Table of Content - Volume 13 Issue 1 - Janauary 2020
Study of dengue fever in Bihar population at a tertiary care centre (JLNMCH, Bhagalpur)
Amrendra Kumar Singh1, Gagan Gunjan2, Rajkamal Choudhary3, Ajay Kumar4
1Assistant Professor, 3Associate Professor,4Post Graduate Student, Department of General Medicine, JLNMCH Bhagalpur, Bihar, INDIA. 2Assistant Professor, Department of General Medicine, RIMS, Ranchi, Jharkhand. Email: akschinku@gmail.com
Abstract Background: Dengue fever has spread globally, especially children are more susceptible to this mosquito bite infectious disease. As this disease has different clinical manifestations hence it is compulsory to update the clinical profile and laboratory investigation to rule out different stratification of patho- physiological status. Method: The blood samples of clinically suspected were tested by Rapid card test, NS1 Ag and detection of IgM , IgG antibodies to dengue virus. Chest X-ray was also done if there was suspicion of ascitis and pleural effusion. USG was done in severe Nausea and vomiting patients to rule out the complications. Results: Fever – 75 (100%) headache 73 (97.3%) Body ache 72 (96%) Abdominal Pain 68 (90.6%) Retro – orbital pain 36 (48%) Dry cough 35 (45.3%) Anorexia, Nausea 10 (13.3%) Diarrhoea 10 (13.3%) vomiting 12 (16%) Rash (Prurtis) 7 (9.33%). Joint pain 5 (6.66%) Malena 4 (5.33%). Hypotension 6 (8%) Feeble pulse pressure 6 (8%) Tourniquet test was +ve. pleural effusion 4 (5.33%, Ascitis 7 (9.33%) oedema of Gallbladder 3 (4%), Icterus 2 (2.66%) altered sensorium 2 (2.66%) leucopoenia 62 ( 86%), Thrombocytopenia 62 (86%) S. Creatinine 6 (8%). NS1 +ve patients 63 (84%). IgM 5 (6.66%), Mixed (NS1/IgM/IgG) 7 (9.33%). Conclusion: The present study of DF will be quite useful to prognosticate the morbidity and mortality of the patients. Key Words: Dengue Fever, Dengue Haemorrhagic Fever ,Thromboyctopenia, Female Aedes aegypti Mosquito.
INTRODUCTION Dengue is the most important mosquito borne viral infection across the globe with approximately 50-100 million cases annually1.Four serotypes of dengue virus (DENV 1-4) may be transmitted by the primary vector the female Aedes aegypti mosquito infection. While one DENV strain confers permanent immunity to that strain, but it provides limited protection to subsequent infection by other strains2. Dengue viruses have single stranded positive polarity ribonucleic acid (RNA) viruses of the family Flaviviridae, the most common cause of arboviral disease in the world. The dengue fever (DF) and dengue haemorrhagic fever (DHF) has increased dramatically in decades across the world.3 India represents 34% of global burden of apparent dengue infection with regular dengue out breaks as compared to other countries.4 Dengue fever has been changing distribution trends and has variable clinical presentation which needs to be updated constantly with clinical profile laboratory parameters of dengue fever so that, there will be least morbidity and mortality in dengue fever patients as it is haemorrhagic and can be fatal if ignored in the initial stages of diagnosis.
MATERIAL AND METHODS 75 adult patients admitted at JLNMCH, hospital Bhagalpur – 812001. (Bihar) having the symptoms of Dengue fever were selected for study. Inclusive criteria – The patients were confirmed dengue having NS1 positive of IgM positive or having both NS1 and IgM positive or Dengue Elisa reactive having minimum CBC count. Exclusion criteria – patients with less CBC count due to bone marrow disease, cirrhosis of liver, Negative NS1 and IgM history of blood Transfusion and Immuno – compromised, Malignant patients were excluded from the study. Methods
Statistical analysis – various parameters of study classified with percentage. Mean value and with standard duration were also studied in SPSS 2007 software Ratio of male and female was 2:1.
