International Journal of Advances in Medicine

Patel MK et al. Int J Adv Med. 2020 Sep;7(9):1418-1422

http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933

DOI: http://dx.doi.org/10.18203/2349-3933.ijam20203608
Original Research Article

Assessment of clinical and hematological profile in dengue fever

Mehul K. Patel, Hitesh J. Patel*

Department of Medicine, Gujarat Medical Education and Research Society Medical College, Dharpur-Patan, Gujarat,
India

Received: 14 July 2020

Accepted: 04 August 2020

*Correspondence:
Dr. Hitesh J. Patel,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Dengue is one of the most important viral diseases especially in the tropical regions. According to the
WHO almost 50 million people get dengue infection annually and WHO estimates almost half of the world’s
population lives in countries having endemicity for dengue infection. This study is an attempt to elucidate the positive
laboratory profile of serologically diagnosed dengue patients so as to facilitate early diagnosis, treatment,
management and vector control measures, to reduce the morbidity and mortality because of this disease.
Methods: This study was conducted on 80 indoor patients. Patients presenting to the emergency department,
outpatient department (OPD) or pediatric OPD with complaints of fever and clinical features of dengue with positive
NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Hemogram was done on
automated cell counter analyzer (Sysmex XP 100) which included hemoglobin, hematocrit, total leucocyte count
(TLC), differential leucocyte count (DLC) and platelets count.
Results: Raised hematocrit (>47%) was noted in 10 (16.6%) of patients at presentation and the hematocrit ranged
from 20- 51%. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less
than 4000 cells/cumm was present in 25 % cases. In the present study out of 80 cases of dengue fever, 85% cases had
thrombocytopenia and 15% cases had severe thrombocytopenia (< 20,000/cumm) with bleeding manifestations.
Conclusions: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along
with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that
dengue cases can be diagnosed in their initial stages.

Keywords: Dengue, Hemogram, Hematocrit, Leucopenia

INTRODUCTION lives in countries having endemicity for dengue

infection.2
The word dengue is believed to have originated from
Swahili language “ki denga pepo”, which describes There are four anti-genetically related but distinct
sudden cramp like seizure. The clinical symptoms serotypes of the dengue virus: DENV-1, DENV-2,
suggestive of dengue virus infection were described as DENV-3, and DENV- 4. It is a positive-stranded
early as 265-420 AD in China. At that time the disease encapsulated ribonucleic acid (RNA) virus. In humans,
was associated with water and insects.1 one serotype produces lifelong immunity against
reinfection but only temporary and partial immunity
Dengue is one of the most important viral diseases against the other serotypes.1 Classic dengue fever is
especially in the tropical regions. According to the WHO marked by rapid onset of high fever, headache, retro-
almost 50 million people get dengue infection annually orbital pain, diffuse body pain (both muscle and bone),
and WHO estimates almost half of the world’s population weakness, vomiting, sore throat, altered taste sensation,

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 Patel MK et al. Int J Adv Med. 2020 Sep;7(9):1418-1422

