Classic Dengue Fever Research Articles

Clinico-epidemiological profile of dengue fever cases admitted at tertiary care hospital, Rajkot, Gujarat, India

Background: Dengue fever (DF) and its severe forms - Dengue haemorrhagic fever (DHF) and Dengue shock syndrome (DSS) have emerged as a notable public health problem in recent decades in terms of the mortality and morbidity associated with it. Methods: A cross-sectional prospective study was conducted at PDU Government Medical College, Rajkot during 1st January to 31st December, 2014. All confirmed Dengue cases were admitted in this institute during 2014 included in the study. The data entry was done in Microsoft Office Excel 2007 and analysis was done using the same software and appropriate tests were applied. Results: This study included 145 patients who were admitted to the institute during the calendar year 2014. 62% were males. 69% were in the age group 15-44 yrs. 59% cases were from rural origin. During September to December, 2014, 80% cases were admitted. 74% cases were consulted by doctor before admission at PDU Government Medical College, Rajkot. Fever was present in all the cases i.e. (100%), followed by myalgia (99%), headache (96%), vomiting (78%) and epistaxis (63%). Majority of the cases presented with Classical Dengue fever i.e. (90%) followed by DHF (10%). Most common complication was bleeding from nose and mouth i.e. (66%). No any death due to Dengue was reported during study period. 93% cases were discharged and 7 % cases were DAMA from PDU Government Medical College, Rajkot. Conclusions: The most common age group for Dengue fever was 15-44 yrs. Most of the patients were male and also from rural origin. Most of the cases occurred during the period of September to December, 2014. Fever was present in all the cases and bleeding from nose and mouth was the commonest complication of Dengue. No any death due to Dengue was reported during study period.

Rabies virus phosphoprotein induces mitochondrial dysfunction, oxidative stress, and neuronal process degeneration: Implications for future therapy of human rabies

myositis (2) indirect effects due to metabolic complications resulting in encephalopathy and cerebrovascular complications due to thrombocytopenia and platelet dysfunction and (3) postinfectious immunemediated acute disseminated encephalomyelitis, Guillain Barre syndrome and optic neuritis. Material and methods: This was a descriptive cross sectional study including seropositive patients diagnosed with Dengue fever (DF), Dengue with warning signs and Severe Dengue with neurological manifestations presenting to Medicine Department of LLR Hospital, Kanpur. Results: 10 (2.6%) patients had neurological manifestations out of 383 seropositive patients. Out of ten, nine patients were male and only one patient was female. Among them 10% patients come under category of classical dengue fever, 10% patients suffered from dengue with warning signs and 80% with severe dengue .4 patients had encephalopathy,3 other patients had encephalitis, 2 patients presented with single episode of symptomatic generalized seizure and 1 patient presented as having an intra cranial hemorrhage. Conclusions: Neurological manifestations of dengue are manifold and it is necessary to consider dengue as a cause for the above neurological presentations in endemic zones of the disease.

Neurological manifestations among patients with HIV — Active tuberculosis coinfection, Sudan 2014

myositis (2) indirect effects due to metabolic complications resulting in encephalopathy and cerebrovascular complications due to thrombocytopenia and platelet dysfunction and (3) postinfectious immunemediated acute disseminated encephalomyelitis, Guillain Barre syndrome and optic neuritis. Material and methods: This was a descriptive cross sectional study including seropositive patients diagnosed with Dengue fever (DF), Dengue with warning signs and Severe Dengue with neurological manifestations presenting to Medicine Department of LLR Hospital, Kanpur. Results: 10 (2.6%) patients had neurological manifestations out of 383 seropositive patients. Out of ten, nine patients were male and only one patient was female. Among them 10% patients come under category of classical dengue fever, 10% patients suffered from dengue with warning signs and 80% with severe dengue .4 patients had encephalopathy,3 other patients had encephalitis, 2 patients presented with single episode of symptomatic generalized seizure and 1 patient presented as having an intra cranial hemorrhage. Conclusions: Neurological manifestations of dengue are manifold and it is necessary to consider dengue as a cause for the above neurological presentations in endemic zones of the disease.

