Hematological and biochemical indicators for the early diagnosis of dengue viral infection

ABSTRACT

To determine the haematological and biochemical indicators for the early diagnosis of dengue viral infection. A case series. At Medical Unit-III, Ward 7, Jinnah Postgraduate Medical Centre and referred cases from Faiz-e-Rehman Hospital, Metroville, Karachi from September to November 2007. Patients presenting with a fever of less than 2 weeks duration, generalized morbiliform rash and bleeding manifestations were included. Clinical history was recorded and patients were placed on fluid and haematological support. Diagnosis was established by Polymerase Chain Reaction [PCR] for dengue virus or detection of dengue virus specific IgM and IgG. Results: One hundred and four patients met the inclusion criteria during the study period. Sixty six patients had clinical and haematological features suggestive of grade I Dengue Hemorrhagic Fever [DHF]; 34 patients had grade II DHF and 4 had grade III DHF out of whom 3 progressed to grade IV DHF. All the patients presented with fever followed by generalized morbiliform rash [81.73%], vomiting [79.8%], abdominal pain [65.38%], backache [62.5%], depression [60.6%] and mucosal bleeding manifestations [34.6%]. Clinically, conjunctival infection was present in 93 patients [89.4%], hepatomegaly 59 [56.7%], lymphadenopathy in 17 [16.3%], splenomegaly in 13 [12.5%], pleural effusion in 11 [10.5%] and ascites in 8 [7.6%]. Common laboratory findings were thrombocytopenia in 100% patients, leucopenia in 55 [52.8%], raised hematocrit in 52 [50%], and elevated aminotransferases, gamma GT in 100 [96%] patients. The overall mortality was 2.88%. In this series clinical history and examination supported by the triad of thrombocytopenia, raised hematocrit and elevated liver enzymes was sufficient for the early diagnosis of dengue hemorrhagic fever without waiting for dengue serology