Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients

Abstract

Backgrounds Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic. Methods This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients’ clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study. Results Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue. Conclusion The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.

Different Profiles of Cytokines, Chemokines and Coagulation Mediators Associated with Severity in Brazilian Patients Infected with Dengue Virus

“…The hematological and biochemical parameters that we determined among dengue patients were consistent with what has been reported in studies of dengue epidemics with the other serotypes [ 40 , 41 ]. The dengue patients, especially DwWS/SD patients, had greater leukopenia, greater thrombocytopenia and higher elevated transaminase levels than the AUFI patients.…”

A murine model of dengue virus infection in suckling C57BL/6 and BALB/c mice

“…Several studies in DENV patients have reported biochemical alterations, such as transaminitis, increased LDH and CK levels in plasma and thrombocytopenia 43‐47 . At day 8 PI, DENV‐2 infected C57BL/6 mice showed a significant increase in AST and ALT levels indicating liver damage, and elevated LDH and CK levels in plasma suggesting tissue injury compared to control mice (Figure 4A,C,E,G).…”

Nationwide Distribution of Dengue Virus Type 3 (DENV-3) Genotype I and Emergence of DENV-3 Genotype III during the 2019 Outbreak in Bangladesh

“…Secondary infection with DENV-2, DENV-3, and DENV-4, as well as primary infection with DENV-3, was shown to increase the risk of severe dengue disease [ 30 ]. In a recent study in northern Bangladesh, the rate of severe dengue was documented as 5.9% of patients, although the incidence of secondary infection was considerably lower than that of primary infection [ 31 ]. The predominance of DENV-3, emergence of its novel genotype III, and potentially high rate of secondary infection may pose a concern for the increased prevalence of dengue and its burden in Bangladesh.…”