Clinical Profile and Outcome of Dengue Fever in Multidisciplinary Intensive Care Unit of a Tertiary Level Hospital in India

Abstract

Background India is one of the seven identified countries in South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks. Even though the dengue prodrome and evolution of illness are most often similar in many patients, progress and outcome may differ significantly depending on the severity of illness as well as treatment instituted. We studied the clinical manifestations, outcome and factors predicting mortality of serology confirmed dengue fever cases admitted in Multidisciplinary Intensive Care Unit (MICU) of a high acuity healthcare facility in India. Methodology All patients with serology proven dengue fever admitted to MICU between 1st July 2015 and1st December 2015 were included in the study. Clinical presentation, laboratory findings, severity of illness scores and outcome were recorded. Results Majority of the patients (58.4%) belonged to 21–40 year age group. Hepatic (96.8%) followed by hematological (79.2%) involvement were the most common findings. CNS involvement observed among 27%. Survival to hospital discharge was 78.9%. Respiratory and gastrointestinal system involvement was associated with increased mortality. Acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and shock were the clinical syndromes associated with mortality. Serum lactate, aspartate transaminase (AST) and alanine transaminase (ALT) were significantly elevated among non survivors. Significant difference in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) scores was also observed among survivors and non survivors. Conclusion Organ system involvement and higher disease severity scores are strong predictors of mortality. High index of suspicion for atypical manifestations of dengue is warranted. How to cite this article Padyana M, Karanth S, Vaidya S, Gopaldas JA. Clinical Profile and Outcome of Dengue Fever in Multidisciplinary Intensive Care Unit of a Tertiary Level Hospital in India. Indian J Crit Care Med 2019;23(6):270–273.

Maternal and fetal outcomes of dengue fever in pregnancy: a large prospective and descriptive observational study

“…Depletion of intravascular volume leads to features of shock and hypoperfusion of various organs, instituting a cascade of hypoxic injury in various organ systems leading to shock and multi-organ dysfunction, which is a frequent cause of death in dengue [ 18 ], as also seen in our study. Multiorgan dysfunction syndrome particularly ARDS and AKI, were accompanying factors in most cases of dengue deaths in our study and they have been shown to be strong predictors of mortality in non-pregnant patients with dengue [ 19 ]. Therefore, organ dysfunction in pregnant women with dengue requires vigilant monitoring and intensive management in ICU, to salvage such women.…”

Viral characteristics and clinical presentation in dengue co-infection- Findings from a facility based observational study in Odisha, India

“…Among the dengue positive cases, 593 (60.9%) were male and 381 (39.1%) were female. The mean age among positive cases was 31 Month wise distribution of dengue cases showed the occurrence to be high during May to November with maximum in the month of August (Figure -1).…”

“…Other study shows that erythema, morbilliform rash, cutaneous hypersensitive reactions as atypical presentations of dengue (30). Infections caused by typhoid bacilli, leptospira, enterovirus with fever and gastro intestinal symptoms may simulate dengue fever (31).…”

Look Out for Fever: Clinical Profile of Dengue in Young Adults in a Tertiary Care Center in North India

“…16 Padyana et al found gall bladder wall edema in 44% of their cases on ultrasonography. 21 The authors suggest that ultrasound features of thickened gall bladder wall, pleural effusion, and ascites in a febrile patient should strongly favor the diagnosis of DF.Complications encountered in our cases included bleeding in 44 (10.29%), ARDS in 7 (1.67%), myocarditis in 6 (1.44%), seizures in 6 (1.44%), hemarthrosis in 1 (0.24%), and encephalopathy in 1 (0.24%) patient. Patil has reported altered sensorium & convulsions as neurological complications.…”

“…13,14 The clinical profile of dengue revealed fever as the most common presenting symptom (99.76%), as also substantiated by Chan et al, Fujimoto and Koifman et al, Kauser et al, Mandal et al, Imam and Prashanth, Jayadas et al, and Padyana et al who have reported fever in 99.7, 79.8, 100, 100, 98.3, 100, and 94.8% of their patients, respectively. 13,14,[17][18][19][20][21] Other presenting symptoms were vomiting and pain abdomen that can be due to liver injury caused by the dengue virus. 14 It is imperative to remember that other infections that cause fever and gastrointestinal symptoms such as typhoid, leptospirosis, enteroviral infections are common in India and may often lead to a delay in diagnosis of dengue.…”