STUDY OF CLINICAL PATTERN OF DENGUE IN
INPATIENTS IN THIRUVANANTHAPURAM
Dr Sreejith N. Kumar
Chairman IMA Research cell
AIM
To study the morbidity pattern of Dengue fever in Thiruvananthapuram and to identify
possible clinical complications.
BACKGROUND
There are reports of spread of Dengue in Kerala state, especially in Thiruvananthapuram
district. According to the data from State Health service more than 60% of cases in Kerala
have been reported from Thiruvananthapuram. There were suggestions in media about
variations in presentation of Dengue and increased virulence of the virus leading to
unexpected complications. There is growing concern and scare amongst the public about
these reports and increasing incidence of Dengue. IMA Research cell planned to conduct the
study to ascertain the morbidity pattern and to see whether there are more complications to
answer the doubts in the minds of health professionals, planners and public.
MATERIALS AND METHOD
The study format was decided by IMA Research cell in consultation with the leaders of IMA
and Professional experts. Physicians in Thiruvananthapuram were briefed about the study
procedure in the Physicians club meeting. The study questionnaire was distributed to all
physicians who were asked to record the details of patients in the form provided. Separate
forms were used for each patient. Inpatients with Dengue fever were included in the study.
The details recorded by the Physicians were collected and analysed by the IMA Research
cell.
RESULTS
16 physicians from 11 hospitals gathered the data for the study.
Table 1 Symptoms, Signs observed
N = 330
Symptom
Fever
Body ache
Head ache
Vomiting
Pain abdomen
Nausea
Blood in stool
Loose stool
Chills
Cough
Petichae
No of patients
327
237
162
84
42
39
33
21
9
9
9
Percentage
99.09
71.8
49
25
12.7
11.8
10
6.3
2.7
2.7
2.7
Wheezing
others
6
1.8
Hematuria (1), Rash (1), Arthralgia (1), Oliguria (1), Peri
orbital puffiness (1), Pleural effusion (1), cervical lymph
adenopathy (1)
Table 2 Diagnostic test
Test
IgM antibody
IgG
NS 1
IgM + NS1
IgM + Ig G
Total done
144
12
102
6
12
Positive
132
12
102
6
IgM 9, IgG 12
Table 3 Platelet abnormalities
Platelet results
available
Thrombocytopenia of
totalplatelets done
Platelets < 50,000
Patients requiring
platelet transfusion
Patients recovered
285
86.3
279
97.8
123
78
43.1
23.6
285
100
Table 4 liver enzyme abnormalities
Test
Total done
High
ALT
78
69
AST
63
63
AST was generally higher than ALT.
Normal
9
0
200-500 IU/L
21
9
>500 IU/L
3
12
Table 5 Complications
Hepatitis, lung injury
Hepatitis
Pleural effusion, asicites, facial puffiness
Dengue shock syndrome, GI Bleed
Hepatitis, Acidosis, Hypoxia
Oliguria
Petichae
Epistaxis
Hypokalemia
Mortality
TOTAL
1
1
1
2
1
1
2
4
1
0
14 (4.2%) major 6 (1.8%), minor 8(2.4%)
CONCLUSIONS
1. Fever, headache and body ache are the commonest symptoms of Dengue. Abdominal
symptoms are also common. Blood in stools is not uncommon.
2. Thrombocytopenia is common and generally recovers completely.
3. Liver enzymes are usually elevated, but not too high. AST was generally higher than
AST.
4. Rate of complications of Dengue are generally low (4.2 %). More complications
might have been observed in this study than those in outpatients, as the patients
included were those requiring IP care. Mortality was not observed in this study.
5. It is unlikely that there are gross genetic mutations that are clinically relevant. The
disease pattern has not shown significant variation from those described in standard
references.
RECOMMENDATIONS
Further studies are needed to confirm the clinical pattern in larger group of patients.
Considering that recovery from Thrombocytopenia is common, need for platelet transfusion
should be probed further.
Since the percentage of complications and mortality is low, disease burden will have to be
minimised in order to contain the public health impact of the present Dengue epidemic.
Hence thrust should be on vector (mosquito) control.
Public should be reassured about absence of complications in majority and should be advised
not to panic.
Primary care facilities would be adequate to manage vast majority of patients and only those
with very low platelets (<50000), high liver enzymes and features of fluid extravasation like
pleural effusion, ascites will require advanced care in secondary and tertiary care facilities.
Acknowledgement:
We acknowledge the contribution of the following hospitals and physicians of
Thiruvananthapuram.
Sl.No.
Hospital
Physician
1
SUT
Dr. K.P. Paulose
2
General hospital
Dr. Syamsunder
3
Chelsa
Dr. Shanmugam
4
SUT
Dr. Ajith Kumar
5
KIMS
Dr. Rajalekshmi
6
Medical College
Dr. Ajit Chakravarthy
7
KIMS
Dr. Rajmohan
8
Ramakrishna Mission
Dr. Gopinathan Nair
9
KIMS
Dr. Mathew Thomas
10
Azeesia Medical College
Dr. K. Sreekantan
11
SK Hospital
Dr. Priya
12
PRS Hospital
Dr. Josemon Thomas
13
Lords Hospital
Dr. Sunil
14
Jubilee Hospital
Dr. Antony Newton
15
Ananthapuri
Dr. Gopal
16
SUT
Dr. Ramesan Pillai