Is there any association between body mass index and severity of dengue infection?

2021 ◽  
Author(s):  
Mohd Syis Zulkipli ◽  
Sanjay Rampal ◽  
Awang Bulgiba ◽  
Devi Peramalah ◽  
Nor'Ashikin Jamil ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Platelet Count ◽  
Dengue Fever ◽  
Body Mass ◽  
Dengue Infection ◽  
Mixed Effects ◽  
Warning Signs ◽  
Severe Dengue ◽  
Full Blood Count ◽  
Response Analysis

Abstract Background Dengue, an acute infectious disease caused by a flavivirus, is a threat to global health. There is sparse evidence exploring obesity and the development of more severe dengue cases in adults. With increasing prevalence of obesity in areas with a high risk of dengue infection, obesity may increase the burden and mortality related to dengue infection. Our study aimed to determine the association between obesity and the development of more severe dengue infection in primary healthcare settings and whether these associations were modified by dengue fever phase. Methods A cohort study was conducted among laboratory-confirmed dengue patients aged >18 y in the central region of Peninsular Malaysia from May 2016 to November 2017. We collected demographic, clinical history, physical examination and laboratory examination information using a standardized form. Dengue severity (DS) was defined as either dengue with warning signs or severe dengue. Participants underwent daily follow-up, during which we recorded their vital signs, warning signs and full blood count results. Incidence of DS was modeled using mixed-effects logistic regression. Changes in platelet count and hematocrit were modeled using mixed-effects linear regression. The final multivariable models were adjusted for age, gender, ethnicity and previous dengue infection. Results A total of 173 patients were enrolled and followed up. The mean body mass index (BMI) was 37.4±13.75 kg/m2. The majority of patients were Malay (65.9%), followed by Chinese (17.3%), Indian (12.7%) and other ethnic groups (4.1%). A total of 90 patients (52.0%) were male while 36 patients (20.8%) had a previous history of dengue infection. BMI was significantly associated with DS (adjusted OR=1.17; 95% CI 1.04 to 1.34) and hematocrit (%) (aβ=0.09; 95% CI 0.01 to 0.16), but not with platelet count (x103/µL) (aβ=−0.01; 95% CI −0.84 to 0.81). In the dose response analysis, we found that as BMI increases, the odds of DS, hematocrit levels and platelet levels increase during the first phase of dengue fever. Conclusion Higher BMI and higher hematocrit levels were associated with higher odds of DS. Among those with high BMI, the development of DS was observed during phase one of dengue fever instead of during phase two. These novel results could be used by clinicians to help them risk-stratify dengue patients for closer monitoring and subsequent prevention of severe dengue complications.

scholarly journals Clinical profile of dengue fever in children: analysis of 2017 outbreak from Central Kerala, India

2018 ◽  
Vol 5 (6) ◽  
pp. 2265 ◽  
Author(s):  
Senthil Kumar K. ◽  
Rajendran N. K. ◽  
Ajith Brabhukumar C.
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Clinical Profile ◽  
Severe Dengue ◽  
High Morbidity ◽  
Care Hospital ◽  
High Grade Fever

Background: In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. The objective of this study is to assess the clinical profile of the dengue infection in children less than 15 years of age and to evaluate the outcomes of dengue fever from March 2017 to July 2017 at the Pediatric Department of Karuna Medical College, the tertiary care hospital in Palakkad.Methods: In this retrospective study, medical records were reviewed and analyzed. Patients with suspected dengue infection were classified further into 2 groups, Dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (dengue hemorrhagic fever and/or dengue shock syndrome (DHF/DSS) according to WHO.Results: A total of 77 cases were classified into 67 (87%) non-severe and 10 (13%) severe dengue cases. The most common age of presentation was above 10 yrs. The mean age of admission was 8.9 yrs. The most common presenting symptom was fever seen in 93% followed by vomiting in 68%. Elevation in Aspartate transaminase (SGOT) and thrombocytopenia were found in 32.4 %.Conclusions: High grade fever, vomiting, abdominal pain and skin rash with normal or low platelet count were the presenting features. Early diagnosis, monitoring and prompt supportive management can reduce mortality.

scholarly journals Epidemiological and Clinical Features of Dengue Infection in Adults in the 2017 Outbreak in Vietnam

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Bui Vu Huy ◽  
Le Nguyen Minh Hoa ◽  
Dang Thi Thuy ◽  
Nguyen Van Kinh ◽  
Ta Thi Dieu Ngan ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Dengue Fever ◽  
Clinical Features ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Warning Signs ◽  
Severe Dengue ◽  
Severe Bleeding ◽  
Cross Sectional ◽  
Number Of Patients

