Original Research

Presence of Warning Signs in Dengue Fever as the predictors of Progression to Severe Disease

Abdul Khalid1
AJK Medical College Muzaffarabad
Rubina Rafique1
AJK Medical College Muzaffarabad
Ali Arshed1
AJK Medical College Muzaffarabad
Mazhar Hamdani1
AJK Medical College Muzaffarabad
Shaukat Raja1
AJK Medical College Muzaffarabad
Marium Jabeen2
Abbas Institute of Medical Sciences Muzaffarabad
Ayesha Ishaq2
Abbas Institute of Medical Sciences Muzaffarabad

✉ Correspondence: Abdul Khalid Email: abdulkhalid301@gmail.com

DOI https://doi.org/10.70302/jpsim.v3i4.2259
Volume: 3, Issue 4 Pages: 295–300 Published: 18 Dec 2022
Received: 25 Jul 2022 Accepted: 04 Oct 2022 Published Online: 18 Dec 2022

Abstract

Objective

To assess the prevalence of different Warning Signs, hematological and biochemical abnormalities in patients hospitalized with dengue fever and to assess the Presence of Warning Signs in Dengue Fever as the predictors of Progression to Severe Disease.

Methods

The study included those patients who had clinical evidence of the presence of some of the warning signs of dengue fever during primary evaluation either in the Emergency of Outpatient departments. The confirmation of diagnosis was based upon further clinical and serological evaluation (NS1Ag, IgM and IgG antibody titers). A study Performa was used to document the history and warning signs of dengue fever. All patients had complete hematological and relevant biochemical profiles during hospital stay. The prevalence of different warning signs was documented and their association with deterioration into severe disease was assessed.

Results

A total of 100 patients who had the confirmed diagnosis of dengue fever were included in the study. The fever, associated with chills and rigors was the most common symptom and mode of presentation. There was clinical evidence of dehydration in 30% and capillary refill was decreased in 70% of patients. The history of abdominal pain and vomiting was present in 31% and 19% of patients respectively. There was subjective feelings of weakness and lethargy in 35%, while 2% patients had a positive torniquet test. The clinical evidence of mucosal and gross bleeding was present in 8% of cases and 2% had capillary leakage and developed ascites and pleural effusions. The correlation of the presence of warning signs leading to severe disease was statistically not significant in the study.

Conclusion

Severe Dengue fever developed in 8% of cases, but the correlation of the presence of warning signs and deterioration to severe disease was statistically not significant in the study.

Keywords
Dengue Fever Severe dengue fever Dengue hemorrhagic fever

How to Cite This Article

Khalid A, Rafique R, Arshed A, Hamdani M, Raja S, Jabeen M, et al.. Presence of Warning Signs in Dengue Fever as the predictors of Progression to Severe Disease. J Pak Soc Intern Med. 2022;3(4):295–300. doi:10.70302/jpsim.v3i4.2259

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Brady OJ. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLOS Neglected Tropical Diseases. 2012;6(8):e1760.
  2. Bhatt S. The global distribution and burden of dengue. Nature. 2013. 496(7446): 504–7.
  3. Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Res 2012;136:373e90.
  4. World Health Organization. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. 2009, Geneva: World Health Organization. 1-147.
  5. Balmaseda A, Standish K, Mercado JC. Trends in patterns of dengue transmission over 4 years in a pediatric cohort study in Nicaragua. J Infect Dis. 2010; 201(1): 5–14
  6. Alves MJ, Fernandes PL, Amaro F. Clinical presentation and laboratory findings for the first autochthonous cases of dengue fever in Madeira island, Portugal, October 2012. Euro Surveill. 2013;18(1): 6.
  7. Humayoun M A, Wassem T, Jawa AA, Hashmi M S, AkramT.Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virusoutbreak in Punjab, Pakistan. Int J Infect Diss.2010; (14)S: 54–9
  8. Jayanthi HK, Tulasi SK. Correlation study between platelet count, leukocyte count, nonhemorrhagic complications, and duration of hospital stay in dengue fever with thrombocytopenia. J Family Med Prim Care. 2016;5(1):120-3.
  9. Ahmed S, Arif F, Yahya Y, Rehman A, Abbas K, Ashraf S, et al. Dengue fever outbreak in Karachi 2006 - A study of profile and outcome of children under 15 years of age. J Pak Med Assoc. 2008;58(1):4–8.
  10. Dhooria GS, Bhat D, Bains HS. Clinical profile and outcome in children of dengue hemorrhagic fever in North India. Iran J Pediatr. 2008;18(2):222–8.
  11. Swamy AM, Mahesh PY, Rajashekar ST. Liver function in dengue and its correlation with disease severity: a retrospective cross-sectional observational study in a tertiary care center in Coastal India. Pan Afr Med J. 2021;40(4):261.
  12. Martina BEE, Koraka P, OsteMunasinghe DR, Rajasuriya K. Hepatitis in dengue fever. Ceylon Med J. 1967;12(4):222–23.
  13. Sedhain A, Adhikari S, Regmi S, Chaudhari SK, Shah M, Shrestha B. Fulminant hepatic failure due to dengue. Kathmandu Univ Med J. 2011;9(34):73–5.
  14. Seneviratne SL, Malavige GN, de Silva HJ. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg. 2006;100(7):608–14
  15. Saha AK, Maitra S, Hazra SCh. Spectrum of hepatic dysfunction in 2012 dengue epidemic in Kolkata, West Bengal. Indian J Gastroenterol. 2013;32(6):400–3.
  16. Tariq Waseem, Hina Latif, Bilquis Shabir. An unusual cause of abdominal pain in dengue fever. AJEM. 2014. DOI:http//doi.org/10.1016/j.aejm.2014.01.011 doi:10.1016/j.aejm.2014.01.011
  17. Malavige GN, Ogg GS. Pathogenesis of vascular leak in dengue virus infection. Immunology. 2017;151(3):261-9.
  18. Rodrigo C, Sigera C, Fernando D. Plasma leakage in dengue: a systematic review of prospective observational studies. BMC Infect Dis. 2021; https://doi.org/10.1186/s12879-021-06793-2 doi:10.1186/s12879-021-06793-2
  19. Lima, MR, Nogueira, RM, Schatzmayr, HG, de Filippis, AM, Limonta, D, and dos Santos, FB. A new approach to dengue fatal cases diagnosis: NS1 antigen capture in tissues. PLoSNegl Trop Dis. 2011;5(1): e1147
  20. Lin CC, Huang YH, Shu PY. Characteristic of dengue disease in Taiwan: 2002-2007. Am J Trop Med Hyg. 2010; 82(4):731-9.
  21. Min-Sheng Lee, Kao-Pin Hwang, Tun-Chieh Chen, PoLian Lu, Tyen Chen. Clinical characteristics of dengue and dengue hemorrhagic fever in a medicalcenter of southern Taiwan during the 2002 epidemic. J Microbial Immunol Infect. 2006; (39): 121-129.
  22. Beltrán-Silva SL, et al. Clinical and differential diagnosis: Dengue, chikungunya and Zika. Rev Med Hosp Gen Méx. 2016;http://dx.doi.org/10.1016/j.hgmx.2016.09.011 doi:10.1016/j.hgmx.2016.09.011

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2022 Journal of Pakistan Society of Internal Medicine.
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