum, bleeding per vagina, hematochezia, and hematuria.[4] In endemic area, it was suggested that any cases presenting with hemorrhagic problem following the history of fever should be screened for dengue. Finally, the concurrent infection with dengue is possible. Many tropical infections can be coincident with dengue. The good examples are malaria and chikungunya.[5] Hence, searching for any possible concurrent problem in dengue patients is needed. Furthermore, the present emerging Zika virus infection which is usually misdiagnosed as dengue [6] can also copresent with dengue.[7]



 
  References Top

1.
Mehta SR, Bafna TA, Pokale AB. Demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital. Med J Dr DY Patil Vidyapeeth 2018;11:128-31.  Back to cited text no. 1
    
2.
Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5.  Back to cited text no. 2
    
3.
Wiwanitkit S, Wiwanitkit V. Afebrile dengue: An easily forgotten manifestation. Ann Trop Med Public Health 2013;6:686.  Back to cited text no. 3
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4.
Wiwanitkit V. Bleeding and other presentations in Thai patients with dengue infection. Clin Appl Thromb Hemost 2004;10:397-8.  Back to cited text no. 4
[PUBMED]    
5.
Gupta N, Gupta C, Gomber A. Concurrent mosquito-borne triple infections of dengue, malaria and chikungunya: A case report. J Vector Borne Dis 2017;54:191-3.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Joob B, Wiwanitkit V. Zika virus infection and dengue: A new problem in diagnosis in a dengue-endemic area. Ann Trop Med Public Health 2015;8:145-6.  Back to cited text no. 6
  [Full text]  
7.
Roth A, Mercier A, Lepers C, Hoy D, Duituturaga S, Benyon E, et al. Concurrent outbreaks of dengue, chikungunya and Zika virus infections – An unprecedented epidemic wave of mosquito-borne viruses in the pacific 2012-2014. Euro Surveill 2014;19. pii: 20929.  Back to cited text no. 7
    




 

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