Purpose. The clinical features and laboratory results of dengue-infected adult patients admitted to the hospital during the 2017 outbreak were analyzed in this study. Method. This is a cross-sectional study. 2922 patients aged 18 years or more with dengue fever in National Hospital for Tropical Diseases (NHTD) in the North and Hospital for Tropical Disease (HTD) in the South of Vietnam were recruited in this study. Result. Patients were admitted in the hospital around the year and concentrated from August to December, in 53/63 (84.0%) provinces in Vietnam, and patients in all ages were affected. The number of patients with dengue fever was 1675 (57.3%), dengue with warning signs 914 (31.3%), and severe dengue 333 (11.4%), respectively. Among patients with severe dengue, severe plasma leakage and dengue shock account for 238 (8.1%), severe organ impairment 73 (2.5%), and severe bleeding 22 (0.75%). The rate of mortality was 0.8%, and the outcome of dengue patients is worse in the elderly and people with underlying diseases. Conclusion. The 2017 dengue outbreak occurred in a larger scale than in the previous years in terms of time, location, and number of patients. More elderly patients were infected by dengue in this outbreak, and this may contribute to the mortality rate. Clinical manifestations of dengue patients in Southern Vietnam are more typical than the northern, but the rate of severe dengue is not different. The mortality risk and underlying conditions associated with dengue-infected elderly patients are worthy of further investigations in the future.

ROLE OF PLATELET PARAMETERS IN DENGUE FEVER IN CHILDREN

2021 ◽  
pp. 42-43
Author(s):  
Mithilesh Kumar ◽  
R. K. Sinha ◽  
Debarshi Jana
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Recovery Phase ◽  
Warning Signs ◽  
Severe Dengue ◽  
Distribution Width ◽  
Female Ratio ◽  
Group A ◽  
Group B

Aim: To evaluate the role of platelet parameters in dengue fever and also to determine relationship of platelet parameters with platelet count and the severity of the disease. The platelet para Materials and methods: meters [platelet count, plateletcrit, mean platelet volume (MPV), platelet distribution width (PDW)] of 50 dengue infected children were calculated using BC 3000 plus Mindray Automated Hematology Analyzer. Normal range of MPV is 7.5-11.5 . Plateletcrit cut off value in thrombocytopenia is 0.2-0.36%. The PDW reported varies with reference intervals ranging from 8.3 to 56.6%. Subjects were divided into four groups according to their platelet count on day 3 of illness (<20,000 cells/cumm, 20,000 to 50,000 cells/cumm, 50,000 to 100,000 cells/cumm and >100,000 cells/cumm). Platelet indices were studied among these groups and also the indices were evaluated with respect to the severity of disease as group A (dengue without warning signs), group B (dengue with warning signs and group C (severe dengue). Results: Male: female ratio was 28:22. Mean age of presentation was 7.8 + 2.2 years. Thirty-ve patients belonged to Group A, 26 to group B and 2 belonged to group C. PLT (cells/cumm) on Day 3 and Day 7 was 91,828 ±33,532 vs 195,371 + 70,586 in Group A patients (p<0.0001), 69,076 ±45,904 vs 163,230 + 85,053 in Group B patients (p=0.0018) 38,500 + 38,890 vs 86,000 + 28,284 in Group C patients (p=0.29). PCT (%) on Day 3 and Day 7 was 0.09 + 0.04 vs 0.18 + 0.06 in Group A patients (p<0.0001), 0.07 + 0.04 vs 0.15 + 0.07 in Group B patients (p=0.0009) and 0.04 + 0.04 vs 0.08 + 0.28 in Group C patients (p=0.84). MPV () on Day 3 and Day 7 was 10.73 + 1.07 vs 11.34 + 1.09 in Group A patients (p=0.0212), 10.41 + 1.39 vs 10.87 + 0.99 in Group B patients (p=0.3389), 9.35 + 1.62 vs 10.3±1.41 in Group C patients (p=0.59). PDW () on Day 3 and Day 7 was 14.46 ± 1.35 vs 13.22 + 1.10 in Group A patients (p=0.0001), 14.61 + 1.36 vs 13.0 + 0.76 in Group B patients (p=0.0011) and 14.5 + 1.84 vs 13.5 + 0.71 in Group C (p=0.54). Though MPV was lower in patients with platelet count <20,000 cells/cumm (8.57 + 0.5 ) as compared to other groups, it was not statistically signicant (p=0.325). PCT increases with increase in platelet count on Day 3 and Day 7 (p=0.000). Though PDW was lower on Day 3 in patients with platelet count <20,000 cells/cumm as compared to the other 3 groups, it was not statistically signicant (p=0.0740). Conclusion: Lower platelet count and low PCT are seen with severe dengue, increasing platelet count and PCT suggest recovery phase of dengue. MPV had no correlation with severity of dengue or level of thrombocytopenia suggestive that there is no role to predict severity of dengue. PDW does not uctuate with severity of dengue or level of thrombocytopenia

scholarly journals Study of hepatic involvement in children with dengue infection

