1711. Comparison of the clinical course and prognosis of dengue cases with and without Diabetes Mellitus

Abstract

Background Dengue, the most prevalent arboviral infection disease worldwide affects more than 2.5 billion people. Puerto Rico has endemic transmission of dengue virus (DENV). Chronic diseases like diabetes mellitus (DM) tend to increase susceptibility to infectious diseases. Diabetes mellitus (DM) is also one of the chronic diseases with higher prevalence in the United States (9.1%) and Puerto Rico (12.8%), and its effect on arboviral infections is understudied. Methods A Sentinel Enhanced Dengue Surveillance System was established in a tertiary hospital in the southern region of Puerto Rico. Study aims are to describe and compare the clinical course and prognosis of dengue in patients with and without the DM co-morbidity. A retrospective case-control study (2012-2015) was performed, where 1,005 participants with confirmed dengue were identified. Results In those with dengue, we examined 57 cases with DM and 171 controls without DM on presentation. Mean age of participants was 40 years old, 31 (54.4%) were males. Relevant clinical features of cases were high blood pressure (HBP) in 51%, muscle pain (70.2%) and joint pain (63.2%). Laboratory results were thrombocytopenia (40%), high creatinine >1.2mg/dl (18.5%), high BUN >20mg/dl (16.6%) and low albumin < 3.4 g/dl (28.7%). For controls, clinical and laboratory results were HBP in 26.9%, muscle pain (64.3%) and joint pain (56.7%); thrombocytopenia (38.6%), high creatinine (4.7%), high BUN (1.8%) and low albumin (21.6%). ANOVA test compared the means of clinical features and laboratory parameters between the case and control groups. The results indicate that high blood pressure, high creatinine and high BUN were significantly more common in cases than in controls (P < 0.01). Cases that had high creatinine (OR = 2.03 [CI: 0.01 – 6.08]), high BUN (OR = 1.30 [CI: 0.93 – 1.81]) and high blood pressure (OR = 1.02 [CI: 0.93 – 1.11]) were more likely to present bleeding, a warning sign for severe dengue. Also, diabetic cases that presented thrombocytopenia were more likely to be admitted to the hospital (OR = 2.64 [CI: 0.36 – 19.37]). Conclusion Understanding the clinical manifestation of dengue in patients with DM can increase clinician awareness of the importance of this co-morbidity in order to implement preventive measures and improve clinical outcomes. Disclosures All Authors: No reported disclosures