INTRODUCTION:

Dengue fever and Dengue hemorrhagic fever (DHF) are acute febrile illnesses caused by four closely related virus serotypes of genus Flavivirus (DEN1-4). It is also known as break-bone fever¹. Dengue is transmitted to humans by the bite of Aedes aegypti². Co-infection with circulating DENV 1 and DENV 2 was reported in 1982 in Columbia. It has been known that sequential infection of more than one serotype of dengue increases the severity of dengue symptoms³.

Dengue is almost epidemic throughout in India for over two centuries as a benign and self-limited disease. In recent years, the disease has changed its course manifesting in the severe form as DHF and with increasing frequency of outbreaks⁴.

In the last 50 years, there has been a 30-fold increase in the incidence of dengue fever with geographic spread into new countries, including India, and in the present decade, the disease has spread from urban to rural settings. Dengue is predominantly found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. It is estimated that 52% of the global population that is at the risk of DF infection lives in the South East Asian Region⁵. Confirmation of Dengue infection is an essential pre-requisite in the management of complications. The standard test for Dengue infection is the detection of Dengue specific IgM/IgG along with NS1 Antigen. Antibody detection is an indirect method of diagnosis and, therefore, is prone to false-positive as well as false-negative results⁶. IgM antibody is the first immunoglobulin isotype to appear. In a suspected case of dengue, the presence of an anti-dengue IgM antibody can be detected, usually the fifth day of infection and suggests recent infection and a newer parameter NS1appears be sensitive as well as highly specific and reliable for diagnosis of DI from the first day of fever⁷. The main objective of this study is to study the clinical occurrence and laboratory findings of dengue fever.

MATERIALS AND METHODS:

Study design and Study site:

A prospective observational study was carried out at the General medicine Department and Dengue ward of a tertiary care teaching government hospital situated at the Ballari district of northern Karnataka.

Duration of study:

The study was conducted for a period of one year From August 2017 – July 2018.

Sample size:

The following formula was used to calculate the sample size.

n= Z² x p x (1-p) / e²

= (1.96)² x 0.25 x 0.75/ (0.05)²

= 288.12

= 288

Where,

n= minimum sample size

Z= 1.96 for Confidence Interval at 95%

p= 25% (Estimated)

e= margin of error as 5%

Study criteria:

Patients of either gender above 14 years of age and diagnosed with dengue positive were enrolled in the study. Patients having an unclear diagnosis and incomplete medical information were excluded from the study. Written informed consent was obtained from all patients.

Study Procedure:

Patients were identified and selected based on inclusion and exclusion criteria. Informed consent was obtained from each patient who was enrolled in the study. Relevant data were collected in a specially designed data collection form. Collected data were assessed and analyzed with the help of Microsoft Excel and SPSS software. The data were summarized in the table and figures.

RESULTS:

Age and Gender Distribution:

In our study out of a total of 315 patients male were higher than female and the dengue was commonly prevalent in the age group of 15-30 years followed by 30-45 years. The complete sociodemographic details are illustrated in figure no. 1.

Figure no. 1: Age and Gender distribution

Common symptoms:

The most common clinical findings on dengue fever were fever (99.68%), generalized body ache (GBA, 58.41%), Headache (49.20%), and joint pain (47.30). The incidence of complications of dengue fever was less. The complete data on clinical manifestations is depicted in table no. 1.

Table no. 1: Occurrence of common sign and symptoms

Symptoms	Male	Female	Total	Percentage
fever	158	156	314	99.68
Headache	75	80	155	49.20
Retro-orbital pain	5	11	16	5.07
Joint Pain/ Arthritis	81	68	149	47.30
Nausea/ Vomiting	45	54	99	31.42
GBA	103	81	184	58.41
Rashes	4	3	7	2.22

Diagnosis and laboratory findings:

The majority of dengue cases were diagnosed by detecting antigen and antibody in blood serology. NS1 antigen (67.61%) was positive in maximum patients followed by the IgG antibody (8.57%). While analyzing the patient's laboratory data it was seen that hematocrit (26.34%) was elevated in the patients whereas the white blood cells (36.19%) and platelet count were decreased (96%) in patients suffering from dengue fever. The complete details are shown in table no. 2, 3, 4, and 5.

