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COMMENTARY
Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 268  

Dengue in pregnancy: An important problem in tropical obstetrics


Department of Community Medicine, Dr D.Y. Patil University, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Osun State, Nigeria

Date of Submission07-Oct-2019
Date of Decision31-Dec-2019
Date of Acceptance31-Dec-2019
Date of Web Publication3-Jun-2020

Correspondence Address:
Viroj Wiwanitkit
Department of Community Medicine, Dr D.Y. Patil University, Pune, Maharashtra; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Osun State

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_279_19

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How to cite this article:
Wiwanitkit V. Dengue in pregnancy: An important problem in tropical obstetrics. Med J DY Patil Vidyapeeth 2020;13:268

How to cite this URL:
Wiwanitkit V. Dengue in pregnancy: An important problem in tropical obstetrics. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Sep 27];13:268. Available from: http://www.mjdrdypv.org/text.asp?2020/13/3/268/285768



Dengue is an important arbovirus infection that is the current public health problem in tropical countries. This infection is still an important vector borne disease that affects millions of world's population. In general, dengue is transmitted by Aedes mosquito vector. The infection can occur in any age groups. The infection in specific groups of patients such as pregnant women is interesting. The report of dengue in pregnancy published in Med J Dr DY Patil Univ is a good and interesting report showing the clinical epidemiology of dengue in pregnancy, which is a little-mentioned clinical problem in tropical obstetrics.[1]

In general, a pregnant woman can get dengue infection by getting bitten by mosquito vector.[2] The common clinical manifestation is acute febrile illness. In a recent report from Thailand, the most common clinical presentation of dengue infection in pregnant women is fever.[3] In the case with second infection, the immunopathological process might lead to thrombocytopenia and bleeding presentation. The classical clinical triad of dengue, hemoconcentration, and atypical lymphocytosis and thrombocytosis might help in the presumptive clinical diagnosis of dengue.[4] Nevertheless, in endemic settings, there are usually other infections that might clinically mimic dengue. In addition, the atypical laboratory finding such as low hematocrit and leukopenia is observable.[5] The definitive diagnosis of dengue usually requires laboratory confirmation. Regarding dengue in pregnancy, the diagnosis is sometimes difficult. Sometimes, patients might have an uncommon chief complaint such as abdominal pain. In extremely rare case, there might be an uncommon intra-abdominal problem. A good example is acalculous cholecystitis.[6]

For clinical management, symptomatic and supportive treatment is required. Standard fluid replacement therapy is recommended.[4] For a pregnant patient, closed monitoring for hematological change is necessary.

The effect of infection on fetal in utero is also interesting. In a recent report from Thailand, it has been reported that pregnant dengue patients might present with threatened abortion.[5] However, there is no clear conclusion on the association between dengue infection during pregnancy and abortion.[7] In addition, there is no confirmation that dengue can increase the risk of preterm labor. There is also no evidence that dengue has teratogenic effect. Nevertheless, a recent meta-analysis showed that there is an association between dengue infection in pregnant women and preterm birth and low birthweight.[7]

Finally, vertical transmission of dengue is possible.[8] If dengue occurs during peripartum period, an important consideration is on vertical transmission. To diagnose vertical transmission is sometimes difficult and requires molecular diagnosis for confirmation. In an endemic area, there is also a chance that the newborn separated gets bitten by mosquito vector and acquires the disease.



 
  References Top

1.
Bhardwaj D, Chawla S, Sahoo I, Rathore P, Sharma A, Siddiqui N. Dengue in pregnancy. Med J DY Patil Vidyapeeth 2020;13:269-72.  Back to cited text no. 1
    
2.
Malhotra N, Chanana C, Kumar S. Dengue infection in pregnancy. Int J Gynaecol Obstet 2006;94:131-2.  Back to cited text no. 2
    
3.
Wiwanitkit V. Dengue haemorrhagic fever in pregnancy: Appraisal on Thai cases. J Vector Borne Dis 2006;43:203-5.  Back to cited text no. 3
    
4.
Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5.  Back to cited text no. 4
    
5.
Khamim K, Khamim B, Pengsaa K. Dengue infection in pregnancy. Southeast Asian J Trop Med Public Health 2015;46 Suppl 1:153-60.  Back to cited text no. 5
    
6.
Berrington WR, Hitti J, Casper C. A case report of dengue virus infection and acalculous cholecystitis in a pregnant returning traveler. Travel Med Infect Dis 2007;5:251-3.  Back to cited text no. 6
    
7.
Paixão ES, Teixeira MG, Costa MD, Rodrigues LC. Dengue during pregnancy and adverse fetal outcomes: A systematic review and meta-analysis. Lancet Infect Dis 2016;16:857-65.  Back to cited text no. 7
    
8.
Wiwanitkit V. Unusual mode of transmission of dengue. J Infect Dev Ctries 2009;4:51-4.  Back to cited text no. 8
    




 

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