Clinical Profile and Outcome of Patients with Dengue Syndrome in Hospital Care

A retrospective study on the socio-demographic factors and clinical parameters of dengue disease and their effects on the clinical course and recovery of the patients in a tertiary care hospital of Bangladesh

Dengue, a mosquito transmitted febrile viral disease, is a serious public health concern in Bangladesh. Despite significant number of incidences and reported deaths each year, there are inadequate number of studies relating the temporal trends of the clinical parameters as well as socio-demographic factors with the clinical course of the disease. Therefore, this study aims to associate the clinical parameters, demographic and behavioral factors of the dengue patients admitted in a tertiary care hospital in Dhaka, Bangladesh during the 2019 outbreak of dengue with the clinical course of the disease. Data were collected from the 336 confirmed dengue in-patients and analyzed using SPSS 26.0 software. Majority of the patients were male (2.2 times higher than female) who required longer time to recover compared to females (p < 0.01), urban resident (54.35%) and belonged to the age group of 18–40 years (73.33%). Dengue fever (90.77%) and dengue hemorrhagic fever (5.95%) were reported in most of the dengue patients while fever (98%) was the most frequently observed symptom. A significantly positive association was found between patient’s age and number of manifested symptoms (p = 0.013). Average duration of stay in the hospital was 4.9 days (SD = 1.652) and patient’s recovery time was positively correlated with delayed hospitalization (p < 0.01). Additionally, recovery time was negatively correlated with initial blood pressure (both systolic (p = 0.001, and diastolic (p = 0.023)) and platelet count (p = 0.003) of the patients recorded on the first day of hospitalization. Finally, a statistical model was developed which predicted that, hospital stay could be positively associated with an increasing trend of temperature, systolic blood pressure and reduced platelets count. Findings of this study may be beneficial to better understand the clinical course of the disease, identify the potential risk factors and ensure improved patient management during future dengue outbreaks.

Comparison of clinical manifestation of dengue fever in Bangladesh: an observation over a decade

BACKGROUND

The clinical presentation of dengue fever had been observed to change with time since its first outbreak in 2000 in Bangladesh. This report showed the clinical presentation of the 2019 outbreak in Bangladesh along with its comparison to previous outbreaks witnessed in this region.

METHODS

This hospital-based cross-sectional study was conducted in one of the largest tertiary care hospitals in Dhaka city. A total of 553 laboratory-confirmed and 194 probable dengue cases were interviewed. The clinical manifestation of the confirmed cases of the current outbreak was compared with three of the outbreak reports retrieved from the databases. R version 3.6.3 was used for data analysis.

RESULTS

Among the confirmed cases, two-thirds were male (63.2%) and the average age was 27(± 11) years. Positive tests for NS1 and IgM were present in 99.6% (n = 525/527) and 82.6% (n = 38/46) of the cases, respectively. Thrombocytopenia was present in 66.1% of cases. Fever (100%) was common for all. Gastrointestinal (GIT) features, including abdominal pain (86.5%), anorexia and/or vomiting (69.6%), and Diarrhea (> 3 motions/day) (26.2%) were more frequent than typical rash and other pain symptoms. Hypotension was present in approximately a quarter of patients (25%). GIT features (anorexia, nausea, and/or vomiting) and hypotension were more common among adult participants while bleeding manifestation (melena and vaginal bleeding, p = 0.009 & 0.032) was more frequent in pediatric patients. Compared to outbreaks of 2008, 2016, and 2018, increasing trends in GIT symptoms e.g. anorexia, abdominal pain, and diarrhea were observed. While a negative trend in hemorrhagic manifestations (skin rash, melena, and conjunctival hemorrhage/hemorrhagic sclera) and arthralgia/joint pain were found.

CONCLUSION

The present outbreak was noticeably characterized by GIT symptoms and hypotension in addition to the typical clinical features like rash and pain symptoms. An increasing trend in GIT features and decreasing trend in hemorrhagic manifestations was noted over the last decade of dengue outbreaks.

Clinico-epidemiologic characteristics of the 2019 dengue outbreak in Bangladesh

BACKGROUND

Dengue fever shows a broad range of clinical presentations worldwide. Here we report on our clinical findings during the 2019 dengue outbreak in one of the largest tertiary care hospitals in Dhaka, the capital of Bangladesh.

METHODS

A total of 747 suspected dengue cases (553 confirmed and 194 probable) were interviewed with a pro forma case record form. Statistical analyses were conducted using SPSS 20.0. Ethical clearance was obtained from the Dhaka Medical College.

RESULTS

The mean age of the dengue cases was 27 y and approximately two-thirds were male. Positive tests for NS1 and anti-dengue immunoglobulin M antibody were present in 91.9% and 59.4% of the cases, respectively. Thrombocytopenia was present in 69% of cases and fever was present in 99.1% of cases. Gastrointestinal (GI) features, including anorexia and/or vomiting (69.4%), abdominal pain (39.8%) and diarrhoea (25.6%), were more prevalent than typical rash and pain symptoms. Hypotension was present in approximately one-quarter of patients (25.4%). Probable and confirmed dengue cases have shown similar clinical characteristics and laboratory findings.

CONCLUSIONS

The 2019 outbreak of dengue fever in Bangladesh was characterized by increased presentation with GI features. Recognition of this trend would permit early diagnosis and proper management of patients.

Tourniquet Test for Dengue Diagnosis: Systematic Review and Meta-analysis of Diagnostic Test Accuracy

BACKGROUND

Dengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point of care test, the clinical diagnosis of dengue is complex. The World Health Organisation has outlined diagnostic criteria for making the diagnosis of dengue infection, which includes the use of the tourniquet test (TT).

PURPOSE

To assess the quality of the evidence supporting the use of the TT and perform a diagnostic accuracy meta-analysis comparing the TT to antibody response measured by ELISA.

DATA SOURCES

A comprehensive literature search was conducted in the following databases to April, 2016: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, BIOSIS, Web of Science, SCOPUS.

STUDY SELECTION

Studies comparing the diagnostic accuracy of the tourniquet test with ELISA for the diagnosis of dengue were included.

DATA EXTRACTION

Two independent authors extracted data using a standardized form.

DATA SYNTHESIS

A total of 16 studies with 28,739 participants were included in the meta-analysis. Pooled sensitivity for dengue diagnosis by TT was 58% (95% Confidence Interval (CI), 43%-71%) and the specificity was 71% (95% CI, 60%-80%). In the subgroup analysis sensitivity for non-severe dengue diagnosis was 55% (95% CI, 52%-59%) and the specificity was 63% (95% CI, 60%-66%), whilst sensitivity for dengue hemorrhagic fever diagnosis was 62% (95% CI, 53%-71%) and the specificity was 60% (95% CI, 48%-70%). Receiver-operator characteristics demonstrated a test accuracy (AUC) of 0.70 (95% CI, 0.66-0.74).

CONCLUSION

The tourniquet test is widely used in resource poor settings despite currently available evidence demonstrating only a marginal benefit in making a diagnosis of dengue infection alone.

REGISTRATION

The protocol for this systematic review was registered at

PROSPERO

CRD42015020323.