Profile of hepatic involvement in dengue infections in adult Pakistani population.

Somia Iqtadar,Naima Huma,Fawad Ahmad Randhawa,Nabeel Akbar

doi:10.12669/pjms.334.13026

Somia Iqtadar, Naima Huma + Show 2 more

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https://doi.org/10.12669/pjms.334.13026

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Abstract

Objectives:To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients.Methods:Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study.Results:About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF (38.15 vs 18.6%). Hyperbilirubinemia was noted in 40 (18.2%) patients, 28 (12.7%) in DF and 12(5.5%) in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger (<20 years) age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72(32.7% vs 40(18.2%)]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/l in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years.Conclusion:Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic.List of abbreviations:DF: Dengue FeverDHF: Dengue Hemorrhagic FeverDSS: Dengue Shock SyndromeDIC: Disseminated intravascular coagulationALT: Alanine transaminaseAST: Aspartate aminotransferase

Highlights

Dengue Fever is a vector-borne tropical infection caused by Dengue virus (DENV)
Patients presenting in OPD or emergency during the above mentioned period having history of fever ≤ 10 days with two or more of retro orbital pain, headache, arthralgia, myalgia, rash, hemorrhagic manifestations[14], thrombocytopenia (
Of the 220 patients included in the study, 164 were diagnosed as Dengue fever (DF), 52 as Dengue Hemorrhagic Fever (DHF) and four as DengueShock Syndrome (DSS)

Summary

Introduction

Dengue Fever is a vector-borne tropical infection caused by Dengue virus (DENV). It causes four spectra of disease ranging from; an asymptomatic infection to Dengue fever (DF), Dengue Hemorrhagic Fever (DHF) and DengueShock Syndrome (DSS).[1]. Dengue Fever is a vector-borne tropical infection caused by Dengue virus (DENV). It causes four spectra of disease ranging from; an asymptomatic infection to Dengue fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue. Shock Syndrome (DSS).[1] It has recently emerged as the fastest growing epidemic of the world.[2] Every year, 100 million people are reported to suffer from dengue fever in the tropical countries with 250,000 cases of DHF taking 24,000-25,000 lives per year. South East Asia which is famous for tourism bears the bulk of the patient burden.[3] For the last few years, cases have frequently been reported from Pakistan throughout the year with a peak incidence after the rainy seasons. A huge epidemic of Dengue Fever struck Punjab in 2011, with 352 reported deaths and there have been smaller outbreaks eversince.[4]

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