Safflower yellow inhibits the inflammatory response and regulates microglial polarization in LPS-stimulated bv2 cells

myositis (2) indirect effects due to metabolic complications resulting in encephalopathy and cerebrovascular complications due to thrombocytopenia and platelet dysfunction and (3) postinfectious immunemediated acute disseminated encephalomyelitis, Guillain Barre syndrome and optic neuritis. Material and methods: This was a descriptive cross sectional study including seropositive patients diagnosed with Dengue fever (DF), Dengue with warning signs and Severe Dengue with neurological manifestations presenting to Medicine Department of LLR Hospital, Kanpur. Results: 10 (2.6%) patients had neurological manifestations out of 383 seropositive patients. Out of ten, nine patients were male and only one patient was female. Among them 10% patients come under category of classical dengue fever, 10% patients suffered from dengue with warning signs and 80% with severe dengue .4 patients had encephalopathy,3 other patients had encephalitis, 2 patients presented with single episode of symptomatic generalized seizure and 1 patient presented as having an intra cranial hemorrhage. Conclusions: Neurological manifestations of dengue are manifold and it is necessary to consider dengue as a cause for the above neurological presentations in endemic zones of the disease.

Clinicopathological study of 50 cases of Dengue

Aim and objective: The objective of this study was to correlate laboratory tests during the evolution of dengue fever, comparing frequencies between the different clinical forms in order to use test results to predict the severity of the disease. Methods: This is an observational, descriptive and retrospective study of 50 patients with clinical and serological diagnoses of dengue fever. The tests analyzed were blood count, platelet count, and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations. Results: Thrombocytopenia and elevated transaminases were observed in patients with classic dengue fever. The main laboratory abnormalities found in dengue hemorrhagic fever were thrombocytopenia, hemoconcentration and elevated transaminases, similar to severe dengue with the exception of hemoconcentration. Most laboratory abnormalities started on the 3rd day but were more evident on the 5th day with restoration of values by the 11th day; this was more prominent in under 15-year-olds and with the more severe clinical forms. Conclusion: These results are relevant in assessing the disease because they can be used as markers for more severe forms and can help by enabling the adaptation of the therapeutic conduct to the needs of individual patients.

PAIgG and PAIgM levels in secondary dengue virus infections lead to thrombocytopenia in patients from KP, Pakistan

ObjectiveTo understand the impact of platelet associated immunoglobulin G (PAIgG)/platelet associated immunoglobulin M (PAIgM) on severity of dengue virus infection leading to thrombocytopenia. MethodsIn this study we examined a total of 52 patients who were having secondary infection of dengue in acute phase by using competitive ELISA. ResultsA decrease in the platelet count was observed at the acute phase of infection while all along the recovery stage the count of platelet was significantly increased. A significant decrease was observed in PAIgG and PAIgM in these subjects. Inverse correlation was found between platelets count and PAIgG/PAIgM among the subjects studied. In the platelets elution from ten subjects, anti-dengue virus immunoglobulin G and immunoglobulin M were observed. PAIgG and PAIgM with inclined levels were higher in dengue hemorrhagic fever than the classical dengue fever. In the development of dengue hemorrhagic fever PAIgM inclined level was independently associated with high specificity, showing a possible indication of dengue hemorrhagic fever. ConclusionsThis study suggests that in secondary dengue virus infection, the PAIgG and PAIgM levels, and the activity of anti-dengue virus play key roles, both in the development and severity of the disease.

Pleuropulmonary manifestations of dengue fever in children and adolescents

From November 2007 to April 2008, 196 patients were admitted to the Short Stay Unit and/or Intensive Care Unit of the Instituto de Puericultura e Pediatria Martagao Gesteira with clinical presentations suggesting dengue fever. Included in this retrospective case series are 181 patients who had laboratory confirmation of dengue fever; 51.9% (94/181) had classical dengue fever and 48.1% (87/181) had dengue hemorrhagic fever. Patients ranged from 4 months to 15 years of age; the median age being 9 years (mean ± SD; 8.5 ± 3.6 years). There were 90 cases with pleuropulmonary manifestations: 30 of 94 cases with classical dengue fever and 60 of 87 cases with dengue hemorrhagic fever. In descending order, the changes found were pleural effusion, elevation of the diaphragm, and pleural opacity. Radiological manifestations appeared a median of 6 days after hospitalization (range, 3 to 11 days). In 89/90 (98.9%) cases with pleuropulmonary manifestations, early therapeutic approaches resulted in resolution of clinical and radiologic findings.