2017 ◽  
Vol 4 (6) ◽  
pp. 2012
Author(s):  
Hima Bindu Tirumani ◽  
Vinay Kumar Bejugam ◽  
Altaf Naseem ◽  
Arshad Hussain ◽  
. Nizarlalani
Keyword(s):  
Dengue Fever ◽  
Liver Dysfunction ◽  
Dengue Infection ◽  
Fold Increase ◽  
Liver Function Tests ◽  
Hepatic Function ◽  
Warning Signs ◽  
Severe Dengue ◽  
Cross Sectional ◽  
Hepatic Involvement

Background: Liver dysfunction in children is variable and depends on disease severity. This study was undertaken to identify the range of hepatic involvement in children with dengue infection.Methods: It is a cross sectional observational study conducted in serologically positive dengue fever in children aged between 1-14 years. Hepatic function was studied in all suspected cases over a period of 1 year from June 2015 to June 2016.Results: Out of 55 cases admitted, liver function tests showed AST levels elevated more than 45U/L in 20 (86.9%) DF, 29 (100%) DHF, 3 (100%) DSS patients. ALT levels were elevated more than 45U/L in 16 (69.5%) DF, 24 (82.75%) DHF, 3 (100%) DSS patients. More than 10 fold increase in levels of both AST and ALT was seen in severe dengue.Conclusions: Dengue infection is associated with variable levels of liver dysfunction. The incidence of hepatic dysfunction is more in patients with dengue fever with warning signs and severe dengue. Significant elevation of transaminase levels helps in predicting the occurrence of severe dengue. It is important to be aware of this entity which needs significant attention and management. 

scholarly journals Dengue Fever: Clinical, Laboratory Profile and Outcome in Pediatric Patient

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Pooja Gandhi ◽  
Pinkal Taral ◽  
Krunal Patel ◽  
Sanketsinh Rathod ◽  
Bhavini Rathwa
Keyword(s):  
Platelet Count ◽  
Dengue Virus ◽  
Dengue Fever ◽  
Care Center ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Severe Dengue ◽  
Diverse Range ◽  
Laboratory Profile

Introduction: Infection with any of the 4 dengue virus serotypes results in a diverse range of symptoms, from mild undifferentiated fever to life-threatening hemorrhagic fever and shock. Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient management. So a study was carried out to know its clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients. Aim: To study the clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients at tertiary care center. Method: Retrospective Observational study from 1st May 2019 to 31st April 2021. Result: Total 323 patients were studied during 1st May 2019 to 31st April 2021. Most common presentation was fever (100%), most common clinical finding is hepatomegaly (14.2%). All severe dengue infection has platelet count < 50000/cumm. In study of 323 patients 194(60%) of dengue fever,85(26.4%) of DHF GRADE 1,9(2.8%) of DHF GRADE 2 were discharged .13(4%) patients of DSS were expired.22 patients (6.8%) went DAMA. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases. Keywords: dengue fever, platelet count, outcome

scholarly journals Importance of Platelet Count and Hematocrit in Dengue Fever in Children

2021 ◽  
Vol 44 (2) ◽  
pp. 74-77
Author(s):  
Farhana Rahat ◽  
Morsheda Khanam ◽  
Kazi Iman ◽  
UK Ghosh ◽  
NK Ghosh
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Dengue Hemorrhagic Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Care Hospital ◽  
Pediatric Age Group

Background: Dengue fever has become one of the most important public health concerns now a day due to increasing complications and fatal outcomes. Dengue hemorrhagic fever and dengue shock syndrome are life threatening but reversible complications of dengue fever. Objectives: This study was performed to evaluate the relationship between platelet count and hematocrit with the severity of dengue infection in pediatric age group. Materials & Methods: This was a prospective observational study which included 280 dengue seropositive children of 1 month to 15 years, conducted during 1st June to 30th November, 2018 in a tertiary care hospital of Dhaka. Results: Out of 280 dengue cases, 187(66.78%) had thrombocytopenia and 88(47%) had raised hematocrit. Among the thrombocytopenic patients 44% had dengue fever, 47% had dengue hemorrhagic fever and 9% dengue shock syndrome. A significant co-relation was observed between the severities of thrombocytopenia and raised hematocrit with the appearance of dengue warning signs in case of dengue hemorrhagic fever. Conclusion: Thrombocytopenia and raised hematocrit were related to the severity of dengue hemorrhagic fever. Bangladesh J Child Health 2020; VOL 44 (2) :74-77

scholarly journals Hematological and coagulation profile of dengue infection in age group 1 to 12 years children in a tertiary care hospital

