Clinical and laboratory profile of Expanded Dengue Syndrome: experience of 2019 outbreak from Dhaka, Bangladesh

Abstract

Background & objectives: Bangladesh is afflicted with periodic Dengue outbreak every few years and one of the worst upsurge was recorded in 2019. That year there was an increasing trend of dengue with unusual symptoms which were not so common before. This study aims to describe the experience of three tertiary care centres of Dhaka regarding the clinical and laboratory, hospital outcome and management profile of the EDS cases admitted from 2019 outbreak. Methods: This was a cross sectional observational study which took place from 1st August to 31st December, 2019 at three major tertiary care centres in Dhaka, Bangladesh. Out of total 2,017 screened dengue cases 49 met the inclusion criteria and 39 were enrolled after taking informed written consent. Data was analysed using MS excel and graph pad prism 9.3.1 (San Diego, CA, USA). A probability value of p < 0.05 was considered statistically significant. Results: Out of the 39 cases, majority were male (79.49%) with median (±IQR) age of 33(±9) years. Hypertension (4; 10.26%) was the most commonly associated co-morbidity. Among the systemic manifestations, most prevalent was hepatitis (38.49%) followed by encephalopathy (12.82%). Majority of the patients were suffering from primary infection (85%). Case fatality rate was 15.38%. Hepatitis and meningoencephalitis were the predominant cause of death. This study records the only known case report of ARDS complicating dengue from Bangladesh. None of the patients from our cohort were managed by steroids. Only 2 (5.13%) out of 39 cases received antibiotics. Interpretation & conclusion: In the year of 2019, an unusual rise in EDS cases with about 15.4% fatality was observed in this study. Hepatitis was the most common presentation and cause of death. Here we also report the first ARDS case encountered in Bangladesh. Despite the multifaceted presentation of EDS indiscriminate use of antibiotics and steroid was minimal. Early recognition of multifarious features of EDS is important for choosing the targeted treatment option which can avert many deaths. The results of this study underlines the necessity for more in-depth research into the risk factors that are contributing to mortality in EDS cases.