Session: Poster Session: Tropical Diseases
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: To investigate the changing trends in clinical profile, effect on liver function and risk factors for bleeding in adult patients treated at a tertiary care hospital in Delhi during the outbreak. Methods: This observational study was conducted in the emergency department of an academic urban hospital during 2004 outbreak in India. All consecutive adult patients with clinical features satisfying the WHO criteria for Dengue fever were recruited in the study. Patients underwent detailed clinical evaluation including laboratory and radiological investigations towards symptoms of dengue. Statistical analysis was done using SPSS version 16. Results: Out of 265 eligible patients screened, 208 cases were included in the study. Mean age of patients was 27.1 years (range 11-80 years); 78% were males. The cases were defined as DF 122, DHF/DSS 86, 176 primary and 32 secondary infection. The predominant presentations were fever(100%),myalgia (61.5%),vomiting(42%),headache(36%),rash(24.3%),abdominal pain(16.8%), seizures(1.6%),and bleeding manifestations 103(49.5%). Myalgia OR=3.13 p<0.001, hepatomegaly OR=2.56 p=0.036, morbiliform rash OR=2.53 p=0.004 and headache OR=1.94 p=0.024, were independently associated with increased likelihood of spontaneous bleeding. The prominent unusual feature observed was moderate elevation of transaminases: in DF and DHF/DSS; the mean (range) AST [125(23-448), 137(24-609) ] IU (p=0.3), ALT [111 (42-325),115(32-461)] IU (p=0.6) and serum alkaline phosphatase[174(59-530), 153(56-610)] IU (p=0.3). All patients recovered except one (0.48%) who succumbed due to intracranial hemorrhage. Conclusion: Fever, myalgia, rash, thrombocytopenia, increasing age and decreased mortality rate were the predominant manifestations. Asymptomatic elevation of transaminases was observed independent of severity of infection. The study corroborates trends reported from other parts of Asia. Collaborative studies integrating different centres in Asia may be beneficial in better understanding the pathogenesis specific to the region.