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

Evaluation of clinical and laboratory characteristics of dengue viral infection and risk factors of dengue hemorrhagic fever: a multi-center retrospective analysis

BACKGROUND

Dengue Viral Infection (DVI) has become endemic in Pakistan since the first major outbreak in Karachi in 1996. Despite aggressive measures taken by relevant authorities, Pakistan has been dealing with a worsening dengue crisis for the past two decades. DHF is severe form of dengue infection which is linked with significant morbidity and mortality. Early identification of severe dengue infections can reduce the morbidity and mortality. In this context we planned current study in which we find out the different factors related with DHF as well as clinical laboratory features of DHF and compare them to DF so that patients can be best evaluated for DHF and managed accordingly at admission.

METHODS

Retrospective study conducted over a period of 6 years (2013-2018) in two tertiary care hospitals in Pakistan. Data were collected by using a pre-structured data collection form. Data were statistically analyzed to determine the clinical and laboratory characteristics of DVI and risk factors of dengue hemorrhagic fever (DHF).

RESULTS

A total 512 dengue cases (34.05 ± 15.08 years; Male 69.53%) were reviewed. Most common clinical manifestations of DVI were fever (99.60%), headache (89.1%), chills (86.5%), rigors (86.5%), myalgia (72.3%). Less common clinical manifestations were vomiting (52.5%), arthralgia (50.2%) and skin rashes (47.5%). Furthermore, nasal bleeding (44.1%), gum bleeding (32.6%), pleural effusion (13.9%) and hematuria (13.1%) were more profound clinical presentations among DHF patients. Mortality rate was 1.5% in this study. Logistic regression analysis indicated that delayed hospitalization (OR: 2.30) and diabetes mellitus (OR:2.71), shortness of breath (OR:2.21), association with risk groups i.e., living near stagnant water, travelling to endemic areas, living in endemic regions (OR:1.95), and presence of warning signs (OR:2.18) were identified as risk factors of DHF. Statistically we found that there is strong association of diabetes mellitus (DM) with DHF while the patient suffering from DM individually had higher odds (2.71) of developing DHF than patients without disease.

CONCLUSIONS

The current study demonstrated that the clinical and laboratory profiles of DF and DHF are significantly distinct. Significant predictors of DHF were advanced age, diabetes mellitus, ascites, pleural effusion, thick gallbladder and delayed hospitalization. The identification of these factors at early stage provides opportunities for the clinicians to identify high risk patients and to reduce dengue-related morbidity and mortality.

Clinical profile and early severity predictors of dengue fever: Current trends for the deadliest dengue infection in Bangladesh in 2022

Objectives

In 2022, Bangladesh had the highest dengue-related fatality (281). This study evaluated clinical profiles to detect early changes to predict dengue fever severity.

Methods

This prospective observational study was performed in four government hospitals from June to November 2022 in Dhaka. Febrile patients admitted within 4th day of illness were recruited if they had a confirmed dengue viral infection either by by positive dengue nonstructural protein antigen or anti-dengue immunoglobulin (Ig)M antibody.

Results

We divided 308 patients with confirmed dengue into two groups: 232 (74.3%) in nonsevere dengue and 76 (24.7%) in severe dengue. Men were 205 (66.6%), and the most affected age group was 21-30 years (47.7%). Patients with severe dengue reported a higher number of nausea 80.3%, coughs 57.9%, abdominal pain 56.6%, persistent vomitting 53.9%, dyspnea 35.5%, diarrhea 28.9%, and skin rash at 27.6%. In addition, the disease's febrile phase (≤4 days) showed thrombocytopenia (odds ratio [OR] 6.409, 95% CI 2.855-14.386, p <0.001), hemoconcentration (OR 3.428, 95% CI 1.030-11.405, p 0.045), and hypotension (OR 5.896, 95% CI 1.203-28.897, p 0.029) were associated severe disease.

Conclusions

Hypotension, thrombocytopenia, and hemoconcentration during the febrile phase might indicate progression towards severe disease.