and a centrifugal maculopapular rash. The WHO 2009 manifestations, hematocrit and platelet count were
classification divides dengue fever into two groups: recorded at presentation.
dengue with or without warning signs and severe dengue,
though the 1997 WHO classification is still widely used. Inclusion criteria
The 1997 classification divided dengue into
undifferentiated fever, dengue fever (DF) and dengue Inclusion criteria were febrile patients with positive NS1
hemorrhagic fever (DHF). DHF is further divided in to I antigen or IgM or both on rapid card tests. IgG may be
to IV grades. III and IV grades are called as dengue shock positive or negative.
syndrome (DSS).3,4 Four main characteristic
manifestations of dengue illness are continuous high Exclusion criteria
fever lasting 2-7 days, haemorrhagic tendency as shown
by a positive tourniquet test, petechiae or epistaxis Exclusion criteria were patients with only IgG positive on
thrombocytopoenia (platelet count <100×109/l); and rapid card tests were excluded from the study. Patients
evidence of plasma leakage manifested by with other identified illnesses like typhoid, malaria which
hemoconcentration (an increase in hematocrit 20% above were coexisted with dengue positive serology were
average for age, sex and population), pleural effusion and excluded from the study.
ascites, etc.5,6
Hemogram was done on automated cell counter analyzer
Most common clinical presentation of dengue fever (DF) (Sysmex XP 100) which included hemoglobin,
is of an acute febrile viral disease with headaches, bone, hematocrit, total leucocyte count (TLC), differential
joint and muscular pains, rash and leucopenia. It is also leucocyte count (DLC) and platelets count.
known as break bone fever due to the severe bone pains.7
Platelets counts were cross checked on stained smears.
Dengue hemorrhagic fever (DHF) is characterized by Hematocrit raised >20% of normal was considered as
four major clinical manifestations: high grade fever, hemoconcentration. Leukopenia was taken as total
hemorrhagic phenomena, often with hepatomegaly and, leucocyte count <4,000/mm3. Thrombocytopenia was
in severe cases, signs of circulatory failure. Severe taken as platelets count <1,00,000/mm3.
plasma leakage in these patients can lead to hypovolemic
shock and circulatory failure. This is called dengue shock Biochemical parameters included serum Aspartate
syndrome (DSS) and can lead to death.8 aminotransferase (AST), Alanine aminotransferase
(ALT), total bilirubin (T. Bil.) and alkaline phosphatase
Clinical diagnosis of early dengue patients is challenging (ALP) were done on Cobas c 311 from Roche (Hitachi)
as it presents with nonspecific symptoms, including biochemistry machine.
fever, headache and myalgia. Since there are many
infectious diseases which have similar clinical features, a Statistical analysis
combination of clinical and laboratory parameters in any
acute febrile illness could be used as markers to diagnose The recorded data was compiled and entered in a
early dengue infection. spreadsheet computer program (microsoft excel 2007)
and then exported to data editor page of SPSS version 15
So, this study is an attempt to elucidate the positive (SPSS Inc., Chicago, Illinois, USA). For all tests,
laboratory profile of serologically diagnosed dengue confidence level and level of significance were set at 95%
patients so as to facilitate early diagnosis, treatment, and 5% respectively.
management and vector control measures, to reduce the
morbidity and mortality because of this disease. RESULTS

METHODS Most of the cases were seen in the 20-30 years age group
(Table 1). Majority of the patients were males compared
This was a descriptive study with analysis of patients to females and the male to female ratio was 2:1. Fever
who were admitted for dengue fever in the Department of was the most common presentation and was seen in 34
General Medicine at Tertiary Care center of Gujarat for cases (42.5%) cases (Table 2).
duration of 6 months. This study was conducted on 80
indoor patients. Patients presenting to the emergency Present study showed hemoglobin range of 6 gm% to 17
department, outpatient department (OPD) or pediatric gm% (Table 3). Raised hematocrit (>47%) was noted in
OPD with complaints of fever and clinical features of 10 (16.6%) of patients at presentation and the hematocrit
dengue with positive NS1 antigen test or dengue antibody ranged from 20-51%. The total leukocyte count ranged
serology IgM or IgG or both were included in the study. from 1500 cells/cumm to >11000 cells/cumm.
Age, gender, clinical presentation, duration of fever, Leucopenia with less than 4000 cells/cumm was present
dehydration, hemodynamic status, urine output, in 25% cases. In the present study out of 80 cases of
hepatomegaly, ascites, pleural effusion, presence of dengue fever, 85% cases had thrombocytopenia and 15%
petechiae, positive tourniquet test, other bleeding

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cases had severe thrombocytopenia (<20,000/cumm) with hepatomegaly was noted in 32% and splenomegaly was
bleeding manifestations. seen in 17% of cases.

Table 1: Age wise distribution of study participants. Table 2: Distribution of clinical features.

