Abstract
BackgroundThe clinical presentation of dengue fever had been observed to change with time since its first outbreak in 2000 in Bangladesh. This report showed the clinical presentation of the 2019 outbreak in Bangladesh along with its comparison to previous outbreaks witnessed in this region.MethodsThis hospital-based cross-sectional study was conducted in one of the largest tertiary care hospitals in Dhaka city. A total of 553 laboratory-confirmed and 194 probable dengue cases were interviewed. The clinical manifestation of the confirmed cases of the current outbreak was compared with three of the outbreak reports retrieved from the databases. R version 3.6.3 was used for data analysis.ResultsAmong the confirmed cases, two-thirds were male (63.2%) and the average age was 27(± 11) years. Positive tests for NS1 and IgM were present in 99.6% (n = 525/527) and 82.6% (n = 38/46) of the cases, respectively. Thrombocytopenia was present in 66.1% of cases. Fever (100%) was common for all. Gastrointestinal (GIT) features, including abdominal pain (86.5%), anorexia and/or vomiting (69.6%), and Diarrhea (> 3 motions/day) (26.2%) were more frequent than typical rash and other pain symptoms. Hypotension was present in approximately a quarter of patients (25%). GIT features (anorexia, nausea, and/or vomiting) and hypotension were more common among adult participants while bleeding manifestation (melena and vaginal bleeding, p = 0.009 & 0.032) was more frequent in pediatric patients. Compared to outbreaks of 2008, 2016, and 2018, increasing trends in GIT symptoms e.g. anorexia, abdominal pain, and diarrhea were observed. While a negative trend in hemorrhagic manifestations (skin rash, melena, and conjunctival hemorrhage/hemorrhagic sclera) and arthralgia/joint pain were found.ConclusionThe present outbreak was noticeably characterized by GIT symptoms and hypotension in addition to the typical clinical features like rash and pain symptoms. An increasing trend in GIT features and decreasing trend in hemorrhagic manifestations was noted over the last decade of dengue outbreaks.
Highlights
The clinical presentation of dengue fever had been observed to change with time since its first outbreak in 2000 in Bangladesh
The initial descriptive cross-sectional study was conducted at the inpatient Department of Medicine, ‘Dengue Corner’ of Sheikh Hasina Burn and Plastic Surgery Institute and Department of Pediatrics in Dhaka Medical College Hospital (DMCH) during the dengue outbreak of 2019
A total of 747 suspected dengue cases were approached and 553 cases were confirmed by laboratory investigation and 194 were designated as probable cases
Summary
The clinical presentation of dengue fever had been observed to change with time since its first outbreak in 2000 in Bangladesh. This report showed the clinical presentation of the 2019 outbreak in Bangladesh along with its comparison to previous outbreaks witnessed in this region. Bangladesh is a country that is most adversely affected by dengue almost every year [3]. The first official outbreak of dengue was reported in 2000 with a total of 5551 cases and 93 reported deaths [4]. In 2019, the country witnessed its largest outbreak in history with > 100,000 confirmed cases and 120 deaths [5]. In 2020, amidst the pandemic, a total of 1026 confirmed cases were reported by the Directorate General of Health in Bangladesh [6]
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