Shilpa Avarebeel1, Prahlad K. A2, Lubna Tabassum3
ABSTRACT: BACKGROUND: India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF) / dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics. OBJECTIVE: To study the clinical profile (incidence, clinical manifestations, and complications) of the dengue fever cases in our setting. To know the knowledge, attitude and practice of people with regards to dengue in the locality. STUDY DESIGN: Descriptive and Exploratory study. All patients admitted from May 2010 to April 2011 with the suspected diagnosis of dengue fever, dengue hemorrhagic fever and dengue shock syndrome were followed. All cases confirmed by positive serology (IgM alone or IgG & IgM both) were studied in detail and classified as Dengue fever, Dengue hemorrhagic fever and Dengue shock syndrome as per the case definition. These patients were followed, and their clinical profile, outcome along with demographic profile, knowledge regarding dengue and practices related to dengue/mosquito control were determined. The Study proforma was designed based on the objective of the study and it was pretested and used after modification (enclosed annexure). Data was analyzed using statistical software SPSS- version 16. Data were expressed as mean±SD for parametric variables and actual frequencies or percentages for non-parametric data. Comparison between groups was done using studentâ??s t test for independent groups, Chie square test, one-way Anova test, Karl Pearsonâ??s Correlation test. Statistical significance is taken at p <.05. RESULTS: Study included Total 134 dengue positive cases were admitted to the hospital from May 2010 to April 2011. 81% had dengue fever, 18.65% had dengue hemorrhagic fever and 1(.74%) had dengue shock syndrome. Most of dengue cases occurred during the month of June, 36(26.86%).Majority of the cases were from Mysore 85(63.43%), Maximum number of cases were in the age group of 26-35years, (49 out of 134(37%), Average duration of stay in the hospital was less than 7days. Fever was present in all cases, 16(11.19%) had bleeding manifestations. Leucopenia and thrombocytopenia do not go together. LFT alterations were seen mainly in SGOT and SGPT. Mean SGOT value was 238.82 ± 448.25 IU/L. Mean SGPT value was 127.89 ± 201.02 IU/Majority 82(62%) had platelet count between 20-50,000c/cumm. If there is right upper quadrant tenderness on examination, chances of finding an abnormal finding on USG is significant. Mean IgM levels among those who developed complications was 22.44±13.81 panbio units which was significantly lower than those who did not develop complications. There was no significant correlation between platelet count and IgM levels. All were given symptomatic treatment. 54 out of 134(39%) received an average of 4 units platelet transfusion, 21(16%) received steroids. There was significant association between the number of platelet units transfused and the platelet count before transfusion. Mean platelet count in those who received platelet transfusion was significantly lower than who did not receive platelet transfusion. In 21
ORIGINAL ARTICLE
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 1/ Issue 4 / June, 2014. Page 212
patients who received steroids as treatment, mean platelet count was 24,190±11,070 cell/cumm, which was statistically significantly lower than those who did not receive steroids. Out of 134, 132(98%) were discharged, 9(7%) developed complications and 2 died. Among the complication 3(2%) had hepatitis, 3(2%) had encephalitis, 2(1%) had hepatitis and encephalitis. 1 had ARDS. Two patients died, one due to ARDS and the other due to multi organ dysfunction. Knowledge about dengue was present in 125(93%) patients, but only 101(75%) took preventive measures. 95(70.89%) patients knew that mosquito bite causes dengue, and 110(82%) knew that dengue spreads as well. Television and Radio were the major source of information about dengue to the common man. We found that, 50% of the study population followed simple measure of fully covering the water storage containers in order to prevent mosquito harbor. All 134 patients practiced measures to prevent mosquito bites, among them 56% used mosquito nets /screens. CONCLUSION: Community awareness, early diagnosis, management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.
