Abstract
Dengue infection (DF) is a mosquito born endemic disease with rising trend in Sri Lanka. Diagnosis of DF is clinical, supported by investigations. The phase of illness, warning signs, hydration and hemodynamic status of the patient determine the need for hospitalization and fluid management. Fluid management is crucial in prognosis. Ultrasonography (USG) is empirical to arrive at management decisions; exact role of USG is reviewed in this article. Gall bladder wall thickening (GBWT) and pericholecystic fluid are early and consistent sonographic features of dengue haemorrhagic fever, whilst hepatomegaly, splenomegaly, pleural effusions and pericardial effusions are the other features. Among various morphological appearances of GBWT, “honey comb” and “reticular” patterns are most frequent in severe DF. Morphology of GBWT is positively correlated to the disease progression and recovery, thus considered to be a useful sonographic signs in predicting the disease progression. Plasma leakage in DF is frequently depreciated by measuring the ascetic fluid volume, hence not recommended to use as a guideline in fluid management. USS measured inferior vena cava diameter (IVCd) and inferior venacava collapsibility index (IVC-CI) are of value in assessing intra vascular fluid volume. Calculation of IVC-CI is possible with “(IVCdmax − IVCdmin)/IVCdmax” formula. Even though, the liver involvement in DF is yet to be understood, hepatomegaly with elevated liver enzymes are the commonest manifestations. Liver involvement in DF could be ranged from mild transient liver cell dysfunction to acute fulminant hepatic failure. Bleeding tendency in DF, limits histopathological evaluation of the liver, hence pathogenesis is poorly understood. Future non invasive (sonographic) studies would be of value in the liver assessment. Further studies are recommended to assess IVC-CI pertaining to the volume status and patient outcome to postulate new fluid management guidelines.
Highlights
Dengue infection (DF) is a mosquito born viral disease
Further studies are recommended to assess inferior venacava collapsibility index (IVC-CI) pertaining to the volume status and patient outcome to postulate new fluid management guidelines
Gallbladder morphology in dengue fever As described earlier Gall bladder wall thickening (GBWT) and pericholecystic fluid collections were frequent in DF
Summary
Dengue infection (DF) is a mosquito born viral disease. This century, DF was a periodic disease with predictable out breaks in Sri Lanka; the disease shows a more endemic pattern with an inclining trend in incidence. The “warning signs” of severe dengue infection are abdominal pain, tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, liver enlargement more than 2 cm, rise of haematocrit and rapid decrease in platelet count. “Severe infection” is defined by significant plasma leakage and shock (DSS); fluid accumulation with respiratory distress; bleeding manifestations or organ impairment. Common complications that are seen in critical phase (CP) are bleeding manifestations and organ impairments[3].
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