Abstract
BackgroundDemographic features of dengue fever have changed tremendously in Pakistan over the past two decades. Small scale studies from all over the country have reported different aspects of individual outbreaks during this time. However, there is scarcity of data looking at the overall trend of dengue virus infection in the country. In this study, we examined annual trends, seasonality, and clinical features of dengue fever in the Pakistani population.MethodsDemographic information and dengue IgM status of all patients tested for dengue IgM antibody at Aga Khan University Hospital from January 2003 to December 2007 were analyzed to look for trends of IgM-positive cases in Pakistan. In addition, clinical and biochemical parameters were abstracted retrospectively from medical records of all patients hospitalized with IgM-proven dengue fever between January 2006 and December 2007. These patients were categorized into dengue fever and dengue hemorrhagic fever according to the WHO severity grading scale.ResultsOut of a total of 15040 patients (63.2% male and 36.8% female), 3952 (26.3%) tested positive for dengue IgM antibody. 209 IgM proven dengue patients were hospitalized during the study period. During 2003, IgM positive cases were seen only during the months of July-December. In contrast, such cases were detected throughout the year from the 2004–2007. The median age of IgM positive patients decreased every year from 32.0 years in 2003 to 24.0 years in 2007 (p<0.001). Among hospitalized patients, nausea was the most common presenting feature found in 124/209 (59.3%) patients. Children presented with a higher median body temperature than adults (p = 0.010). In addition, neutropenia was seen more commonly in children while raised serum ALT levels were seen more commonly in adults (both p = 0.006). While a low total white cell count was more common in patients with dengue fever as compared to Dengue Hemorrhagic Fever (p = 0.020), neutropenia (p = 0.019), monocytosis (p = 0.001) and raised serum ALT level (p = 0.005) were observed more commonly in the latter group.ConclusionsDengue virus is now endemic in Pakistan, circulating throughout the year with a peak incidence in the post monsoon period. Median age of dengue patients has decreased and younger patients may be more susceptible. Total and differential leukocyte counts may help identify patients at risk of hemorrhage.
Highlights
Dengue Virus (DV) is an enveloped, single-stranded, positive RNA virus and a member of the family Flaviviridae, genus flavivirus
Dengue virus is endemic in Pakistan, circulating throughout the year with a peak incidence in the post monsoon period
Demographic data from all patients tested for dengue IgM antibody between January 2003 and December 2007 at AKUH was included in this study
Summary
Dengue Virus (DV) is an enveloped, single-stranded, positive RNA virus and a member of the family Flaviviridae, genus flavivirus. In South East Asia, the average number of cases of DHF per year has increased from 10,000 in the 1950s to over 200,000 in the 1990s. Epidemic dengue fever was common in Asia and Pacific throughout the twentieth century [3]. Dengue virus made its route geographically into Asia through South Asian countries [4]. In the 20 years, the disease spread throughout South East Asia and by the mid 1970s, DHF was the leading cause of hospitalization and death among children in this region. There is scarcity of data looking at the overall trend of dengue virus infection in the country. We examined annual trends, seasonality, and clinical features of dengue fever in the Pakistani population
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