Demographic and clinical variables in the dengue epidemic in Punjab, Pakistan

Objectives

To identify the latest trends in the clinical picture and severity of the disease, which will help better understand and manage dengue.

Methodology

It was a cross-sectional, hospital-based study performed in the tertiary care hospitals of Punjab from August 21 to December 2022, in which serologically and polymerase chain reaction (PCR) confirmed patients with dengue infection, were enrolled. Demographic and clinical variables were recorded on a pre-tested Performa, processed and presented in frequency and percentages, and graphs were generated. Mean and standard deviation was used to present continuous variables.

Results

Out of a total of 580 patients, 472 were diagnosed with Dengue Fever (DF) and 108 with Dengue Hemorrhagic Fever (DHF). About 79.31% of the patients were male and 20.69% were females. The mean age of patients was 32.5±9 years. Among the clinical features the percentage of high-grade fever, body aches, and vomiting were the highest. The liver function profile showed that serum bilirubin, Serum aspartate transaminase (AST), serum alanine transaminase (ALT,) and alkaline phosphatase (ALP) levels were markedly raised.

Conclusion

This study showed that with time the trends in the presentation of dengue are slowly shifting, which will help us better manage the disease burden in the future.

Twenty-two years of dengue outbreaks in Bangladesh: epidemiology, clinical spectrum, serotypes, and future disease risks

Dengue is the most rapidly spreading mosquito-borne disease and has become a major public health threat, particularly for tropical and subtropical countries including Bangladesh. This comprehensive review aims to summarize the overall scenario of dengue, including disease burden, clinical spectrum, seroprevalence, circulating serotypes/genotypes, and spatial distribution since the first recorded outbreak in Bangladesh. Since the first recorded outbreak in 2000, dengue epidemiology has shown the typical epidemic pattern with more frequent and bigger outbreaks and gradual geographic expansion to non-endemic regions in Bangladesh. For instance, highly confined Rohingya refugee camps that provide shelters to nearly 1.2 million forcibly displaced vulnerable Myanmar nationals in Cox's Bazar district confronted a massive outbreak in 2022. Recent major outbreaks are found to be associated with the emergence of serotype DENV-3, which was undetected for a long time. Consequently, changes in serotypes might be attributed to increased severity in clinical manifestation in recent years. The existing weak surveillance and risk management systems are inadequate to deal with impending dengue risks. The healthcare system, particularly at the district level, is not prepared to manage impending large-scale dengue outbreaks in Bangladesh. Our findings would contribute to the development of strategies for dengue control and management in Bangladesh as well as other similar settings elsewhere in the world.

Epidemiological Investigation of the 2019 Dengue Outbreak in Dhaka, Bangladesh

Introduction. Bangladesh experienced its largest dengue epidemic in 2019. Our objective was to investigate the epidemiological, clinical, and laboratory characteristics of the hospital-admitted dengue patients during this epidemic. Methods. This cross-sectional study was conducted among 369 adult dengue patients admitted to two tertiary care hospitals in Dhaka, Bangladesh, from June to September 2019. The disease severity was determined according to the WHO’s 2009 classification. Results. The average age of the patients was 33.3 (SD 14) years with a predominance of men. Almost 10% developed severe dengue (plasma leakage 67%, clinical bleeding 25%, and organ involvement 25%). Fever, headache, retro-orbital pain, diarrhea, and warning signs such as abdominal pain, clinical fluid accumulation, and persistent vomiting were the most common clinical presentations. Thrombocytopenia, leukopenia, elevated HCT levels, and ALT/AST were common laboratory findings. Conclusions. Severe dengue was mostly attributable to plasma leakage with warning signs, especially abdominal pain, clinical fluid accumulation, persistent vomiting, and altered hematological parameters which might assist in the early prediction of severe dengue.

