Study of haematological profile of Dengue Fever and its clinical implication
Keywords:
Dengue, thrombocytopenia, DHF, DSS
Abstract
Background: Dengue virus, a mosquito-borne human viral pathogen, has recently become a major national health problem.The disease is transmitted in rainy season. There are four dengue virus serotypes, called DEN-1, DEN-2, DEN-3, and DEN-4. The clinical manifestation of dengue infection varies from asymptomatic to severe life threatening illness in the form of DHF/DSS. Dengue haemorrhagic fever or DSS may be fatal in 40% to 50% of untreated patients. Laboratory diagnosis of dengue virus infection depends upon demonstration of specific antibodies in serum samples. Early diagnosis and monitoring is largely dependent on haematological parameters. As no specific antiviral therapy is available, supportive therapy is of most importance.Methods: NS1, Ig M & Ig G detection by Dengue Day 1 Test kit, haematological parameters by automated analyzer & peripheral smear, coagulation profile analysis by ACL-7000 coagulation meter, LFT by BACKMAN COULTER AU480.Result: Out of 100 cases, 95 (95%) of the patients had fever, 39 (39%) cases had leukocyte count <4,000/ mm3, thrombocytopenia (<1,00,000/mm3) was observed in 81, 48 cases had derranged LFT with thrombocytopenia,17 cases had prolonged APTT which correlated with thrombocytopenia, 14 cases had raised APTT & deranged LFT which also showed thrombocytopenia.Conclusion:Thrombocytopenia was most predominant haematological discrepancy. Most cases (70%) were of classical DF & (28%) were cases of DHF who had fever, showed thrombocytopenia & deranged haematological parameters which signifies disease severity. 2% cases presented with hypotension & altered consciousness with severe thrombocytopenia & prolonged APTT (DHF/DSS) which indicates very poor prognosis & had fatal outcome. Initial leukopenia & leukocyte count returning to normal by ninth to tenth day after therapy in most of the cases indicates that leukocyte count an important benchmark for clinical improvement. Dengue fever does not have specific medical therapy hence clinical recovery monitoring is largely dependent on haematological parameters.References
1. Bulletin of the WHO; 1980; 58(1):1-21.
2. Schwartz E. Study of dengue fever among Israeli travellers to Thailand.WHO, Dengue Bull 2002; 26: 162-7.
3. Raghunath D, Rao Durga C (Ed); Prida Malaist ; Immunopathogenesis of DHF ;Arthropod Borne Viral infections- Current status and Research ; Vol 8, Tata Mc- Graw Hill, New Delhi;2008: 137
4. Kabra SK, Jain Y, Singhal T, Ratageri VH. Dengue hemorrhagic fever. Clinical manifestations and management. Ind J Ped 1999; 66: 93-101.
5. DENGUE .Guidelines for diagnosis, treatment, prevention and control, 2nd Edition, World Health Organization, Geneva 2009: 1-144.
6. Victor TJ,Malathi M, Asokan R, Padmanaban P.Laboratory- based dengue fever surveillance in Tamil Nadu. Indian J Med Res. 2007;126:112-5.
7. Ronald M. A (Ed); Pathogenesis of infectious diseases, 1stedition,Mosby international, USA; 1999:517.
8. Wang S, He R, Patarapotikul J, Innis BL, Anderson R.Antibody enhanced binding of dengue- virus to human platelets. J ViroS 1995.20; 213;1: 254-7.
9. Qui FX, Gubler DJ, Liu JC, Chen QQ. Dengue in China. A clinical review. Bull World Health Organ 1993; 71(3/4): 349-59.
10. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, et al. A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med Public Health. 1999; 30(4): 735-40.
11. Butt N, Abbassi A, Munir S.M, Ahmad S.M, Sheikh Q.H; Haematological and Biochemical indicators for early diagnosis of Dengue viral infections; Journal of the college of physicians and Surgeons Pakistan; 2008; Vol 18:282-285.
12. Bethell B .D, Gamble J; Non-invasive measurement of micro vascular leakage in patients with Dengue hemorrhagic fever; Journal of clinical infectious diseases; 2001; Vol 32:243-253.
13. Narayanan M, Aravind M A; Dengue Fever-Clinical and laboratory parameters associated with complications; Dengue bulletin; 2003; Vol 27:108-115.
