RESUMO
Background: Dengue fever, an emerging public health issue in Pakistan bears considerable morbidity and mortality. This descriptive cross sectional study was conducted to analyze clinical, hematological and serological characteristics of dengue fever variants and to identify biomarkers that predict its severity
Methods: 105 dengue cases [>12 years] were selected after ethical approval from Rawal Institute of Health Sciences and Benazir Bhutto Hospital Rawalpindi over 6 months [July to Dec 2015]. Patients having pre-existing hematological disorder, liver disease, malaria and typhoid co-infection were excluded. Demographic data, clinical findings, hematological and serological profile documented. Patients were classified as classic dengue fever [DF], dengue hemorrhagic [DHF] and dengue shock syndrome [DSS]. Data analyzed via SPSS version 17
Results: Among 105 cases, there were 79[75%] males and 26[25%] females. Mean age was 30 +/-12.8 years and mean duration of symptoms 5 +/-2 days. Dengue fever was found in 75[75%], dengue hemorrhagic fever 24[23%] and dengue shock syndrome 2[2%]. Gender, mean age and duration of symptoms were comparable between DF, DHF and DSS. Common clinical features were fever [100%], headache [56%], muscle pain [43%], vomiting [43%], retro-orbital pain [23%], bleeding [12%] and hypotension [10%]. Thrombocytopenia, leukopenia and pancytopenia were frequent in DHF vs. DF. Dengue NS-1 antigen positive in 71[90%] of DF cases vs 16[57%] DHF and 1[50%] DSS. Dengue-IgM positive in 32[47%] DF vs. 19[79%] DHF and 2[100%] DSS. Dengue -IgG detected in 33[42%] DF vs. 17[71%] DHF and 1[50%] DSS. 101[96%] dengue cases were treated successfully and one case expired
Conclusion: Dengue-IgG and IgM are better predictive variables for dengue hemorrhagic fever as compared to NS-1 antigen that predicts classic dengue fever. Utilizing these predictive variables, imminent severe dengue may be identified and with vigilant monitoring, fluid resuscitation and pre-hand arrangement of blood products we may reduce complications and mortality in high risk cases