Form Of Dengue Infection Research Articles

A RETROSPECTIVE OBSERVATINAL STUDY OF SERUM AMINOTRANSFERSASE LEVELS IN THE ASSESSMENT OF SEVERITY OF DENGUE FEVER

Liver involvement in dengue fever is manifested by the elevation of transaminases due to direct attack of virus itself or the use of hepatotoxic drugs.Objective of our study was to assess the serum aminotransferase level in patient with dengue fever and to correlate serum aminotransferase level and severity of dengue fever. This is a prospective observational study. Atotal of 50 fever patients admitted with positive dengue serology in Medicial ward, ZMCH ,Dahod,were included after satisfying the inclusion and exclusion criteria. All the patients were subjected to complete history taking and clinical examination. Investigations like complete blood count, liver function test, dengue serology and abdominal ultrasound were done in all patients.A total of 50 dengue serology positive patient were included in the study. Among them there were 27 (54%) males and 24(46%) females. In our study 41 patients (82%) had elevated serum transaminase level, Mean ASTlevel was 134.84 IU/Land the mean ALTlevel was 107.88 IU/L. The level of AST is higher when compared to ALT in most of the patients. Among those who had elevated aminotransferase level 12 patients (24%) had both elevated aminotransferase level and free uid in the abdomen. Out of 50 patients 32 (64%) had reduced platelet count (less than one lakh) and all the 32 patients had elevated serum aminotransferase level. There was signicant negative correlation between serum aminotransferase level and platelet count (P value < 0.001).Hepatic dysfunction is very common in all forms of Dengue infection. Serum Aminotransferase level correlate with severity of Dengue fever. Aspartate Aminotransferase was signicantly raised when compared to Alanine Aminotransferase in most of the patients

Liver function tests to predict the severity of dengue fever in serologically positive children below 18 years of age

Background: Dengue fever presents with a diverse clinical spectrum. Although liver is not a major target organ, hepatic dysfunction is a well-recognized feature. In this study authors attempted to study the pattern of hepatic involvement in children with dengue and its association with disease severity.Methods: This was a cross sectional study conducted at Cheluvamba hospital during the period of 1 year. Children <18 years of age with dengue Ns1 Ag and IgM positive were included in this study. After obtaining informed consent, a pre-structured proforma was used to record the relevant information from each subject. After detailed clinical examination and haematological investigation children were categorized into three groups as dengue fever with no warning signs (DNWS), dengue fever with warning signs (DWWS) and severe dengue fever (SDF) according to WHO classification. Statistical analysis was done to know the strength of association between different clinical and biochemical variables and outcome of the disease.Results: The mean age of the study population was 8.65 years with male preponderance. The mean total bilirubin, serum albumin, SGOT, SGPT, ALP, PT and INR were 0.76 mg/dl, 3.8g/dl, 233.18U/L, 118.15U/L, 200.65 U/L, 12.9s and 1.09 respectively. The mean SGOT was significantly higher than SGPT. The degree of deranged LFTs was significantly more in SDF group than DNWS and DWWS groups. Serum albumin was significantly decreased in children with SDF group correlating with disease severity, prognosis and outcome.Conclusions: Hepatic dysfunction was present in all forms of dengue infection, with SGOT rising significantly more than SGPT. All biochemical liver parameters were significantly deranged in patients with severe dengue fever indicating prolonged illness and poor prognosis.

Profile of serum transaminases in patients with dengue infection in a tertiary care hospital

Background: Although dengue virus is a non hepatotropic virus, liver injury due to dengue infection is not uncommon. Atypical manifestations with liver involvement have frequently been reported, ranging from mild elevations of aminotransferase levels to fulminant hepatitis. The aim of the present study is to study the serum transaminases level in various forms of dengue infection and correlate with severity.Methods: An analysis of 151 serologically confirmed cases (0-14 yrs) of dengue from June 2017 to July 2017 at a tertiary care hospital, Dharwad was made to assess the frequency and degree of hepatic dysfunction in children with dengue infection by analyzing serum transaminase levels. Patients were classified according to WHO as dengue without warning signs, with warning signs and severe dengue. Patients were divided into primary and secondary dengue based on serology and serum transaminases levels were assessed in each of the above groups. Patients with normal aminotransferase levels were categorized into Grade A, those with atleast one of the enzymes raised to less than 3 times the reference range as Grade B, those with atleast one of the enzymes elevated more than 3 times but less than 10 times as Grade C and those with elevations more than 10 times as Grade D. χ2 test was applied to check statistical significance.Results: During the study period, the total number of serologically confirmed cases of dengue were 151 among which dengue fever without warning signs were 38, with warning signs were 91 and severe dengue were 22. Serum transaminase levels were significantly raised in severe dengue (χ2=14.228, df=6, p=0.027).It was also found that transaminases were significantly higher in secondary dengue infection than primary dengue ( χ2=10.155, df=3, p=0.017). Transaminases were significantly elevated in non-survivors (χ2=16.958, df=3, p<0.001).Conclusions: Hepatic dysfunction was common in all forms of dengue infection, with AST rising significantly more than ALT. Transaminases were significantly elevated in severe dengue and secondary dengue infections. Patients with significantly high transaminases had a poor outcome.