The Genetic Variant TNFA (rs361525) Is Associated with Increased Susceptibility to Developing Dengue Symptoms

Dengue virus (DENV) is the causal agent of dengue fever. The symptoms and signs of dengue vary from febrile illness to hemorrhagic syndrome. IFITM3 and TNFA are genes of the innate immune system. Variants IFITM3 (rs12252 T>C) and TNFA (rs1800629 G > A and rs361525 G>A) might alter gene expression and change the course of the disease. Our first objective was to determine whether these variants were associated with the susceptibility and severity of dengue. The second was to assess the association of these variants with each symptom. We studied 272 cases with suspected dengue infection, of which 102 were confirmed dengue cases (DENV+) and 170 were dengue-like cases without DENV infection (DENV-). Samples of 201 individuals from the general population of Mexico were included as a reference. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism technique. Odds ratios and confidence intervals were calculated using Pearson's chi-square test and later adjusted for age and sex with a binary logistic regression model. Haldane correction is applied when necessary. We found a significantly higher frequency of the A allele of TNFA rs361525 in both the DENV+ and DENV- groups compared with the general population. Focusing on DENV+ and DENV-, the frequency of the A allele of TNFA rs361525 was higher in the DENV+ group. A broad spectrum of symptoms was related to the A allele of both TNFA variants. We conclude that TNFA rs361525 increases the susceptibility to symptomatic dengue but can also be associated with susceptibility to other dengue-like symptoms from unknown causes.

Pattern of Aedes aegypti and Aedes albopictus Associated with Human Exposure to Dengue Virus in Kinshasa, the Democratic Republic of the Congo

Dengue is a worldwide public health concern. The current study assessed the extent of human exposure to the dengue virus in relation to the distribution pattern of Aedes aegypti and Ae. albopictus in Kinshasa. Cross-sectional surveys were carried out in 2021 and 2022. The baseline entomological survey involved 19 municipalities using a grid cell sampling approach. All containers holding water were inspected for the presence of larvae in each grid. The collected larvae were kept in an insectary until the adult emergence for morphological identification. Four hundred febrile patients attending the hospital were screened for the presence of dengue antibodies (IgG, IgM) and NS1 antigen using a rapid diagnostic test (RDT) Biosynex®. Residences of positive cases were geo-referenced. We evaluated 1850 grid cells, of which 19.5% were positive for Aedes larvae. The positive grid cells were identified in the Ndjili (44.0%), Mont Ngafula (32.0%) and Ngaliema (26.0%), and Limete (32.0%) municipalities. The Ae. aegypti (11.2%) predominated in the northwestern, and Ae. albopictus (9.1%) appeared in the high vegetation coverage areas. Of 61 (15.3%) participants exposed to dengue, 8.3% presented acute dengue. Young, (6-17 years), male, and Mont Amba district participants were most exposed to dengue. In conclusion, dengue occurrence in Kinshasa overlaps somewhat the geographical and ecological distributions of Ae. aegypti and Ae. albopictus. Both species are not homogenously distributed, likely due to environmental factors. These findings can assist the targeted control activities.

Sketch of 2018 dengue outbreak in a megacity, Bangladesh

Background

Dengue has become a major public health threat in Bangladesh since 2000, when the first outbreak was reported. Each outbreak has distinct characteristics, and thus, the report of the outbreak helps to understand the disease process and subsequent clinical management of these patients. On that ground, the study was designed to sketch the clinico-epidemiological characteristics of the 2018 dengue outbreak in Bangladesh.

Methods

This hospital-based cross-sectional study was conducted in one of the largest public medical college hospitals and a single private hospital located in the southern and northern parts of the megacity of the country. A total of 297 confirmed dengue cases were assessed with a preformed pretested questionnaire. Clinico-epidemiological and laboratory parameters were reported along with sociodemographic details. Statistical analysis was performed with SPSS 20.