Does immunoglobulin therapy have a role in treating Dengue virus infection with induced systemic capillary leak syndrome?

The report of severe cardiovascular changes in the eight children with secondary dengue infection and dengue shock syndrome (DSS) by Kositseth et al. [1] was consistent with systemic capillary leak syndrome (SCLS). It is thought to be distinct from classical dengue fever (DF). However, clinicians working in endemic areas need to be aware that such textbook presentations may not be applicable in this age when extremes of climate and increase in air travel have complicated the infection demographics in clinical medicine. A report published in March 2012, showed the high prevalence of SCLS among travelers, a third of which were primary dengue cases and 85% also had classical DF [2]. It is interesting to hypothesize that patients co-infected with two serotypes of dengue virus (DENV) may develop multiple organ failure and DSS, but no specific reports on these complications are available from Asia (DENV-2/-3 and DENV-3/-4), or the Americas (DENV-2/-3 and DENV-3/-4). Whether complications from multiple organ failure and DSS was the case in the recent epidemic of dengue virus related deaths in children and adults from Eastern India during the rainy season/autumn 2012 remains to be proven [3]. As with most infectious pathogens, homologous DENV genetic recombination events have been widely reported [4,5], but fortunately, there have not been any reports of heterologous DENV-serotype recombination events. Such events would result in new chimeric strains and the immunological hypothesis of antibodyenhanced disease and multi-organ failure would be the most likely explanation [6]. Does high-dose intravenous immunoglobulin (hdIVIG) sourced from the local donor population, rather than imported, offer a viable treatment option in DENV-related SCLS? A publication from the European Registry of patients with idiopathic SCLS showed improvement after treatment with hdIVIG [7]. Treatment with hdIVIG certainly remains a feasible option with viral-related autoimmune manifestations such as Kawasaki disease, but will this treatment prove effective against the dreaded thrombocytopenia and SCLS in DENV infection? [8,9] Only a multi-center clinical trial can answer this question. In the interim time, civic and health authorities must work together with entomology and virology centers to prevent unnecessary deaths from this vector-borne disease.

THE CHANGING CLINICAL PERFORMANCE OF DENGUE VIRUS INFECTION IN THE YEAR 2009

Background: Dengue (DEN) virus, the most important arthropod-borne human pathogen, represents a serious public health threat. DEN virus is transmitted to humans by the bite of the domestic mosquito, Aedes aegypti, and circulates in nature as four distinct serological types DEN-1 to 4). The aim of Study: To identify Dengue Virus Serotype I which showed mild clinical performance in fiveyears before and afterward showed severe clinical performance. Material and Method: Prospective and analytic observational study had been done in Dr. Soetomo Hospital and the ethical clearance was conduct on January 01, 2009. The population of this research is all cases of dengue virus infection. Diagnosis were done based on WHO 1997. All of these cases were examined for IgM & IgG anti Dengue Virus and then were followed by PCR examination to identify Dengue Virus serotype. Result and Discussion: DEN 2 was predominant virus serotype with produced a spectrum clinical illness from asymptomatic, mild illness to classic dengue fever (DF) to the most severe form of illness (DHF). But DEN 1 usually showed mild illness. Helen at al (2009–2010) epidemiologic study of Dengue Virus Infection in Health Centre Surabaya and Mother and Child Health Soerya Sidoarjo found many cases of Dengue Hemorrhagic Feverwere caused by DEN 1 Genotype IV. Amor (2009) study in Dr. Soetomo Hospital found DEN 1 showed severe clinical performance of primary Dengue Virus Infection as Dengue Shock Syndrome two cases and one unusual case.Conclusion: The epidemiologic study of Dengue Virus Infection in Surabaya and Sidoarjo; in the year 2009 found changing predominant Dengue Virus Serotype from Dengue Virus II to Dengue Virus 1 Genotype IV which showed a severe clinical performance coincident with primary infection.

