Abstract
BackgroundDengue is the most common vector-borne disease worldwide. It poses a significant health burden in tropical and subtropical countries. Common clinical presentations include retro-orbital pain, fever, headache, nausea, vomiting and aches and pains in the body. A severe form of dengue fever is known as dengue hemorrhagic fever (DHF) that includes signs of hemorrhage. Besides the typical signs and symptoms, atypical presentations of dengue include myositis, hepatitis and encephalitis. Hepatic involvement in dengue has varied presentations. This study aims to highlight the importance of acute hepatitis, an atypical presentation in dengue patients.Methods We conducted a descriptive, cross-sectional study in the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, a tertiary-care hospital serving the area of Southern Punjab, Pakistan. The relevant medical records of 63 patients admitted with dengue-associated hepatitis to the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, between January 1, 2015 and December 1, 2016, were reviewed. Informed consent was given. Information regarding demographic variables and disease course was collected and analyzed.Results This study included 55 men (87.3%) and eight (12.7%) women. Fifty (79.3%) patients were diagnosed with dengue fever (DF). Thirteen patients were managed on the lines of DHF. Out of the total 63 patients, only six were locals. The common clinical presentations in these patients included high fever, retro-orbital pain, severe headache, rash, dark-colored urine, bleeding problems and hepatomegaly. Higher levels of aspartate aminotransferase (AST) were noted in comparison to alanine transferase (ALT). Despite the complicated clinical course in some patients, all patients were managed successfully and discharged, except one.ConclusionThe frequency of acute hepatitis in dengue patients is high, especially in young men. Early diagnosis and prompt treatment are necessary for better prognosis. Although no specific treatment guidelines are available, supportive treatment in a timely fashion can prevent complications. Transfusion with packed cell volume (PCV) and N-acetyl cysteine (NAC) has produced promising results.
Highlights
Dengue is the most common arboviral disease globally with an estimated annual incidence of 100 million cases of dengue fever (DF), 250,000 of dengue hemorrhagic fever (DHF) and 25,000 fatalities [1]
Fifty (79.3%) patients were diagnosed with dengue fever (DF)
Is more commonly present in DF, it is present in DHF as well [18]
Summary
Dengue is the most common arboviral disease globally with an estimated annual incidence of 100 million cases of dengue fever (DF), 250,000 of dengue hemorrhagic fever (DHF) and 25,000 fatalities [1]. The dengue virus belongs to the family of Flaviviridae and is usually spread by the bite of the mosquito, Aedes aegypti [3]. This disease is known as “breakbone fever” because of its classic presentation of influenza-like illness with spiking fevers, fatigue, retro-orbital pain, myalgia and headaches. Dengue is the most common vector-borne disease worldwide. It poses a significant health burden in tropical and subtropical countries. A severe form of dengue fever is known as dengue hemorrhagic fever (DHF) that includes signs of hemorrhage. Besides the typical signs and symptoms, atypical presentations of dengue include myositis, hepatitis and encephalitis. This study aims to highlight the importance of acute hepatitis, an atypical presentation in dengue patients
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