Study of Serum Aminotransferase Levels in Dengue Fever

Abstract

BACKGROUND: The involvement of liver in dengue fever is not uncommon as reported in literature since 1970. Liver and nervous system involvement simultaneously predicts poor outcome in dengue fever. Atypical manifestations include liver involvement with elevation of enzymes, central nervous involvement (encephalopathy) and cardiac alterations (myocarditis). Liver involvement in dengue fever is manifested by the elevation of transaminases representing reactive hepatitis, due to direct attack of virus itself or the use of hepatotoxic drugs. OBJECTIVE OF THE STUDY: Study of serum aminotransferase levels in dengue fever. METHODOLOGY: In this descriptive, cross sectional study, all patients who presented to the Department of medicine with dengue IgM positive were included. Study period of 24 months from July 2010-June 2012, patients attending to M.S. Ramaiah medical college were included (n=166). RESULTS: 166 patients reactive for dengue virus specific IgM antibody were studied. As per WHO classification, 137 (82.5%) patients were classified as dengue fever, 20 (12%) as dengue hemorrhagic fever, and 9 (5.4%) as dengue shock syndrome. Mean age of dengue infection patients was 35.71 ±12.9 (SD) years, with male to female ratio nearly equal. Hepatic dysfunction is very common in all forms of dengue infection, with AST rising significantly more than ALT. Serum aminotransferase levels appear to have a directly proportional correlation with grading of dengue infection. Hyperbilirubinemia, elevated transaminases, hypoproteinemia, hypoalbuminemia and deranged coagulation profile were seen in higher frequency in DHF and DSS group as compared to classical DF group. AST and ALT were significantly higher in patients with secondary infection (IgM & IgG positive) as compared to primary infection (IgM positive). CONCLUSION: Serum aminotransferase levels are significantly raised in all forms of dengue infection and it directly correlates with severity of infection. Serum aspartate aminotransferase was significantly raised compared to alanine aminotransferase levels in all forms of dengue infection. The degree of affection of serum albumin and prothrombin time which are absolute indicators of liver cell function correlated with severity of dengue infection.