Ultrasound as screening modality in management of fever cases in dengue epidemic: Study of 202 cases

Abstract

Aims and Background: Ultrasound is a screening procedure in suspected dengue fevers (DFs) and other febrile illness in epidemic areas with limited laboratory resources to help in prioritizing patients for emergency critical care. DF has become epidemic in India. Symptomatic dengue infection with any of the four serotypes of dengue virus can produce systemic and dynamic disease with a broad spectrum of illness with severe and nonsevere clinical manifestations.Subjects and Methods: A retrospective record-based study of 202 cases of suspected DFs were evaluated by ultrasound for a period of 18 months during epidemic in Radiology Department. All age groups were included in the study. Ultrasound of abdomen and chest performed in between 3rd and 10th day of fever. The data compiled by incorporating sonographic findings, clinical findings, and laboratory results. Laboratory data include serology and platelet count.Results: Ultrasound findings were analyzed, in comparison with clinical detection and laboratory results. Eighty-five percent were pediatric age group. The triad of ultrasound findings is stratified gallbladder wall thickening, 85.2%; ascites, 78%; and pleural effusions, 67.8%. Others are pericardial effusion 2.5%, hepatomegaly 9.1%, and splenomegaly 6.1%. Nearly 18.8% of severe dengue cases were observed. Detection of capillary leakage was 100% on ultrasound and 39.70% on thrombocytopenia. Eighty-six serology positive, 107 with no serology, and 6 seronegative cases were positive for ultrasound. Fifty-five percent isolated gallbladder edema is seen before thrombocytopenia.Conclusion: Ultrasound can be utilized as the mainstay of investigation in epidemic regions with infrastructure shortage. Early demonstration of serosal collection helps to grade DF to severe dengue and prioritize patients for critical care.