Clinical profile of Dengue infection at a center in north Karnataka, India

Dengue is one of the most common arbovirus infection worldwide, which is a vector borne disease caused by the bite of Ades Aegypti mosquito. Symptoms of the infected individuals have a very broad range of presentation having similarities with other infections like malaria and infl uenza like illness etc. It is a retrospective study conducted at a centre in north Karnataka with the sampling method of quota or sequential sampling with inclusion of 121 cases all seropositive for dengue antigen or antibodies or both in the monsoon season from july 2018 till November 2018. The complete blood picture and liver enzymes like SGPT and SGOT were assessed during the period of the infected individuals. Leucopoenia is taken below 4000 cells/cumm, thrombocytopenia is taken below 100000 per cumm and liver enzymes were evaluated and graded as per the CTCAE guidelines version 4.0. The two tailed T Test was used to determine the signifi cant change in the SGOT and SGPT liver enzymes. The symptoms ranged from mild to severe ones like fever, headache, nausea, vomiting, abdominal pain, generalised body ache (myalgia), cough, Rash, retro bulbar pain, bleeding, hypotension, signs of plasma leakage, leucopoenia, thrombocytopenia, SGOT (serum glutamic oxaloacetic transaminase) or AST (Aspartate aminotranferase) and SGPT (Serum glutamic pyruvic transaminase) or ALT (Alanine Transaminase), hypotension (blood pressure of 90/60 mm of Hg or lower), pleural effusion and ascites. 1.7% of the individual even showed seropositivity but didn’t have any episode of fever and elevation of SGOT was signifi cantly raised with respect to SGPT which was nearly within normal range for nearly half of the infected patients. This indicates that muscle injury is more signifi cant with respect to the liver injury during the course of the disease. Negligible number of individual landed up in complications like Dengue Hemorrhagic fever or dengue shock syndrome if prompt and proper management of the disease is done. It was also seen that the affected individuals were more from the age group of 16 years to 37 years, the cause for which still need to be explained on a bigger population size. Research Article Clinical profi le of Dengue infection at a center in north Karnataka, India Adnan Imam1 and Prashanth ED2* 1Junior Resident, Department of General Medicine, Rajiv Gandhi University of Health,,Sciences, Khajabandanawaz Teaching and General Hospital, Gulbarga, Karnataka 585102, India 2Assistant Professor, Department of General Medicine, Rajiv Gandhi University of Health, Sciences, Khajabandanawaz Teaching and General, Hospital, Gulbarga, Karnataka-585102, India Received: 08 May, 2019 Accepted: 30 May, 2019 Published: 31 May, 2019 *Corresponding authors: Prashanth ED, Assistant Professor, Department of General Medicine, Rajiv Gandhi University of Health Sciences, Khajabandanawaz Teaching and General Hospital, Gulbarga, Karnataka-585102, India, Tel: +919243774444; E-mail:


Introduction
Dengue is the most common arbovirus infection worldwide, with transmission occurring in at least 128 countries and around 4 billion individuals are at risk [1]. The dengue cases reported to WHO has increased regularly as an average of less than a thousand cases every year worldwide in the 1950s to more than 3 million cases in 2013 [2][3][4][5]. Dengue is a vector borne disease, caused by dengue virus having serotypes 1-4 and is one of the most important arboviral infections in the subtropical and tropical regions where environmental conditions favour the development and proliferation of Aedes Aegypti, the principal vector of this zoonosis [6,7].
The fi rst case was reported in Madras (now Chennai in 1780, and fi rst outbreak happened in Calcutta (now Kolkata) in 1963 and further outbreaks were also reported in the different parts of India [8,9], Aedes aegypti can breed in polluted water or small collections of water such as fl ower vases or coconut shells [10]. Eggs can survive for long periods, as they are capable of withstanding desiccation. Inadequate wastewater drainage facilitates or improper disposal of garbage, both consequences of unplanned urbanisation, may be responsible for high mosquito densities in endemic areas, during rainy season there is signifi cant increase in the mosquito larval population and this may be the reason that epidemics of the disease coincide with the rainy season [11]. After biting an infected human, dengue viruses enter an adult female mosquito. The virus fi rst replicates in the mid-gut, reaches the haemocoele and haemolymph, and then gains access to different tissues of the insect. After viral replication in the salivary glands, the infected mosquito can transmit the virus to another human [12].
Dengue infections vary in severity, ranging from infl uenzalike self-limiting illness to lifethreatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) which, if left untreated, are associated with mortality as high as 20% [13]. to treat themselves on their own [14]. Individuals even who are seen by a healthcare professional, the clinical presentation of the disease shares similarities with 12 major pathogens, which makes misdiagnosis very common, particularly in areas where there is a high incidence of febrile illnesses [15]. The various manifestations of dengue may not have a clear line of demarcation: apart from the classic features, reports of rare presentations have recently become more frequent [16,17].
The aim of the study is to assess the clinical presentation of the disease with varying degree of symptoms from a milder to life threatening ones with biochemical and haematological parameters alterations in the diseased state.

Material and Methods
This was a retrospective study conducted among 121 patients On statistical analyses with Two Tailed T Test, it was seen that upon comparison between the two sets of data, i.e., SGOT and SGPT levels, in pertinence to the scope of the study which was to prove that SGOT levels vary more signifi cantly and is more refl ective of dengue as far as liver enzymes are concerned,

Discussion
As already been discussed that a patient with dengue infection may manifest with various symptoms and sign which overlaps with many other condition causing acute febrile illness and can be misdiagnosed [19]. During the study we saw that the affected individuals are mainly between the age group of 16 years to 37 years, the older age group was less affected in numbers which as already been seen in other studies too, but it has been also seen that the young adult patients of dengue had a less stay in hospital with respect to the elderly who needs longer hospitalization [20]. However, maybe aging is related with signifi cant changes in the adaptive humoral and cell mediated immunity as well as adaptive humoral immunity [21]. During the assessment of the data we noticed that out of 121 individuals 2 (1.7%) individuals they did not even complaint of high grade fever, but had thrombocytopenia and leucopoenia with SGOT derangement which may have pointed towards the suspicion of dengue infection. This shows that patient may present with wide range of symptoms and signs even without a history of fever in very rare cases, without thrombocytopenia or leucopoenia as well.
Other important thing to be noticed that out of all 121 individuals we did not got a single person with any comorbidities like hypertension, diabetes mellitus or obesity etc. The reason for this is still to be searched for and not much study has been done in India and other places to see the presentation and outcome of the dengue infection with comorbidities.
One more important thing to be noted is that out of all the patients only 14 had spontaneous bleeding and only 2 patients fi tted into the defi nition of dengue hemorrhagic fever as per WHO [13]. There was no mortality in the study data, this clearly shows and support other studies that early diagnosis helps for a better outcome with early treatment and prevent the patient to land up in complications like dengue hemorrhagic fever and dengue shock syndrome, and experience a complete recovery without complications [22][23][24].
We also found that the thrombocytopenia is more common with respect to the leucopoenia which is also present in 57.9% cases. The rise in SGOT is more with respect to the SGPT levels which have already been shown in various other studies, nearly all the studies showed raised ALT and AST [25][26][27][28]. Our study shows that SGPT rise was not seen in nearly half of the patients that is 49.6% with a raise in the SGOT levels. So we can clearly say that the hepatic damage is there but the raised SGOT, points damage more towards the skeletal muscle system due to infl amed muscle cells.