Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

Ricardo Tristão-Sá,Sônia Maria Oliveira Zagne,Beatriz Amin,Claire Fernandes Kubelka,Rita Maria Ribeiro Nogueira,Delso Do Nascimento,Eliana Zandonade,Rivaldo Venâncio Da Cunha,Íris Bucher Froes,Luiz José De Souza,Flávia Fazoli,Oswaldo Gonçalves Cruz,Luiza Oliveira Zagne,Nathália Félix Araújo,Natally De Souza Maciel Rocha

doi:10.1590/s0037-86822012000600004

Abstract

To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

Highlights

To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period
Reverse transcriptase-polymerase chain reaction (RT-PCR): The viral RNA was extracted from the acute-phase sera and it was performed according to Lanciotti et al.[18,19]
A considerable ratio of dengue patients presented some clinical manifestations at day 60

Summary

Introduction

To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. Results: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. 57.7% (15/26) of the symptoms persisted at the end of the second month. Conclusions: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month. The disease predominates in urban centers of tropical regions of developing countries[2,3], where environmental conditions favor the proliferation of its vector, the Aedes aegypti[4], while social and economic issues facilitate disease dissemination This turns dengue into one of the main public health problems in the world[1]. Brazil has suffered many epidemics with severe forms of the disease and currently accounts for more than 70% of the reported cases in the Americas[5]

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Conclusion