14. JW Liu, B S Khor ,C H Lee, Dengue haemorrhagic fever in Taiwan. Dengue bulletin;2003;Vol 27:19.
15. Halstead SB. Dengue Hematological Aspects. Seminars in hematology.1982; 19(2): 116-28.
16. Krishnamurthy K, Kasturi TE, Chittipantulu G. Clinical and pathological studies of an outbreak of Dengue like illness in Visakhapatanam. Ind J Med Res 1965; 53(8): 800-12.
17. Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ, et al. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the philippines. Am J Trop Med Hyg 2005;73(2):435- 440.
18. John M. Gawoski, Winnie W Ooi. Dengue Fever Mimicking Plasma Cell Leukemia. Archives of Pathology and Laboratory Medicine 2003;127(8)1026–7.
19. Sharma S, Sharma SK, Mohan A. Clinical profile of Dengue hemorrhagic fever in Adults during - 1996 outbreaks in Delhi, India. Dengue Bull 1998; 22: 1-7.
20. Harris E, Videa E, Perez L, Sandoval E, Tellez Y, Perez ML, et al. Clinical, Epidemiological and Virologic Features of Dengue in the 199Epidemic in Nicaragua. Am J Trop Med Hyg 2000; 63(1,2): 5-11.
2. Schwartz E. Study of dengue fever among Israeli travellers to Thailand.WHO, Dengue Bull 2002; 26: 162-7.
3. Raghunath D, Rao Durga C (Ed); Prida Malaist ; Immunopathogenesis of DHF ;Arthropod Borne Viral infections- Current status and Research ; Vol 8, Tata Mc- Graw Hill, New Delhi;2008: 137
4. Kabra SK, Jain Y, Singhal T, Ratageri VH. Dengue hemorrhagic fever. Clinical manifestations and management. Ind J Ped 1999; 66: 93-101.
5. DENGUE .Guidelines for diagnosis, treatment, prevention and control, 2nd Edition, World Health Organization, Geneva 2009: 1-144.
6. Victor TJ,Malathi M, Asokan R, Padmanaban P.Laboratory- based dengue fever surveillance in Tamil Nadu. Indian J Med Res. 2007;126:112-5.
7. Ronald M. A (Ed); Pathogenesis of infectious diseases, 1stedition,Mosby international, USA; 1999:517.
8. Wang S, He R, Patarapotikul J, Innis BL, Anderson R.Antibody enhanced binding of dengue- virus to human platelets. J ViroS 1995.20; 213;1: 254-7.
9. Qui FX, Gubler DJ, Liu JC, Chen QQ. Dengue in China. A clinical review. Bull World Health Organ 1993; 71(3/4): 349-59.
10. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, et al. A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med Public Health. 1999; 30(4): 735-40.
11. Butt N, Abbassi A, Munir S.M, Ahmad S.M, Sheikh Q.H; Haematological and Biochemical indicators for early diagnosis of Dengue viral infections; Journal of the college of physicians and Surgeons Pakistan; 2008; Vol 18:282-285.
12. Bethell B .D, Gamble J; Non-invasive measurement of micro vascular leakage in patients with Dengue hemorrhagic fever; Journal of clinical infectious diseases; 2001; Vol 32:243-253.
13. Narayanan M, Aravind M A; Dengue Fever-Clinical and laboratory parameters associated with complications; Dengue bulletin; 2003; Vol 27:108-115.
14. JW Liu, B S Khor ,C H Lee, Dengue haemorrhagic fever in Taiwan. Dengue bulletin;2003;Vol 27:19.
15. Halstead SB. Dengue Hematological Aspects. Seminars in hematology.1982; 19(2): 116-28.
16. Krishnamurthy K, Kasturi TE, Chittipantulu G. Clinical and pathological studies of an outbreak of Dengue like illness in Visakhapatanam. Ind J Med Res 1965; 53(8): 800-12.
17. Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ, et al. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the philippines. Am J Trop Med Hyg 2005;73(2):435- 440.
18. John M. Gawoski, Winnie W Ooi. Dengue Fever Mimicking Plasma Cell Leukemia. Archives of Pathology and Laboratory Medicine 2003;127(8)1026–7.
19. Sharma S, Sharma SK, Mohan A. Clinical profile of Dengue hemorrhagic fever in Adults during - 1996 outbreaks in Delhi, India. Dengue Bull 1998; 22: 1-7.
20. Harris E, Videa E, Perez L, Sandoval E, Tellez Y, Perez ML, et al. Clinical, Epidemiological and Virologic Features of Dengue in the 199Epidemic in Nicaragua. Am J Trop Med Hyg 2000; 63(1,2): 5-11.
Published
2016-08-10
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