Age in years Number Percentage Clinical features Number Percentage

20-30 37 46.25 Fever 34 42.5
31-40 15 18.75 Myalgia 10 12.5
41-50 16 20 Fever and myalgia 12 15
51-60 7 8.75 Headache 4 5
>61 5 6.25 Nausea and vomiting 6 7.5
Total 80 100 Fever and skin rashes 6 7.5
Petechiae 5 6.25
Serum AST and ALT were elevated in 69% cases and Fever and itching 3 3.75
were normal in 31% cases. In the present study, Total 80 100

Table 3: Distribution of study population by hemoglobin and hematocrit level.

Hemoglobin level Hematocrit

Hb (gm/dl) No. of cases % HCT (%) No. of cases %
6-8.9 08 10 20-26 - -
9-11.9 32 40 27-36 38 47.5
12-14.9 28 35 37-46 28 35
15-17.9 12 15 47-56 14 17.5
Total 80 100% Total 80 100%

DISCUSSION number of males was 193 (94.15%), while females were

12 (5.85%) with male to female ratio of 9:1
Dengue is hemorrhagic viral fever which can prove fatal approximately.12
therefore this study is aimed at analyzing hematological
and biochemical parameters for early diagnosis of dengue In this study, we found that fever was the commonest
fever. Thrombocytopenia, leucopenia, increased symptom in dengue patients, followed by headache/retro-
hematocrit, lymphocytosis with reactive/ orbital pain and myalgia. Other prominent symptoms
atypical/plasmacytoid lymphocytes along with altered were arthralgia, skin rash, skin hemorrhage, loose
liver function tests are the hematological and biochemical motion, mucosal bleed and nausea/vomiting. These
abnormalities that appear in dengue fever. Hematological findings were comparable to those documented by others,
and biochemical profile of serologically confirmed 80 though the frequencies of the symptoms varied slightly.
dengue cases were done. In our study, itching, especially in the palms and soles,
was noted in 01% of patients which was comparable to
In the present study most of the cases were seen in the similar study by Deshwal et al.2
20-30 years age group. Deshwal et al studied a total of
515 patients of dengue.9 In their study too maximum Present study showed hemoglobin (Hb) ranging from 6
patients were in 21-40 years age group (62.91%). Vibha gm% to >15 gm%, 32 cases showed Hb of 9-11.9 gm%,
et al studied 100 patients, and observed 49 (49%) to be in followed by 28 cases showed Hb of 12-14.9 gm%, 08 had
the 15 to 25 years age group followed by 33 (33%) cases Hb of 6-8.9 gm% and 12 had Hb of 15-17.9 gm%. In the
in the 26 to 35 years age group.10 Meena et al (12 did a study by Meena et al hemoglobin ranged from 7.5-17.5
randomized study of 100 patients with dengue fever.11 g/dl; mean hemoglobin value was 12.6 g/dl.12
Ahmed et al (n=205) observed the age range for dengue Hemoglobin level more than 15gm% was seen in 6%
as 10-65 years and the mean age was 31.29 years cases. Dongre et al observed hemoglobin level from 3.6
(SD+13.65).12 Our findings compare well with the gm/dl to 16.7gm/dl with a mean of 11.9 gm/dl.13 Studies
observations of the above authors. done by Gajera et al and Butt et al showed hematocrit
values raised in 28% and 50% cases respectively. In
In our study majority of the patients were males studies done by Gajera et al and Butt et al there are more
compared to females and the male to female ratio was cases of dengue hemorrhagic fever 30% and 100%
2:1. Deshwal et al and Vibha et al too observed a male respectively.14,15
predominance in their studies with 72.8% and 70% male
patients respectively.9,10 The male to female ratio was In the present study, total leukocyte count ranged from
1.7:1 in Vibha et al study. In the study by Ahmed et al the 1500 to >11000 cells/mm3. In Deshwal et al study

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 Patel MK et al. Int J Adv Med. 2020 Sep;7(9):1418-1422

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17. Ahmed AB, Bhattacharyya DK, Baruah S, Brahma

Cite this article as: Patel MK, Patel HJ. Assessment
B, Bharadwaj R. Clinical and Laboratory Profile of
of clinical and hematological profile in dengue fever.
Dengue Fever. Int J Med Res Prof. 2017;3:113-6.
Int J Adv Med 2020;7:1418-22.

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