Table no. 2: Dengue diagnosis based on blood serology

	Male	Female	Total	Percentage
NS1 only	111	102	213	67.61
IgG only	4	23	27	8.57
IgM only	9	7	16	5.07
NS1+IgG	16	2	18	5.71
Ns1+IgM	9	10	19	6.03
IgG+IgM	8	11	19	6.031
NS1+IgG+IgM	0	3	3	0.95

Table no. 3: findings on Haematocrit

Haematocrit	Male	Female	Total	Percentage
Normal	110	104	214	67.93
Elevated	41	42	83	26.34
Reduced	7	11	18	5.71

Table no. 4: findings of white blood cells among patients.

White Blood Cells	Male	Female	Total	Percentage
<4000	69	45	114	36.19
4000-11000	82	109	191	60.63
>11000	8	2	10	3.17

Table no. 5: Findings on platelet count among dengue patients

Platelets	Male	Female	Total	Percentage
<20000	26	25	51	16.19
20000-50000	90	71	161	51.11
50000-100000	39	53	92	29.20
>100000	3	8	11	3.49

Temporal association of dengue fever:

Analyzing the complete data for a year, it was seen that the incidence was higher in the month of October (42.5%) (September-November, 72%), whereas the incidence of dengue was less in all other months. The complete information on the temporal association of dengue fever is illustrated in figure no. 2.

Figure no. 2. Temporal association of dengue fever

DISCUSSION:

Dengue is emerging as a major health problem in India. Several factors like urbanization, transport development, changing habitats and improper water storage practices, which facilitate breeding of Aedes aegypti, contribute to its rapid spread. This study explored the distribution of dengue fever cases. In our study, males (159) are slightly more affected than females (156). Similar results were found in the study conducted by Md. Yousuf Khan et al.⁸ Most of the patients was in the age group of 15-30 years in both males (77) and females (73). This was strongly in liaison with the study conducted by Arti Jain². Fever was the most common clinical features presented in our study, followed by GBA, then headache, then arthritis, respectively⁹. The result was similar to that found by most of the studies in India. Fever was found in almost all, i.e. 99.68% of the patient. Generalized body ache (GBA) was found in 58.41%, which is in contrast with the study conducted by Md. Yousuf Khan, where the headache is the 2^nd most incidences after fever⁸.

In this study, out of 315 cases, 213 (67.62%) cases were positive for NS1 only. This is supported by a study conducted by Malavige GN et al. The positivity with NS1 is higher than other parameters because NS1 appears to be highly specific and reliable for diagnosis of dengue infection from the first day of fever¹⁰. IgG and IgM were found to be 27 (8.57%) and 16 (5.08%), respectively. NS1 antigen in combination with IgG or IgM is positive in 18 (%) and 19 (6.03%), respectively. In the present study, elevated hematocrit was found in 83 (26.35%) patients. In correlation, a study conducted by Md. Yousuf Khan et al. Showed 23.33% of cases have raised hematocrit⁸. Leucocytosis and leucopenia were found to be 10 (3.17%) and 114 (36.19%) respectively. Leucopenia was found predominant (38.66%) in the study conducted by Khan Md. Y et al. In our study, most of the patients have platelet count in the range of 20,000 to 50,000 cells/mm³ (51.11%). In contrast to our study the study conducted by Sheema A et al. and Karoli R et al. where platelet was in the range of 50,000-1,00,000 cells/mm³. This was higher than our study^11,12. The temporal association of dengue was high in the trimester of September-November; these results were supported by the study conducted by the Lepakhsi G et al., and Deshwal R et al.^13,14.

CONCLUSION:

Dengue is one of the common endemic diseases in northern Karnataka. The most common symptoms for dengue are concluded as fever, GBA, Headache and joint pain in our study. As the flavivirus feed on the protein substances all the blood count parameters were affected. Blood hematocrit was elevated, but WBC and platelet counts were severely decreased. The prevalence was found higher in the monsoon season of September to November. As the mosquito is the vector for transmitting dengue from infected victims to a healthy individual. All the patients enrolled in the study were counseled regarding diseases and education was provided on various preventive measures.

REFERENCES:

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12. Ritu Karoli, Jalees Fatima, Zeba Siddiqi, et al. Clinical Profile of Dengue infection at a Teaching Hospital in North India. J Infect Dev Ctries. 2012;6:551-554.

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Received on 15.11.2019 Modified on 24.01.2020

Research J. Pharm. and Tech. 2020; 13(12):5783-5786.

DOI: 10.5958/0974-360X.2020.01008.2