English

BACKGROUND: The involvement of liver in dengue fever is not uncommon as reported in literature since 1970. Liver and nervous system involvement simultaneously predicts poor outcome in dengue fever. Atypical manifestations include liver involvement with elevation of enzymes, central nervous involvement (encephalopathy) and cardiac alterations (myocarditis). Liver involvement in dengue fever is manifested by the elevation of transaminases representing reactive hepatitis, due to direct attack of virus itself or the use of hepatotoxic drugs. OBJECTIVE OF THE STUDY: Study of serum aminotransferase levels in dengue fever. METHODOLOGY: In this descriptive, cross sectional study, all patients who presented to the Department of medicine with dengue IgM positive were included. Study period of 24 months from July 2010-June 2012, patients attending to M.S. Ramaiah medical college were included (n=166). RESULTS: 166 patients reactive for dengue virus specific IgM antibody were studied. As per WHO classification, 137 (82.5%) patients were classified as dengue fever, 20 (12%) as dengue hemorrhagic fever, and 9 (5.4%) as dengue shock syndrome. Mean age of dengue infection patients was 35.71 ±12.9 (SD) years, with male to female ratio nearly equal. Hepatic dysfunction is very common in all forms of dengue infection, with AST rising significantly more than ALT. Serum aminotransferase levels appear to have a directly proportional correlation with grading of dengue infection. Hyperbilirubinemia, elevated transaminases, hypoproteinemia, hypoalbuminemia and deranged coagulation profile were seen in higher frequency in DHF and DSS group as compared to classical DF group. AST and ALT were significantly higher in patients with secondary infection (IgM & IgG positive) as compared to primary infection (IgM positive). CONCLUSION: Serum aminotransferase levels are significantly raised in all forms of dengue infection and it directly correlates with severity of infection. Serum aspartate aminotransferase was significantly raised compared to alanine aminotransferase levels in all forms of dengue infection. The degree of affection of serum albumin and prothrombin time which are absolute indicators of liver cell function correlated with severity of dengue infection.

Specificity of Hess Test as a Marker of DHF

Abstract Objectives: Dengue Fever is a public problem in most of the tropical countries of South - East Asia. DHF is a serious form of Dengue Infection, diagnosed on the basis of demonstrating an increased capillary permea-bility and thrombocytopenia with concurrent haemo-concentration. Hess test or Tourniquet test has been recommended as the initial screening procedure of pat-ients with suspected DHF. The objective of the present study was tosee thespecificity of Hess test as a marker of DHF. Methods: In a total of 50 patients of DHF admitted to the Mayo hospital Lahore from September to October 2011 during outbreak of Dengue Infection, were pros-pectively studied. Hess test or tourniquet test was con-ducted in these cases in the standard method. Results: Out of the 50 patients of DHF, only 26 were Hess test positive. These 50 patients were divided into 4 groups, patients with only rash, only bleeding, bleed-ing and rash together and Non-bleeding Non-rash. Out of 09 patients of rash Hess test was positive in only 06 patients (67.7%). In bleedingonly group Hess test was positive in 06 out of 11 patients (54.5%). Similarly in bleeding n rash simultaneously Hess test was positive in 06 out of 07 patients (85.7%). In non bleeding non rash group Hess test was positive in 08 out of 23 pati-ents (34.8%). Conclusion: The tourniquet test was positive in only 52% of all DHF cases. It is concluded that a positive Hess test is a good marker of DHF but negative tourni-quet test may not be sufficient to exclude a diagnosis of DHF in a febrile patient. This necessitates the need for the re-defining the clinical criteria for the diagnosis of DHF, particularly grade I DHF.

Clinical and Virological Factors Influencing the Performance of a NS1 Antigen-Capture Assay and Potential Use as a Marker of Dengue Disease Severity

BackgroundDetection of dengue NS1 antigen in acute infection has been proposed for early diagnosis of dengue disease. The aim of this study was to evaluate the clinical and virological factors influencing the performance of the Platelia NS1 Ag kit (BioRad) and to assess the potential use of NS1 antigen and dengue viral loads as markers of dengue disease severity.Methodology/Principal FindingsBlood specimens were collected from patients hospitalized at the Kampong Cham hospital during the 2006 and 2007 dengue epidemics in Cambodia. Dengue infection was confirmed in 243/339 symptomatic patients and in 17 asymptomatic individuals out of 214 household members tested. Overall sensitivity and specificity of Platelia NS1 Ag kit were 57.5% and 100% respectively. NS1 Ag assay combined with IgM antibody capture ELISA significantly increased the sensitivity for dengue diagnosis. NS1 Ag positivity rate was found significantly higher in DF than in DHF/DSS, in primary than in secondary infections, in patients with a high viremia (>5 log/mL) and in patients infected with DENV-1. In asymptomatic individuals, the NS1 Ag capture sensitivity tends to be lower than that in symptomatic patients. Milder disease severity was observed independently in patients with RNA copy number >5 log10 cDNA equivalents/mL or in high level of NS1 antigen ratio or in DENV-1 infection.ConclusionsOverall sensitivity of NS1 Ag detection kit varied widely across the various forms of dengue infection or disease. Sensitivity was highest in patients sampled during the first 3 days after onset of fever, in patients with primary infection, DENV-1 infection, with high level of viremia and in DF rather than DHF/DSS. In asymptomatic patients, RT-PCR assay has proved to be more sensitive than NS1 antigen detection. The NS1 antigen level correlated significantly with viremia and a low NS1 antigen ratio was associated with more severe disease.