Outbreak Of Dengue Infection Research Articles

“STUDY OF SERUM AMINOTRANSFERASE LEVELS IN DENGUE FEVER”

Dengue infection, an arthropod-borne viral hemorrhagic fever, continues to be a major challenge to public health, especially in South-East Asia. It has a wide geographical distribution and can present with a diverse clinical spectrum. The liver dysfunction could be a direct viral effect or an adverse consequence of dysregulated host immune response against the virus. Hepatic involvement can be characterized by manifestations of acute hepatitis, with pain in the right hypochondrium, hepatomegaly, jaundice, and raised aminotransferase levels. Several outbreaks of dengue infection have been reported from India. However, large clinical studies documenting hepatic involvement in dengue infection, especially in adults, are scarce.

The impact of population mobility on dengue: an experience from Northern Sri Lanka

Dengue infection continues to be a major public health issue and has been a challenge to health authorities for years due to several reasons. It is well known that the virus, mosquito and human factors play significant roles in the transmission of the infection. Traditionally, several preventive measures that are targeted towards the mosquito are well implemented in several countries, including Sri Lanka. Studies have shown that human mobility is a contributing factor in dengue infection and the objective of this report is to give an account on the possibility of human mobility as a major contributing factor for the outbreak of dengue infection in northern Sri Lanka. The gateway “A9” was reopened to the public in mid-2009, as the political unrest had come to a halt by May 2009. Northern Sri Lanka was thereby reconnected with the south, which increased population mobility both ways. An increase in the incidence rate of dengue fever from 10.72 in 2008 to 539.65 in 2010, supported the hypothesis of the possible contribution of human mobility in the dengue outbreak of 2010. Human mobility factors are often overlooked when considering preventive aspects. Preventive measures targeting human movements may enhance effectiveness of dengue control programs.

Association between the degree of hepatic dysfunction and complications among serologically positive and serologically negative dengue infection in children

Objective: To analyze the degree of liver dysfunction among serologically confirmed dengue and dengue suspected cases as per the WHO criteria in children with reference to complications and mortality. Methods: This study was conducted on 200 children between 3 months to 15 years age group, admitted with acute febrile illness during an outbreak of dengue infection. Clinically suspected dengue based on WHO criteria and serologically confirmed dengue patients were included in the study. Liver function tests were analyzed and evaluated the degree of liver damage to assess the outcome, mortality and prognosis of dengue infection. Results: Of the 200 acute febrile patients enrolled in the study, 105 (52.5%) were classified as serologically confirmed dengue, out of which 64(61%) were Dengue fever (DF) and 41(39%) were Dengue hemorrhagic fever (DHF). 95 (47.5%) were classified as suspected dengue cases, as per the WHO diagnostic criteria, out of which 54 (56.8%) were DF and 41 (43.9%) were DHF. There was severe elevation of aspartate transaminase (AST) and alanine transaminase (ALT) in both confirmed DHF (mean 452.6U/l and 210U/l) and suspected DHF (mean 694U/l and 431U/l), moderate elevation in confirmed DF (mean 286.7U/l and 162.5 U/l) and mild elevation in suspected DF (mean 80.2U/l and 48.1U/l). The AST levels were significantly elevated than the ALT levels in both confirmed and suspected cases of DF and DHF. Hepatic dysfunction was more common in confirmed dengue (66%) cases than suspected dengue (57.6%). The common degree of liver damage both in confirmed and suspected cases of DF was grade 0 where as in DHF grade 1. All the patients with encephalopathy had grade 4 liver damage. Dengue complicated by renal failure had grade 3 and 4 liver damage. There was a significantly higher mortality rate in DHF with grade 4 hepatic damage than DF. Conclusion: The degree of liver dysfunction is more significant in both serologically positive and negative DHF than DF. Severe hepatitis (grade 3 and 4) in dengue infection has got worse outcome in terms of mortality and complications as compared to mild to moderate hepatitis (grade 1 and 2). Therefore severe hepatitis can be considered as a bad prognostic indicator of outcome in dengue infection.

Change in demographic pattern of dengue virus infection: evidence from 2011 dengue outbreak in Punjab, Pakistan

Dengue viral infection is a global challenge. Due to global distribution of its vector (Aedes), interepidemic phases have condensed andmore serious cases of dengue illness are being reported, especially in South America and Asia where it has become endemic. Dengue epidemics have been reported occasionally in Pakistan, with involvement of all four serotypes. The first documented outbreak of dengue viral infection occurred in Karachi in 1994, followed by another epidemic in 2005. Most reported deaths in a major outbreak of dengue infection in 2006 in Karachi were due to Serotypes 2 and 3. There have beenmany sporadic cases of dengue viral infection in Punjab,with amajor outbreak in 2003.Many cases of dengue fever have subsequently been reported in this province. Age and gender are considered to be major factors in dengue viral infection. Many studies have reported an age

Outbreak of dengue infection in rural Davangere, Karnataka

Outbreak of dengue infection in rural Davangere, Karnataka

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.

Prevalence and Clinical Differentiation of Dengue Fever in Children in Northern India

Although an increasing trend in outbreaks of dengue infection is seen in the northern Indian plains, the importance of dengue infection as a cause of acute undifferentiated febrile illness (AUFI) round the year is not known and the validity of clinical signs and simple laboratory parameters in differentiating dengue from other causes of AUFI has been sparsely reported. To study the prevalence of dengue infection as a cause of AUFI seen round the year and validity of clinical and simple laboratory features for its diagnosis. Consecutive children between 6 months and 12 years of age presenting to outpatients on 3 predecided weekdays with complaints of fever of 15 days or less duration and having no localizing signs of infection were enrolled over a 1-year period. Blood counts, liver function tests and ELISA test for dengue IgM were performed besides other investigations. Those testing positive for IgM were considered "probable dengue" (PD) while those with negative IgM tested after 5 days of illness were considered "non-dengue" (ND). Clinico-laboratory features were compared between PD and ND. A randomly selected subsample of IgM +ves was tested for dengue genome by real time PCR assay. Of 298 children enrolled over 1 year, 56 (18.8%) tested positive for dengue IgM and 132 were ND. Comparing PD and ND, age, duration of illness at presentation, rash, bleeding manifestations, vomiting, platelet count, liver transaminases, serum proteins, albumen and bilirubin were significant features on univariate analysis. On logistic regression younger age, rash and higher serum alanine transaminase (sALT) levels were the only significant independent predictors for PD. Taking cutoff of age as 60 months or less and sALT > 40 units, one or more of these features were seen in 50/56 PD cases (sensitivity 89.3%). All of these were present in only 1 of 132 ND cases (specificity 99.2%). Randomly selected 44 of the 56 IgM +ve patients were subjected to PCR assay, of which 15 were positive. Dengue transmission occurs round the year in this region. The cause of AUFI was definitely dengue in 15/298, i.e., 5% cases and likely to be dengue in another 13.8% cases. In children presenting to outpatients here with AUFI, young age, rash, and raised sALT are significant independent pointers to dengue. A combination of clinical and laboratory features including liver enzymes could be used to achieve high sensitivity and specificity. These results should be validated in a separate data set.