Classical and Hemorrhagic Dengue among Bangladeshi Adults: A Single Center Cohort Study

Abstract

Background: Dengue is a mosquito-borne viral disease worldwide. The number of new cases and mortality in Bangladesh increased in recent years. This study aims to observe the difference between demographic data, warning signs, high-risk co-morbidity, treatment pattern, and laboratory investigations in two different types of dengue fever during the pick tropical season. Method: This retrospective observational study was done in Holy Family Red Crescent Medical College from May to October 2019 from hospital records of a total of 102 dengue NS1 positive patients. The classical dengue fever (CDF) group consists of 72 patients and the dengue hemorrhagic fever (DHF) group consists of 30 patients. Demographic data, high-risk co-morbidity (pregnancy, old age, DM, HTN), ‘warning sign’ (abdominal tenderness, mucosal bleeding, lethargy, restlessness, persistent vomiting, clinical fluid accumulation, liver enlargement > 2cm, increase HCT, decrease Platelet), treatment pattern, and laboratory findings were compiled, analyzed and compared between two varieties. Result: Out of 102 patients, the majority were male 63 (61.76%). The mean age was 34 years in both groups of patients. ‘Warning signs’ were observed in a higher percentage in the dengue hemorrhagic fever group, which were statistically significant (p < 0.01 and p < 0.05). Most of the patients (80.55%, 93.33%) received 1000 ml infusion/day in both groups. Where only 15 patients received fresh frozen plasma. Use of cephalosporin (30%), steroid (43.33%), and tranexamic acid (23.33%) were higher percentages in dengue hemorrhagic fever than classical dengue fever (12.5%, 26.39%, 18.05%). Among hematological tests, changes observed in platelet and total WBC count in between two groups were statistically significant. Radiological and other lab findings also revealed a higher percentage of patients affected in the dengue hemorrhagic fever group. Conclusion: The incidence rate of classical dengue was higher than the hemorrhagic type, but the ‘warning sign’ and significant thrombocytopenia and leucopenia in hemorrhagic dengue fever can be considered for the progression towards dengue shock syndrome. Monitoring hematocrit concentration and plasma therapy are not much of benefit in hemorrhagic type because of fluid accumulation.