Dengue Gaining Ground

The dengue viruses, enveloped positive-sense RNA viruses with a genome of approximately 11 kb, and consisting of four related but anti genetically distinct serotypes, cause the most common arthropod-borne viral disease in man. In most cases, dengue virus infection is asymptomatic, but can potentially cause an acute febrile disease ranging in severity from classical dengue fever to a life-threatening hemorrhagic condition with shock syndrome. Its mode of transmission is by the mosquito species Aedes aegypti and Aedesalbopictus, both species notoriously known as intermittent feeders of human blood, and with ecological niches well-adapted to human habitation [2]. It has been assumed for many years that there are approximately one hundred million dengue infections per year, but recent estimate indicates 390 million per year, of which 96 million manifests clinically [3]. Still, there are no anti-viral drugs against dengue disease, and neither prophylaxis nor vaccines exist. An effective dengue virus vaccine would need to provide a balanced immune response against all four serotypes. This has proven difficult to achieve despite considerable efforts. A number of dengue vaccines candidates are in pipeline, but it remains to be seen when there will be a well-tolerated and effective vaccine licensed and available on the market [2].

Dengue Fever : Study of 100 Cases in a Tertiary Care Hospital in Dhaka City

Dengue is a rapidly spreading mosquito-borne viral disease worldwide. The endemicity in Bangladesh is also increasing gradually. The study was a prospective observational one, documented the presenting features and outcome of management. It was carried out in Department of Medicine in Holy Family Red Crescent Medical College Hospital, Dhaka from June 2013 to December 2013. Total 100 admitted cases of both sera positive and sera-negative were included in this study. Detailed history was taken, clinical examination and relevant investigations were done. Out of 100 patients 54 (54%) were male and 46 (46%) were female. So male to female ratio was 1.7:1. The age of the patients ranged from 12-75 years. Among them 20-40 years age group was highest 63%. Patients of higher socio-economic group were (69%) more affected. Out of 100 cases 54 had classical dengue fever (DF), 46 had dengue hemorrhagic fever (DHF). Antibody was positive in 81% cases. All patients presented with high fever, headache in 90%, retro-orbital pain in 45%, body ache in 56%, and backache in 48%. Leucopenia found in 60, platelet count <100x1091L was in 57, HCT- normal 17, <20% rise in 48%, ?20% rise in 28%. With proper management all patients were recovered.

Association of Mean Platelet Volume with Severity, Serology & Treatment Outcome in Dengue Fever: Prognostic Utility.

Dengue is the most rapidly spreading mosquito-borne viral disease in the world. Dengue fever (DF) with its severe manifestations such as dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) has emerged as a major public health problem of international concern. Thrombocytopenia and bleeding are common complications of dengue fever, hence besides platelet counts, there is a need to assess the role of mean platelet volume. Studying association of mean platelet volume (MPV) with severity, serology & treatment outcome to assess its prognostic utility, which can be of great help in limiting morbidity & mortality associated with dengue fever. The present study was conducted in Central Pathology Lab of SMS Medical College & Hospital, Jaipur, Rajasthan from the period of March 2013 till October 2013. Blood samples were collected from 200 patients with NS 1 Antigen positivity experiencing febrile illness, clinically consistent with dengue infection. Evaluation of platelet counts, MPV, IgM and IgG antibodies was done in all these cases. Categorical data were presented as numbers (percent) and were compared among groups using Chi-square test. Groups compared for demographic data were presented as mean and standard deviation and were compared using student t-test, ANOVA and Post-Hoc Test, Tukey Test using SPSS, version 20 for Windows. A total of 200 Dengue fever cases were studied. Out of which, 68% cases were of DF, 23% DHF & 9% DSS i.e. classical dengue fever was most common presentation. Maximum (44%) cases were in age group of 15-24 years. Fever was the presenting complaint in all cases (100%). 98% cases of dengue had thrombocytopenia. MPV showed no significant correlation with severity, serology & treatment outcome, thus excluding its role in dengue cases. Mean platelet volume is not important as prognostic parameter in dengue fever.

