Clinical profile of dengue fever in a tertiary care centre in North Western India

Abstract

Background: Dengue virus is a mosquito-borne human pathogen that exclusively causes acute infection. Infection may result in a spectrumof clinicalmanifestations ranging from asymptomatic infection to life-threatening complications typified by vascular leakage. Aatypicalmanifestations including hepatitis have been described. In this study we tried to look for the hepatic involvemenmt in patients of Dengue fever with warning signs. Methods & Materials: Confirmed (NS1/ IgM positive) adult dengue patients (age >12 years) with warning signs (abdominal pain, persistent vomiting, mucosal bleed, lethargy, restlessness, hepatomegaly, clinical fluid accumulation and increase in haematocrit with worsening thrombocytopenia) visiting emergency department of a tertiary care hospital in North India, were analysed for degree of thrombocytopenia, derangement in liver function tests and presence of significant capillary leak. Patients with established chronic liver disease, hepatitis B or hepatitis C infection, established DHF/DSS were excluded from the study. Results:Amongst88patients included in the study,mostprominent liver involvement was asymptomatic transaminitis with AST more than ALT. Correlation was found between the degree of transaminitis and thrombocytopenia, only 10% of patients with normal AST had platelet counts of 40g/day for >1 year) with p-value of 0.012. 34.7% patients with evidence of capillary leak were found to have severe liver involvement as compared to 17.9% of patients without capillary leak. (AST more than 10 times the upper limit of normal (p-value =0.054). Conclusion: Liver involvement is common in dengue patients withwarning sign and correlatsewith degree of thrombocytopenia and capillary leak. Alcohol consumption may be an independent predictor for severity of dengue realted hepatic damage.