OBSERVATION AND RESULTS Table – 1: Clinical manifestations observed in Dengue fever patients with percentage – 75 (100%) had fever 73 (97.3%) headache, 72 (96%) had Body ache, 68 (90.6%) abdominal pain 36 (48%) had retro – orbital pain, 35 (46.6) had dry cough, 34 (20%) had anorexia, 15 (13.3%) had back pain, 10 (13.3%) had Nausea, 10 (13.3%) had Diarrhoea, 12 (16%) had vomiting, 7 (9.33%) had Rash (Pruritis), 5 (6.66%) had joint pain, 4 (5.33%) had melena. (Table-1).
Table 1: (Total No. Of patients) Clinical Manifestations of dengue fever
Table – 2: Alarming (warning) signs in Dengue fever patients 6 (8%) had hypotension (<90/60 mmHg) 6 (8%) Feeble pulse pressure (<20 mm Hg) 6(8%) had positive tourniquet test 4 (5.33%) had pleural effusion, 7 (9.33%) had Ascitis, 3 (4%) had edema of gall bladder, 2 (2.66%) Icterus, 2 (2.66%) had altered sensorium. Table 2: Alarming (warning) signs in Dengue fever patients (Total No. of patients 75)
Table – 3: Laboratory findings in Dengue fever – 6 (8%) patients Hb% (>10mg/dl), 48 (64%) had leucopoenia (<4000/ul), 62 (82.6%) had thrombocytopenia (<1.0 lac/ul), 12 (16%) had Haematocrit (>45%), 3 (4%) PT (>14 sec), 3 (4%) had a PTT, 3 (4%) had INR (>1.2), 6 (8%) had serum creatinine (>1.2 mg%). Table 3: Laboratory findings in Dengue fever
Table – 4: Serological Study in Dengue fever patients 63 (84%) had NS1 positive, 5 (6.66%) had IgM positive, 7 (9.33%) had Mixed (NS1/IgM+IgG) positive.
Table 4:Serological Study in Dengue fever patients (Total No. of patients 75)
In the present study of DF in Bihar population – The Clinical Manifestation were – 75 (100%) had fever, 73 (97.3%) had headache, 72 (97.3%) had body ache, 68 (90.6%) had abdominal pain, 36 (48%) had retro – orbital pain, 35 (46.6%) had dry cough, 34 (45.3%) had anorexia, 15 (20%) had back pain, 10 (13.3%) had Nausea, 10 (13.3%) had Diarrhoea, 12 (16%) had vomiting, 7 (9.33%) had rash (pruritis), 5 (6.66%) had joint pain, 4 (5.33%) had melena (Table – 1). The alarming (warning) signs in DF were – 6 (8%) had hypotension (<90/60 mmHg), 6 (8%) had feeble pulse (<20 mmHg), 6 (8%) had positive tourniquet test 4 (5.33%) had pleural effusion, 7 (9.33%) 3 (4%) edema and of Gallbladder, 2 (2.66%) Icterus, 2 (2.66%) altered sensorium (Table – 2). The laboratory findings were 6 (8%) Hb% (> 10 gm/dl), 48 (64%) had leucopoenia (<4000/Iu), 12 (16%) haematocrit (>45/), 3(4%) PT (>14sec), 3 (4%) a PTT (>14 sec), 6 (8%) S. Creatinine (>1.2 mg/dl) Table – 3).Serological Study in DF was 63 (84%) patients were NS1 +ve, 5 (6.66%) had IgM positive, 7 (9.33%) were +ve in mixed (NS1/IgM+IgG). (Table – 4).These findings were more or less in agreement with previous studies 5,6,7.The children in the age group 1 to 4 were most commonly affected followed by children in the age group of 5-14 year8, but the early diagnosis and treatment of DF especially among children has proved to be an effective intervention to reduce the morbidity and mortality due to DF9. Rain during the monsoon brings down the temperature which leads to increase in the evaporation rate and thus helps to maintain secondary reservoirs containing rain water10 which breed the mosquito which causes DF.
SUMMARY AND CONCLUSION Aedes mosquitoes breed in the stagnant waters and discarded junk materials. Unfortunately every cities of India has slum areas, which are predominantly covered with stagnant drainage water in which mosquito breed throughout year which is the main source of mosquitoes. Hence awareness regarding infectious diseases like Dengue, Chickengunya, Malaria has to be created among slum-dwellers and vaccination is necessary to prevent such fatal disease.
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