Recent progress in dengue vaccine development.

Dengue virus (DENV) has four distinct serotypes. DENV infection can result in classic dengue fever and life-threatening dengue hemorrhagic fever/dengue shock syndrome. In recent decades, DENV infection has become an important public health concern in epidemic-prone areas. Vaccination is the most effective measure to prevent and control viral infections. However, several challenges impede the development of effective DENV vaccines, such as the lack of suitable animal models and the antibody-dependent enhancement phenomenon. Although no licensed DENV vaccine is available, significant progress has been made. This review summarizes candidate DENV vaccines from recent investigations.

English

INTRODUCTION: Dengue viral infections are among the most important mosquito- borne diseases of the Indian subcontinent and have become a major global public health concern. Spread of disease has led to increased recognition of atypical manifestations, apart from the classical clinical features of dengue infection. METHODOLOGY: This case study was conducted at the department of Pediatrics in collaboration with the Microbiology Department of Dr. Ulhas Patil Medical College, Jalgaon District of Maharashtra in West India during the period of 2 years from July 2012 to June 2014. Clinically suspected and serologically confirmed cases of dengue fever were included in the study. Clinical and biochemical parameters were compared between the two groups of dengue fever and dengue hemorrhagic fever. RESULTS: 247 patients clinically suspected and serologically confirmed cases of dengue infection were enrolled in the study. One sixty one (65%) patients were males and 86 (35%) were females. One seventy three (70%) patients had a classical dengue fever while 74 (30%) had dengue hemorrhagic fever. The most common symptoms were headache (212, 86%), skin rash (163, 66%), abdominal pain (131, 53%), vomiting (119, 48%), and hemorrhagic manifestations were present in 84 (34%) patients. Atypical manifestations were recorded. Notably, 9% of patients had neurological involvement and 5% had multi-organ failure. Overall mortality was 4.5%. CONCLUSION: Dengue infection poses a huge burden to the healthcare system; its spectrum ranges from mild self-limiting illness to severe fatal disease. It can have varied and multi-systemic manifestations which can go unrecognized. Deaths occurred in 55% (6/11) cases were associated with dengue neurological manifestations needs support to the clinicians should have a high index of suspicion for atypical manifestations in dengue endemic countries.

Clinical Outcomes and Virus Characteristics of Dengue in Kidney Transplant Recipients: Report of 11 Cases From a Single Center.

Introduction: The growing number of transplants (Tx) in developing countries has brought the impact of neglected tropical diseases such as Dengue infection (DI) and the natural course of this disease to the attention of researchers dealing with kidney Tx in tropical areas. Objectives: To report the impact of DI in 11 Tx recipients (KTx) in a single center in Brazil. Methods: From January 2010 to December 2013, all KTx with confirmed diagnosis of DI were studied. Results: Eleven KTx requiring hospitalization were diagnosed as DI in 306 KTx (3.6%). Two cases occurred in 2010 and 9 during the outbreak of 2013. Patients were a mean age of 48 ±17 years, Caucasian (81%), males (63%), and non-diabetics (9%). Immunosuppression protocols consisted of induction therapy in 82% of cases; 72% were using calcineurin inhibitors and all patients were taking steroids. Diagnosis was made 34 ± 26 months after transplantation and the principal clinical features were fever (72%), muscular pain (73%), leucopenia (90%), and thrombocytopenia (81%). Ten (91%) cases were diagnosed as classic dengue fever (DF), and one had dengue hemorrhagic fever/shock syndrome (DHF/DSS). All diagnoses were confirmed by at least one of the following serologic tests: NS1- dengue nonstructural protein 1 antigen (3/4; 27%), dengue-specific immunoglobulin M serology (7/8; 64%), or dengue virus serotype by reverse transcriptase-polymerase chain reaction (7/9; 64%). The viremia time was 6 ± 7 (3-28) days, and co-infection with cytomegalovirus was present in 18% of cases. Dengue type 1 was the main subtype (6 cases). Graft dysfunction occurred in 10 patients, but none lost their grafts after a mean follow-up time of 17±14 months. The only patient with DHF/DSS had fulminant course and died (9%). Conclusions: The most common DI virus affecting our Tx population was type1. It seems that the clinical manifestation disease in KTx is not different from that in the general population. However, KTx seems to carry the risk of life-threatening complications in patients with DHF/DSS.

