The Changing Clinical Spectrum of Dengue Fever in the 2009 Epidemic in North India: A Tertiary Teaching Hospital Based Study 999-1002
Dr. Seema Awasthi M.D. (Pathology)
Teerthanker Mahaveer Medical College, Moradabad, U.P., India.
Introduction: Dengue fever epidemics have been causing major concerns in India since the last two decades. Many parts of India, including the north regions, are now endemic for the Dengue infection. This retrospective study was conducted in a tertiary teaching hospital in north India to determine the changing trends of the clinical features in the Dengue patients of this region in the recent years.
Materials and Methods: A retrospective study of four months was conducted on 309 cases who presented with fever, who were suspected as Dengue fever cases and they were admitted in the study. A detailed history and the clinical examination findings were recorded and all the cases were subjected to laboratory investigations which included a complete haemogram, a liver function test, a kidney function test and serological tests. All the patients were treated symptomatically.
Result: Among the 309 suspected Dengue patients, the male: female ratio was 2:1. The Dengue serology was studied for all the cases and only 34 cases were found to be positive (male: female =1.6:1). On clinical examination, a maculo-papular erythematous rash was found to be present in 69% cases and petechiae were present in 38% of the cases. 8% of the cases showed a tendency for spontaneous bleeding. Among these 8% cases with a bleeding tendency, 9 interesting cases showed normal platelet counts and prothrombin times. Renal failure, an altered sensorium, pleural effusions and shock developed in 4, 1, 1 and 1 cases respectively. A platelet count of <1,00,000/cmm was found in 84% cases and 26% cases had a platelet count of less than 20,000/cmm, out of which 20% cases had platelet transfusion. The haemoglobin reduction was not significant in most of the cases and 57 % of the cases showed elevated liver enzymes. 21 cases (6.79%) showed hepatomegaly and splenomegaly was present in 28 cases (9.06%).
Conclusion: This study showed slight differences in the clinical profile and the course of illness as compared to the findings of previous studies from the same region, thus indicating a need for the early identification of the Dengue cases to prevent further complications and mortality in the future.