Mucocutaneous manifestations of dengue viral infection during 2011 epidemic in Lahore, Pakistan

ABSTRACT

To investigate the type and correlate the appearance of mucocutaneous signs and symptoms with different stages and clinical types of Dengue viral infection. Two hundred patients of dengue virus infection admitted in the dedicated Dengue Unit at Services Hospital, Lahore from 1st September to 31st October 2011 were included in the study. Presenting features were noted. The patients were physically examined for the presence of skin and mucosal lesions and findings were recorded. Serologic tests for anti-dengue immunoglobulin M [IgM] antibodies, Total and Differential Leukocyte Count [TLC and DLC], Platelet count and Liver Function Tests [LFTs] were done in all the patients. Of the 200 patients with dengue infection, 83 [41.5%] were classified as dengue fever [DF], 116 [58%] as dengue hemorrhagic fever [DHF] and one [0.5%] as dengue shock syndrome [DSS]. Cutaneous involvement was seen in 160 [80%] of patients. Of these 160 patients, 130 [81.25%] had single while 30 [18.75%] had multiple manifestations. The most common cutaneous finding was pruritis [47.50%], followed by erythema [37.50%], flushing [23.35%], eccyhmosis [18.13%], petechiae [16.88%], and macular/scarlatiniform eruption [13.7%]. Mucosal involvement was seen in 35.63% of patient, with dry tongue/ cracked lips being the most common [39.7%], followed by mucosal bleed [36.6%], and conjunctival involvement [10.2%]. The most common initial presentation was flushing [27 patients] within 1-3 days followed by mucosal involvement [47 patients] during 4-6 days and cracked lips [30 patients] in 7-10 days. Cutaneous involvement was more common in DF [41.5%] while mucosal involvement was more remarkable in DHF [58%]. This study describes the variety of mucocutaneous features associated with dengue viral infection whichm may evolve during the course of the disease. There is a clear correlation between various skin manifestations and stages of infection. Cutaneous signs and symptoms are more commonly observed in DF and mucosal involvement in DHF