Stumbles on the path to dengue control

Dengue control is in trouble. Since the severe form of dengue infection was described more than 50 years ago, this disease has spread to every corner of the tropics. 1 Hammon WM Rudnick A Sather GE Rogers KD Morse LJ New hemorrhagic fevers of children in the Philippines and Thailand. Trans Assoc Am Physicians. 1960; 73: 140-155 PubMed Google Scholar , 2 Brady OJ Gething PW Bhatt S et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012; 6: e1760 Crossref PubMed Scopus (977) Google Scholar , 3 Bhatt S Gething PW Brady OJ et al. The global distribution and burden of dengue. Nature. 2013; 496: 504-507 Crossref PubMed Scopus (5450) Google Scholar In 2010, 4 billion people were at risk of infection with any of the four dengue viruses (DENV1–4), more than 390 million individuals were infected, and 96 million had overt disease. 3 Bhatt S Gething PW Brady OJ et al. The global distribution and burden of dengue. Nature. 2013; 496: 504-507 Crossref PubMed Scopus (5450) Google Scholar During a dengue infection, a small subset of individuals with circulating infection-enhancing dengue antibodies are at risk of an abrupt onset of acute vascular permeability accompanied by abnormalities in haemostasis, potentially leading to shock, severe bleeding, and death. 4 Halstead SB Dengue. Lancet. 2007; 370: 1644-1652 Summary Full Text Full Text PDF PubMed Scopus (1153) Google Scholar This severe outcome typically occurs at the time of defervescence after several days of the symptoms of classic dengue fever. Additionally, dengue infections can have unfavourable outcomes in elderly individuals who have pre-existing chronic disorders. These clinical courses create a cruel diagnostic dilemma for physicians and have led to many efforts to identify clinical signs and symptoms premonitory of severe dengue. 5 Leo YS Gan VC Ng EL et al. Utility of warning signs in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis. 2013; 13: 498 Crossref PubMed Scopus (53) Google Scholar Meanwhile, despite the availability of many powerful insecticides, mosquito abatement efforts directed at the control or eradication of the dengue vector Aedes aegypti have conspicuously and universally failed. 6 Gubler DJ Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol. 2002; 10: 100-103 Summary Full Text Full Text PDF PubMed Scopus (1129) Google Scholar Efficacy and safety of celgosivir in patients with dengue fever (CELADEN): a phase 1b, randomised, double-blind, placebo-controlled, proof-of-concept trialAlthough generally safe and well tolerated, celgosivir does not seem to reduce viral load or fever burden in patients with dengue. Full-Text PDF

Polymorphism of DC-SIGN (CD209) promoter in association with clinical symptoms of dengue fever.

C-type lectin DC-SIGN receptor, encoded by CD209, plays a key role in the infection of dendritic cells by dengue virus (DENV). Because the -336A/G SNP (rs4804803) polymorphism in the promoter of CD209 modulates DC-SIGN expression, we investigated the putative association of this polymorphism with DENV infection and its pathogenesis. A control sample of 72 individuals, rigorously selected through a clinical investigation for absence of past dengue fever (DF) was compared to a sample of 168 patients (156 classical DF; 12 dengue hemorrhagic fever), all residents from Pará, Brazil. However, the prevalence of symptoms showed a trend higher in the AA genotype (Wilcoxon test; Z=2.02; p=0.04). Hence, our findings indicate that the G allele downregulates the spectrum of symptoms during the early acute phase of DENV infection, putatively decreasing the viremia, as suggested in the literature.

