What is it about?
The present study is a four year (January 2013- December 2016), retrospective observational study. The study population consists of 264 male or female indoor patients with confirmed diagnosis of dengue fever. Inclusion criteria were discharge diagnosis with(name, registration number, age, sex, diagnosis, symptoms, laboratory investigations, transfusions if any, co-infection, other co-morbidities, date of admission, date of discharge, and discharge status). Indoor files of all these 264 cases were collected from medical records department and data tabulated. The study focuses on incidence and outcomes of CLS in dengue infection along with other various issues among these patients
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Why is it important?
We conclude that patients of DF with thrombocytopenia and transaminitis should be evaluated early by ultrasonography for CLS. Hemoconcentration and hypoproteinemia are not sensitive tools to pick up capillary leakage in clinical practice. Isolated left side pleural effusion and pericardial effusion are not seen in DF and if present one should look for another cause. The case series raises question on the accepted theory of relation between capillary leakage and severe dengue infection. Further, since capillary leakage was seen in 78.8% of primary dengue infection cases, it also questions the validity of the immune enhancement theory of DHF/severe dengue. Viral burden may be a key factor in determination of disease severity rather than sequential infections or secondary infection.
Perspectives
Some important clinical pearls observed are: 1.Thrombocytopenia and transaminitis are seen in all cases of CLS. This suggests that all patients of dengue infection with these two laboratory abnormalities should be screened early by ultrasonography for CLS and observed for DHF/DSS. Further,hemoconcentration and hypoproteinemia are not sensitive tools to pick up capillary leakage in clinical practice. 2. Isolated left pleural effusion and pericardial effusion are almost never seen in DF. If present, and in cases who fail to clear capillary leak in a week’s time further evaluation should be done. 3.Capillary leakage is prevalent amongpatients with primary as well as secondary dengue infection. Probably CLS represent a fundamental mechanism of disease in dengue infection rather than a function of host immune status. Viral burden may be a key factor in determination of disease severity rather than sequential infections or secondary infection.
Arun Agarwal
Read the Original
This page is a summary of: Changing Epidemiology of Dengue Fever: Newer Insights and Current Concepts, International Journal of TROPICAL DISEASE & Health, January 2017, Sciencedomain International,
DOI: 10.9734/ijtdh/2017/36416.
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