2021 ◽  
Vol 11 (2) ◽  
pp. 341-353
Author(s):  
Suman Sarkar ◽  
Mamta Kumari ◽  
Amrita Roy ◽  
Anirban Chatterjee ◽  
Partha Pratim Pal
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
World Health ◽  
Infected Mosquito ◽  
Severe Dengue ◽  
Care Hospital ◽  
Coagulation Profile ◽  
D Dimer

Dengue is an arboviral infection of public health problems in tropical and sub-tropical countries transmitted to humans through the bite of an infected mosquito of the Stegomyia family. It varies in severity, ranging from influenza-like self-limiting illness to life- threatening, which if left untreated, are associated with mortality as high as 20%. Find out hematological and coagulation profile in dengue infected children aged 1 to 12 years and association of hematological and coagulation profile with dengue severity. It is an Observational Cross- sectional study done on 100 dengue patients aged 1 to 12 years during the study period from March 2019 –February 2020. Among 100 dengue fever, 85 (85%) were categorized as dengue fever (DF), 11(11%) DF with warning signs and 4 (4%) were cases of severe dengue (DHF/DSS) according to revised World Health Organisation 2009. The most common age of presentation was above 6 years and females were afflicted more with dengue fever.100% dengue patients presented with fever. Persisting vomiting, pain abdomen, hepatomegaly and hypotension indicate progression towards severe dengue. Raised Hb% and PCV, low to normal values of WBC as well as predominantly decrease in platelet was seen in severe dengue cases however, both ESR and CRP were normal. The Liver function test was deranged SGOT&#62;SGPT in almost all of the dengue patients and it was 3 to 4 times maximally in DFW and SD. PT, APTT prolongation, increased D- dimer and hypofibrinogenemia associated with the severity of dengue fever. Dengue is a common viral infection that may have serious consequences especially in children. There is clear difference in pattern of change of both haematological and biochemical parameters in non-severe dengue fever and severe dengue fever. Rising trend of Hb%, PCV, decreasing value of platelet count, raised transaminases (SGOT&#62;SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase

scholarly journals Role of early warning signs in children with severe dengue infection

2018 ◽  
Vol 5 (4) ◽  
pp. 1423
Author(s):  
Sriram Pothapregada ◽  
Vijayalakshmi Sivapurapu ◽  
Banupriya Kamalakannan ◽  
Mahalakshmy Thulasingham
Keyword(s):  
Logistic Regression ◽  
Dengue Fever ◽  
Early Warning ◽  
Dengue Infection ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
Clinical Variables ◽  
Early Warning Signs

Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.Methods: All children (0-12 y of age) diagnosed and confirmed as dengue fever admitted at a tertiary care hospital at Puducherry were retrospectively analysed from hospital case records as per the revised World Health Organization(WHO) guidelines 2009 for dengue fever. The data was analysed by descriptive statistics using SPSS 16.0 statistical software. Early warning signs were analyzed by logistic regression and a P-value of <0.05 was taken as significant.Results: Out of 360 children confirmed with diagnosis of dengue fever, non-severe and severe dengue infection was seen in 214(59.4%) and 146 cases (40.6%) respectively. The most common manifestation of severe dengue infection were shock (40.6%), bleeding (16.7%) and multiorgan failure (2.2%). On logistic regression, the warning signs most commonly associated with severe dengue infection were pain abdomen, hepatomegaly, hypotension at admission and HCT>20% with concomitant platelet<50,000/mm3. Clinical variables which were unlisted in the revised guidelines but significantly associated with severe dengue infection were Age >6 yrs, retro-orbital pain, palmar erythema, joint pain, splenomegaly, positive tourniquet test, right hypochondriac pain and epigastric tenderness.Conclusions: Early identification of the preceding warning signs, timely intervention and vigilant monitoring can reduce the morbidity and mortality in children with severe dengue infection. Since there were other clinical variables not enlisted as warning signs but were significantly associated with severe dengue infection, the list of warning signs in the revised guidelines needs to be expanded.

