Clinicolaboratory profile of expanded dengue syndrome – Our experience in a teaching hospital

Abstract

Introduction: Classic dengue fever presentation has expanded its horizon by involving various organ systems and is named as expanded dengue syndrome. This changing presentation and rising burden across the globe may lead to delayed diagnosis and under reporting of this syndrome. Aim of Study: To analyze clinicolaboratory profile of patients with expanded dengue syndrome. Materials and Methods: About 520 cases of expanded dengue syndrome as per World Health Organization definition criteria 2012 were studied with their informed consent. Detailed history, thorough clinical examination, and relevant investigations were done. Their clinical and laboratory parameters were analyzed. Standard treatment guidelines were followed in all cases. Observation: About 301 patients were male and 219 were female with male-to-female ratio of 3:2. Their age varied from 12 to 76 years with the average age of 47.5 years. About 92% of cases presented with various gastro hepatic manifestations. The commonest gastrohepatic manifestation was transaminitis (57.5%) that is asymptomatic elevation of liver enzymes followed by acalculous cholecystitis (21%) and acute pancreatitis (13.9%). Twenty-nine patients presented with various neurological manifestations. Three patients presented with acute kidney injury and eight patients had coinfection with malaria. Fever with nausea and vomiting was the most common presentation. About 15% of patients presented with bleeding manifestations. About 40.6% of patients presenting as abdominal manifestations had platelet count <20,000/mm 3 and needed platelet transfusion versus 9.8% with other system involvement (central nervous system, cardiovascular system (CVS), renal). Hepatomegaly was the most common ultrasonography (USG) finding being present in 57.5% of patients followed by acalculous cholecystitis in 21.3%. Total mortality was 1.9% in our series. We lost eight patients presenting with neurological manifestations and two patients with coinfection with malaria. Conclusion: Atypical presentations should prompt us to investigate for dengue especially during ongoing epidemics so that expanded dengue syndrome can be diagnosed and treated early.

Assessing the reporting of Dengue, Chikungunya and Zika to the National Surveillance System in Colombia from 2014–2017: A Capture-recapture analysis accounting for misclassification of arboviral diagnostics

“…A significant portion of infected individuals with chikungunya, dengue, and Zika remain asymptomatic, with reports of up to 30% of asymptomatic infections for chikungunya, 50% for dengue, and 80% for Zika [ 1 , 2 , 11 , 15 ]. While most individuals infected with arboviral diseases will spontaneously recover following the febrile stage, there can be severe infections and chronic sequela [ 1 , 5 , 11 , 16 – 18 ]. Lifelong immunity can be developed for chikungunya and for each one of the four dengue serotypes [ 14 , 19 – 21 ].…”

“…Lifelong immunity can be developed for chikungunya and for each one of the four dengue serotypes [ 14 , 19 – 21 ]. However, secondary or subsequent infections from different dengue serotypes increases the risk of severe dengue, which occurs in approximately 1% of all dengue cases, with mortality rates up to 20% [ 3 , 16 , 20 ]. Other severe outcomes include the congenital Zika syndrome, which is a set of congenital malformations that has been causally related to Zika virus exposure in fetuses [ 1 , 22 , 23 ], and acute flaccid paralysis or Guillain-Barré syndrome that could occur with Zika among adults [ 18 , 23 , 24 ].…”

Dengue Virus: Clinical Manifestations and Advances in Diagnosis, Treatment with a Special Focus on Strategies to Limit Mosquito Spread

“…Clinical manifestation of the serious illness includes cold limb extremities, low pulse, low urine output, signs of mucosal bleeding and abdominal pain. One such report expanded the clinical illness involving gastrointestinal and hepatic syndrome with illness of asymptomatic increase of liver enzymes, fulminant hepatc failure, acute pancreatitis, peritonitis, spleen rupture, acalculous cholecysitis, subacute intestinal obstruction and kidney failure (Bijaya et al, 2019).…”

Viral Characteristics and Clinical Presentation in Dengue Co-infection—Findings from a Facility Based Observational Study in Odisha, India

“…Symptoms in dengue vary from mild self limiting fever to severe form of manifestations like severe headache, petechiae, bone pain, enlargement of lymph nodes and frank bleedings (8). In 2012, WHO has expanded the horizon of classic dengue fever and named it expanded dengue syndrome (9).…”