Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study

Abstract

BackgroundDengue infection patients are presented with acute febrile illness. Clinical presentations may mimic other infections. The serology for definite diagnosis is costly and inaccessible in many hospitals. We sought to identify the clinical features and hematologic parameters from a complete blood count (CBC) which distinguish dengue infection from other causes.MethodsThis was a retrospective single center study from Chiang Mai University Hospital. All patients who presented with acute fever between September 2013 and July 2015 were included. The diagnosis of dengue infection must be confirmed by serology. The control groups were patients who presented with acute febrile illness without localizing signs. Clinical data and CBC results were reviewed and compared. The Chi-square test was used to compare categorical variables. The CBC parameters were analyzed using the linear mixed model.ResultsOne hundred and fifty-four dengue and 146 control patients were included. Headache, nausea, loss of appetite and bleeding diathesis were significantly symptoms in dengue patients (p < 0.05). There was some diversity in the the CBC in the dengue patients compared to the control group. Moreover, this study also identified the day of fever which these parameters were statistically significant. The dengue group had higher hemoglobin and hematocrit from day 3 to day 10 (p < 0.001), lower white blood cell count from day 1 to day 10 (p < 0.001), lower platelet count from day 3 to day 10 (p < 0.001), higher monocyte on day 1–4 (p < 0.001), higher atypical lymphocyte percentage on day 5–9 (p < 0.001) and higher eosinophil percentage on day 9–10 (p = 0.001). Furthermore, the neutrophil to lymphocyte percentage ratio of dengue group was > 1 on the first 5 days then reversed on day 6 to Day 9 but in non-dengue group, the ratio was always > 1.ConclusionWe identified important clinical features and CBC parameters to differentiate dengue patients from other patients who had acute febrile illness from other causes. This identification could be done in local hospitals to give an accurate diagnosis, enabling further investigation to be tailored and treatment commenced earlier.

The clinical profile, hematological parameters and liver transaminases of Dengue NS1 Ag positive patients admitted to Jaffna Teaching Hospital, Sri Lanka

“…Lymphocytopenia was widely observed than neutropenia, the mean ratio of neutrophil to lymphocytes were >1 in both febrile phase and critical phase (Table.3) and there is no significance was observed between febrile phase and critical phase. In year 2018 similar observation reported in the Thailand dengue patients, it also stated from day 6-9 (recovery phase ) the ratio was reversed [11].…”

Study of electrolytes in patients of Dengue in a tertiary care hospital in India

“…16 In the present study low haematocrit seen in 27.33% and high haematocrit in 1.33% but another study done by Juthatip C found association of raised haematocrit significantly in dengue fever/DHF. 16 In our patients, low haemoglobin and haematocrit may be due to high incidence of nutritional (iron deficiency) anaemia in the community. Also, we didn't include patients of dengue hemorrhagic fever and dengue shock syndrome in our studys.…”

“…16 In the present study low haemoglobin seen in 30.66% and high haemoglobin in 0.66% but another study done by Chaloemwong J et al, found association of raised haemoglobin significantly in dengue fever/DHF. 16 In the present study low haematocrit seen in 27.33% and high haematocrit in 1.33% but another study done by Juthatip C found association of raised haematocrit significantly in dengue fever/DHF. 16 In our patients, low haemoglobin and haematocrit may be due to high incidence of nutritional (iron deficiency) anaemia in the community.…”

The clinical profile, hematological parameters and liver transaminases of Dengue NS1 Ag positive patients admitted to Jaffna Teaching Hospital, Sri Lanka

“…The mean ratio of neutrophil to lymphocytes were >1 for day 1-5 on admission (Table 1). In year 2018 similar observation reported in the Thailand dengue patients, it also stated from day 6-9 the ratio was reversed [10]. Even though dynamic changes of the mean value for WBC, neutrophil and lymphocytes observed in the dengue NS1 positive patients observed according to the day of NS1 positive, there were no statistical significance observed in WBC, neutrophil and lymphocytes between group A and group B.…”