Clinical and Laboratory Profile of Dengue Fever in the Paediatric Age Group at a Tertiary Care Hospital of West Bengal - A Comparison of Two Subsequent Years

2021 ◽  
Vol 8 (25) ◽  
pp. 2162-2167
Author(s):  
Shankar Sikdar ◽  
Ujjwal Bandyopadhyay ◽  
Sutapa Das ◽  
Mala Bhattacharya
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Dengue Infection ◽  
Warning Signs ◽  
Health Concern ◽  
Care Hospital ◽  
Age Group ◽  
Structural Protein ◽  
Asian Countries ◽  
Paediatric Age

BACKGROUND Dengue is a major public health concern in tropical Asian countries and a most rapidly spreading mosquito borne viral disease with a 30 fold increase in global incidence over the last five decades. Dengue is among the ten leading causes of death in children ranging from 1 to 15 years of age in tropical Asian countries. Complications of dengue fever are common in children. But very limited studies are available on paediatric populations. The virus or non-structural protein (NS1) interacts with platelets and coagulation factors. A combined effect of mild disseminated intravascular coagulation, liver damage and platelet dysfunction results in bleeding in dengue fever. With this scientific knowledge background, the present study was undertaken to identify and document the changing pattern of dengue infection in paediatric age group with a special emphasis on laboratory findings of dengue cases in paediatric age group. METHODS The present descriptive study was conducted for two years in a state run paediatric referral hospital. The sample was purposive by design and consisted of patients who have been diagnosed as having dengue fever with warning signs and admitted. RESULTS Fever was typically high grade (> 103 F) and most patients presented with warning signs within 5 days of illness (64.2 % in year 2016 and 76.6 % in year 2017). Persistent vomiting and abdominal pain were the most common warning signs in both the years. Thrombocytopenia was the commonest laboratory finding. Bleeding in study subjects lead to < 50000 / cu mm platelet count. Most common bleeding was gastrointestinal bleeding (39.2 % of study subjects with platelet count < 50000 / cu mm presented with G. I bleeding). CONCLUSIONS Dengue illness comes with varied presentation. Atypical presentations can delay the diagnosis. Early recognition of warning signs keeping the atypical presentation in mind is important. KEYWORDS Dengue Fever, Paediatric Age Group, Non-Structural Protein (NS1), Thrombocytopenia

scholarly journals A study of various hepatic manifestations in dengue fever and their correlation with severity of dengue fever

2020 ◽  
Vol 7 (3) ◽  
pp. 527
Author(s):  
Shravya Dhanwada ◽  
Samba Siva Reddy R.
Keyword(s):  
Dengue Fever ◽  
Complete Blood Count ◽  
Dengue Infection ◽  
Liver Function Tests ◽  
Warning Signs ◽  
Severe Dengue ◽  
Serum Total Bilirubin ◽  
Hepatic Involvement ◽  
Elevated Liver Enzymes ◽  
A Prospective Study

Background: Hepatic involvement in Dengue is known with protean of manifestations ranging from hepatomegaly, elevated liver enzymes to fulminant hepatic failure. Aim of the study was to study the hepatic manifestations in children with dengue illness.Methods: This is a prospective Study with 60 Patients hospitalized with Dengue infection (Seropositive for Dengue). Dengue Seropositive patients are selected and examined for Hepatomegaly and Jaundice and subjected to complete blood count and Liver function tests were analysed.Results: Of 60 serologically confirmed cases hospitalized with dengue, were classified into (i)(DF), (ii) DHF I (iii) DHF II (iv) DHF III and (v) DHF IV.  In our study, upon 60 seropositive cases were reported at our hospital during the study period of which 18 were DF, 12 were DHF I, 15 were DHFII, 8 were DHF III and 7 were DHF IV respectively. The Hematocrit levels were raised 20% from the baseline in four classes of Dengue and not raised in DF. Most commonly occurred in age group of 5-7 years. Hepatomegaly was the commonest clinical sign seen. Thrombocytopenia was seen in 88% of all cases. Serum total bilirubin was raised in 10% of subjects with severe dengue infection in DHF III and DHF IV. Serum SGOT and SGPT was raised in 63.3% and 56.7% of patients with dengue of all classes including DF respectively. Thrombocytopenia occurred in 75% of patients with dengue fever, 98% with warning signs and 100% in severe dengue.Conclusions: In developing country like India, incidence of dengue outbreaks is increasing. Hepatic involvement of varying degrees have been reported. As hepatic dysfunction in dengue is transient and reversible, early identification of the same would help to reduce life threatening complications. The role of hepato protective drugs in reducing morbidity and mortality should be analysed by further studies. 

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