Results

Male patients were predominantly affected by dengue infection. The mean age of the patients was 31.24 ± 13.99 (SD) years, with a range from 2 to 85 years. Eighty-two percent of patients reported from the Dhaka metropolitan city. The highest percentage of cases (37.1%) was isolated from Bansree, Dhaka city, followed by Rampura (21.4%) and Khilgaon (6.2%). In addition to common symptoms, e.g., fever (90.6%), headache (90.6%), chills (81.8%), anorexia and vomiting (76.4%), backache, and redness of the eyes were two prominent symptoms that affected more than two-thirds of the study population. On the other hand, less common symptoms, such as cough, abdominal pain, and respiratory distress, were present in 39.7%, 33.7%, and 15.5% of patients, respectively. Overall, 17.6% of patients were hypotensive during admission, with a mean systolic blood pressure of 107.65 ± 18.17 (SD) mmHg. Other prominent signs were dehydration (80.5%) and rash (33%).

Conclusion

This outbreak was especially characterized by gastrointestinal symptoms, which were predominant along with other typical features.

Recent two-year advances in anti-dengue small-molecule inhibitors

Dengue is an acute tropical infectious disease transmitted by mosquitoes, which has posed a major challenge to global public health. Unfortunately, there is a lack of clinically proven dengue-specific drugs for its prevention and treatment. As the pathogenesis of dengue has not been fully elucidated, the development of specific drugs is seriously hindered. This article briefly describes the pathogenesis of dengue fever, the molecular characteristics, and epidemiology of dengue virus, and focuses on the potential small-molecule inhibitors of dengue virus, including on-target and multi-targeted inhibitors, which have been reported in the past two years.

Clinical Presentation and Platelet Profile of Dengue Fever: A Retrospective Study

Background: Dengue fever (DF) is a mosquito-borne viral illness carried worldwide by Aedes aegypti and Aedes albopictus mosquitoes. The aim of the present study was to observe the different clinical presentations of dengue fever and the platelet profile analysis in DF patients.

Methods: This retrospective study was performed on 130 diagnosed patients with dengue fever, aged over 14 years. Data collection included patient age, gender, clinical manifestations, hematocrit, platelet count, and evidence of plasma leakage.

Results: Most of the patients belong to the 21-30 year age group, with a greater number of males compared to females. The common presentation of dengue fever was fever and myalgia, observed in 100% and 95.3% of the patients, respectively. A platelet count of less than 1,00,000 was observed in 77% of patients, whereas decreased total leukocyte count (TLC) and hematocrit were observed in 52.3% and 40% of patients, respectively. About 46.15% of patients had bradycardia on examination. Pleural effusion and ascites were found in 20.7% and 15.3% of patients, respectively.

Conclusion: Patients presenting with fever, hemorrhagic symptoms, or signs of plasma leakage should be promptly suspected, timely diagnosed and managed on the grounds of dengue fever.

Clinicopathological alteration of symptoms with serotype among dengue infected pediatric patients

Dengue fever is a self-limiting, acute febrile illness caused by an arbovirus. This infection may be asymptomatic or symptomatic with its potential life-threatening form as DHF/DSS. Severe dengue cases occur typically in children due to overproduction of pro-inflammatory and anti-inflammatory cytokines (called cytokines storm) as well as increased microvascular permeability in them. This study aimed to find prevalent circulating dengue serotype and their clinicopathological association among pediatric patients admitted to tertiary care hospitals in Kolkata, India. Overall, 210 patients were approached and among them, 170 dengue suspected children admitted to three tertiary care hospitals were included in this study. Dengue samples were screened for the presence of NS1 antigen and dengue IgM antibodies by ELISA. Viral RNA was extracted from NS1 seropositive serum samples and subjected to molecular serotyping by semi-nested RT-PCR. All patients were followed up for clinical manifestations and biochemical parameters associated with dengue. Co-circulation of all four serotypes was observed and DENV2 was the major circulating strain. Physiological classification of associated clinical symptoms was done and represented as a percentage variable. A multivariate logistic regression approach was used for making a regression model including dengue-associated clinical symptoms with dengue positivity and negativity as dependent variables. Thrombocytopenia was observed in 69% of patients and the commonest bleeding manifestation was petechia. Liver function profiles of infected patients were observed during follow-up and represented using a box plot. A significant change in trends of dengue-associated clinical manifestations and differential expression of liver functional profile with different phase transitions of dengue fever was obtained in the study population. This article is protected by copyright. All rights reserved.