Echinocytes in the peripheral blood of patients infected with dengue virus may be a predictor of disease severity

Abstract

Background: Echinocytes have been demonstrated as sequalae to serum high-density lipoprotein decreases in patients with liver disease, but not to our knowledge in dengue virus infection. Objective: To investigate any association between echinocytosis and dengue infection. Methods: We retrospectively studied a cross-section of patients at Mahasarakham University Hospital infected with dengue in August 2015. Infection was diagnosed clinically, and by rapid immunochromatography when nonstructural protein 1 antigen, or IgM or IgG antibodies were detected in the serum. We used World Health Organization 2009 and 2011 criteria to define dengue severity. We examined peripheral blood smears made before and after defervescence. Result: Two patients had warning signs, 6 did not, 1 had dengue hemorrhagic fever (DHF), and 7 had uncomplicated dengue fever (DF). The ages of patients with and without warning signs was not significantly different (P > 0.99). Patients with warning signs had a mean (SD) alanine transaminase (ALT) level of 29.67 (20.61) IU/L, while it was 354.50 (219.91) IU/L in those without. The lowest mean platelet count in the patients with warning signs was 98 (66.1) × 103 cell/mm3, while it was 33.5 (21.9) × 103 cell/mm3 in those without. There was no significant difference in mean ALT level (P = 0.28) or the platelet count (P = 0.09) between patients with and without warning signs. Echinocytes were significantly associated with DWS (P = 0.04), but did not differ significantly between the DHF and DF patients (P = 0.13). Conclusion: Echinocytosis may be associated with severe disease. Keywords: Dengue hemorrhagic fever, echinocyte, peripheral blood smear, hepatitis, predictor