Dengue infection with warning signs: The 2019 epidemic

Abstract

BackgroundDengue is a common arthropod-borne viral disease with a variable clinical spectrum, course, and outcome. MethodWe conducted a prospective observational study describing the clinical profile of patients hospitalized for dengue with warning signs during the 2019 epidemic. ResultA total of 1349 patients with dengue, including 459 with warning signs, were seen. It predominantly affects the younger subset of both sexes. A higher proportion of females presented with either a platelet count less than 20,000/mm3 or a rapid fall in platelets. Bleeding manifestations of varying severity were observed in one-fifth of them. Severe bleeding was universal at a platelet count less than 10,000/mm3. Platelet transfusion was indicated in 17 (7.3%) males and 25 (11%) females, with females requiring it at a higher platelet count. While hepatic involvement was frequent, others such as myocarditis, encephalitis, and pancreatitis were infrequent. Coinfections observed included malaria, scrub typhus, and enteric fever. The case fatality rate for the patients with dengue and those with warning manifestations was 0.4% and 1.3%, respectively. ConclusionsDengue epidemics often overwhelm health-care resources. Such epidemics can be successfully managed using a protocolized approach, modified as per the available resources. Platelet transfusions are lifesaving at a count less than 10,000/mm3. With meticulous supportive care, the case fatality rate can be reduced to less than 0.5%.