Dengue Hepatitis Research Articles

Dengue hepatitis: Incidence, spectrum and outcome.

While dengue infection is common in India, there is scarce information on dengue hepatitis. The aim of this study was to analyze the incidence, spectrum and outcome of dengue hepatitis. We retrospectively analyzed consecutive patients, who had hepatitis among those with dengue infection admitted to two tertiary care hospitals in western India from January 2016 to March 2021. Diagnosis of dengue infection was made by serology. Dengue hepatitis was diagnosed and the severity of dengue was categorized by standard criteria. Of 1664 patients admitted with dengue fever during the study period, 199 patients had hepatitis (i.e. incidence of dengue hepatitis was 11.9%). Of the 199 dengue hepatitis patients (age: 29 [13 - 80] years, median [range], 67% males), 100 patients (50%) had severe dengue, 73 (36%) had severe dengue hepatitis, 32 (16%) had dengue shock syndrome and eight (4%) had acute liver failure. Forty-five patients (23%) had acute lung injury and 32 (16%) had acute kidney injury. The dengue hepatitis patients were treated with standard medical care, including vital organ support, as needed-166 (83%) patients survived, while 33 patients (17%) died (cause of death: multi-organ failure: 24 patients, septic shock: nine patients). The presence of shock independently predicted mortality (odds ratio 6.4, 95% confidence interval: 1.2 - 34). Among patients with dengue hepatitis, mortality rate was higher in those with severe dengue (23%), dengue shock syndrome (47%), severe dengue hepatitis (24%) and acute liver failure (38%). In this large series of hospitalized patients with dengue infection, the incidence of dengue hepatitis was 11.9%. Among 199 dengue hepatitis, 17% died; multi-organ failure was the commonest cause for death and death rate was higher in patients with more severe disease. The presence of shock at presentation independently predicted mortality.

Autoimmune hepatitis unmasked by dengue infection - An unexplored and rare association.

Dengue hepatitis is mostly asymptomatic but can lead to liver failure. Autoimmune hepatitis is mainly the disease of females and a potentially treatable cause of chronic liver disease. We report a rare case in which autoimmune hepatitis was unmasked by Dengue infection. The patient was managed for AIH with steroids and azathioprine and became asymptomatic in 30 days. Dengue is a proven risk factor for many autoimmune conditions but its association with AIH is not studied.

Dengue hepatitis with acute liver failure: Clinical, biochemical, histopathological characteristics and predictors of outcome.

Hepatitis infection from non-hepatotropic viruses such as dengue virus (DENV) is increasing worldwide. There is increasing recognition of the changing epidemiology and atypical presentations of DENV infection including acute liver failure (ALF). There is paucity of data regarding incidence, disease characteristics, and markers of prognosis in patients who develop DENV-related ALF. We aimed to study the incidence, clinical features, laboratory characteristics, and determinants of outcome in patients of DENV presenting with ALF. We reviewed all patients with DENV infection and focused on DENV-related ALF from 2014 to 2017. Diagnosis of DENV and ALF was confirmed by serological tests and standard criteria, respectively. Thirty-six patients (20 men, mean age 32.3) developed ALF among 10108 patients with DENV infection (0.35%). Twenty-one patients died (58.3%). Although bilirubin, aspartate and alanine aminotransferase, and international normalized ratio were markedly elevated in all patients with DENV ALF, there was no statistically significant difference between survivors and non-survivors. Lactate levels, pH at admission, and model for end-stage liver disease (MELD) score were the only predictors of mortality. Lactate levels were significantly higher in non-survivors (11.5±4.2mmol/L) than survivors (6.3±3.6mmol/L) (P<0.001). MELD score in non-survivors (26.7±10.2) was significantly higher than in survivors (20±7.2) (P=0.039). Receiver operator characteristic curve showed lactate or pH to be a superior prognostic marker than MELD with an area under the curve of 0.80, 0.79, and 0.70, respectively. Dengue hepatitis progressed to ALF in 0.35%. Development of ALF was associated with a high mortality (>50%). Lactate level, pH, and MELD score at admission were significant determinants of outcome.

Profile of dengue hepatitis in children from India and its correlation with WHO dengue case classification

Profile of dengue hepatitis in children from India and its correlation with WHO dengue case classification

N-acetylcystein in dengue hepatitis.

Sir, The recent report on N-acetylcystein (NAC) in dengue hepatitis is very interesting.[1] Habaragamuwa and Dissanayaka they found that NAC resulted in a good outcome without hepatic transplantation.[1] In fact, hepatic dysfunction is an important, but forgotten complication of dengue.[2] The management of dengue hepatitis is usually supportive and symptomatic treatment. The use of NAC might be useful. However, it should be noted that dengue hepatitis can be self-limited.[3,4] To manage dengue hepatitis, with or without hepatic dysfunction, the critical concept is optimal fluid replacement therapy.[5]

Dengue hepatitis sans dysfunction: experience of a single tertiary referral centre in the north Indian state of Uttarakhand

Hepatic involvement is uncommon in dengue viral infections and is traditionally thought to be associated with severe disease in terms of morbidity and mortality. This study was conducted in order to assess the liver function in patients with dengue virus infection and to analyse its effect upon patient outcome. Three hundred and twenty-seven consecutive patients with dengue virus were categorized into groups A, B, C and D on the basis of elevation of either of the hepatic transaminases (normal, <3, 3-10 and >10 times, respectively). Primary and secondary outcome measures related to morbidity and mortality were studied. Hepatitis was seen in ∼3/4 patients; an increasing grade of liver involvement was significantly associated with fewer platelets (P < 0.001). Recovery of platelets, bleeding manifestations, renal dysfunction, platelet recovery and duration of hospitalization were similar in all groups. Among the patients with manifest bleeding, the platelet count did not differ significantly but the platelet recovery was significantly slower (P = 0.044) with increasing grade. Hepatic dysfunction is self-limited without any increase in morbidity and mortality.

Mo1839 Dengue Hepatitis: Frequency and Severity of Liver Dysfunction and Its Correlation With Survival

Mo1839 Dengue Hepatitis: Frequency and Severity of Liver Dysfunction and Its Correlation With Survival

Atypical manifestations of dengue

As the spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. This review compiles descriptions of atypical manifestations of dengue, such as dengue encephalitis, dengue myocarditis, dengue hepatitis and dengue cholecystitis.