English

Dengue is the arthropode borne viral infection transmitted by mosquitoes to humans. AIM: To study the various clinical manifestations and acute complications of dengue fever. METHODS: 100 cases of confirmed dengue infection admitted to KIMS, Bangalore between December 2009 and September 2011 were studied. A detailed clinical history and physical examination was done and baseline investigations were performed. The cases were followed-up daily for the clinical and laboratory parameters and were treated according to WHO guidelines. The data related to each of these cases was collected, compiled and analyzed. RESULTS: of the total 100 cases there were 61 male and 39 female. Age group of 21-30 (41) was most commonly affected Maximum number of patients was seen in the September, October, august, July. Commonest presentation was Fever (100%) followed by Headache (78%), Myalgia (70%), Arthralgia (66%), low back ache (60%). On examination patients found to have icterus (22%), bleeding spots (26%), rashes (50%), Splenomegaly (18%), Hepatomegaly (15%) and Ascites (9%), pleural effusion (16%), crepitations (7%). Platelet count was not very well correlated with the bleeding tendencies. Incidence of DHF was more with secondary Dengue infection than the primary dengue infection. The frequency of complications was high in the patients with secondary dengue infection than the primary infection. CONCLUSION: In our present study classical dengue fever was most common presentation followed by DHF and DSS. Hypotension, hemorrhagic spots, positive tourniquet test, jaundice, pleural effusion, ascites, neck stiffness are the common findings on examination associated with complicated forms of dengue. Bleeding, shock, hepatitis, polyserositis, meningitis, pneumonia are the complications seen in severe forms. On investigation Deranged liver function test, renal function test, secondary dengue infection, thickened gall bladder wall, hepatosplenomegaly on ultrasound abdomen, pleural effusion and bronchopneumonia on chest radiogram are associated with DHF and DSS. INTRODUCTION: Dengue fever is an arthropod borne viral fever. It is acquiring epidemic proportion in this part of the world and it has become major public health problem with high mortality. Estimates suggest that 50 million cases of dengue infection and 500, 000 cases of dengue hemorrhagic fever occur in Asian countries 1 . It is vital to recognize at the earliest the signs and symptoms, alteration in biochemical parameters and multisystem involvement pattern in dengue to reduce the mortality. In 1998 WHO reported, around 1.2 million cases of Dengue fever and DHF with 3, 442 deaths. In 2001 alone, there were more than 609 000 reported cases of dengue in the Americas, of which 15 000 cases were DHF and incidence is increasing in 2001, Brazil reported over 390 000cases including more than 670 cases of DHF. About 2500 million people are now at risk from dengue. WHO currently estimates there may be 50 million cases of dengue infection every year, with 400, 000 cases of DHF, out of whom more

A descriptive study on dengue fever reported in a Medical College Hospital

Background: Dengue fever is a serious public health problem in terms of its morbidity and mortality. It reports from almost all countries and it is endemic in the tropical countries. Aim: The present hospital study aims to describe the frequency , distribution and case fatality of dengue fever based on the variables such as age, sex and year. Settings and Design: It is a hospital-based retrospective study of 5 years in tertiary care and teaching hospital in South India. Materials and Methods: The data were collected from the medical records department of the hospital and analyzed by using Microsoft excel. Result: Out of 341 reported cases of dengue, 60.70% were males and 39.29% were females. In both males and females, the high proportion of cases were reported in adult age groups (>20 years). Case fatality rate of dengue fever is 1.2%, with 0.97% in males and 1.49% in females. Out of 341 cases, 333 (97.65%) were Classical Dengue Fever and remaining 8 cases (2.34%) were dengue hemorrhagic fever. Conclusion: More cases of dengue fever were reported in the adult age group (20 years and above) and in males compared to low age groups (<20 years) and females. It highlights the involvement of work component in the occurrence of disease. Community-based action program is required for source reduction activities in the outdoor area for arresting the breeding and multiplication of Aedes mosquitoes and thereby to reduce the morbidity and mortality of dengue fever.

Cerebellar Hemorrhage in a Patient during the Convalescent Phase of Dengue Fever.

Cerebellar Hemorrhage in a Patient during the Convalescent Phase of Dengue Fever.