Pleural effusion in dengue. Karachi perspective

ABSTRACT

To study the presentation of pleural effusion among dengue patients in Pakistan and to explore limitations in the diagnosis of these patients by the physicians of a developing country. We conducted a cross-sectional study on patients admitted to Aga Khan University Hospital, Karachi, Pakistan from January 2005 to September 2008. Records of 663 dengue patients were reviewed. Demographic data, respiratory complaints, radiographic studies, and final outcome were studied. Presentation and radiological modality confirming the diagnosis of pleural effusion were noted. Descriptive statistics followed by Chi-Square test were applied, testing against an alpha of 0.05 and 95% confidence interval [CI]. Three hundred and fifty-four [53%] out of a total of 663 dengue syndrome patients did not complain of any respiratory symptoms at presentation, nor did their medical examination elicit any suspicion of PE. Hence, no radiological study was advised. Amongst the remaining 309 patients, 299 [97%] underwent chest x-ray and 10 [3%] had abdominal ultrasound. The pleural effusion was noted in 50 [16%] patients [31 male and 19 female patients, with a mean age of 32 +/- 15 years]. A right-sided pleural effusion was found in 23/50 [46%] patients, left sided in 9/50 [18%], and 18/50 [36%] patients had pleural effusion on both sides. Out of the radiologically confirmed pleural effusion dengue patients, 44/50 [88%] showed altered hemo-concentration with an insignificant odds ratio of 0.7 [p=0.56, 95% CI 0.263-2.066]. Compared to other studies, fewer numbers of our patients suffered from pleural effusion. The diagnostic modality preferred by the physician was the chest X-ray