Study of gastrointestinal manifestations in Dengue fever

Abstract

Background: Dengue is an arthropod borne viral haemorrhagic fever. In India between 2015-2017, 790 deaths have been recorded according to NVBDCP data. Gastrointestinal manifestations are among the most common manifestations in dengue fever, and are most often missed due to lack of awareness. This study aims to find the spectrum of Gastrointestinal manifestations and correlation of GI manifestations with severity of Dengue.Methods: A cross-sectional observational study was conducted on 100 consecutive cases of serologically confirmed Dengue fever. Patients were examined clinically, and laboratory data was assessed till they got discharged. Gastrointestinal manifestations of dengue fever were noted and analyzed.Results: This study included 100 consecutive cases of dengue fever. Mean age of the study population was 32.48+12.40 years of them 77 were males and 23 were female patients. Gastrointestinal manifestations were noted in 96% of the patients. GI manifestations noted were Nausea in 71%, Elevation of transaminases in 59%, vomiting in 54%, pain abdomen in 31%, Ascites in 24% hepatomegaly in 14%, diarrhoea in 13%, Acalculous cholecystitis in 13%, Acute fulminant hepatitis in 6%, Upper GI bleed in 6%, splenomegaly in 5%, and Acute pancreatitis in 4% of patients. Of these, GI manifestations like nausea, vomiting, pain abdomen, GI bleed, ascites, jaundice, elevation of transaminases, acute fulminant hepatitis and acute pancreatitis correlated with severity of Dengue fever . Conclusion: Gastrointestinal manifestations in Dengue fever are much more common than once thought of. In our study it was found in 96 percent of patients making it most common manifestations in dengue fever. Transaminitis and Atypical GI manifestations like acute pancreatitis, acute fulminant hepatitis may indicate severe Dengue. The differential diagnosis of an acute febrile syndrome with abdominal pain or gastrointestinal symptoms in patients living in endemic areas should include Dengue fever.

Study of Hepatic Dysfunction in Dengue Fever: Does it Tell You the Prognosis?

“…Clinical features of hepatic involvement found in various series were abdominal pain (18% to 63%), nausea with or without vomiting (49% to 58%) and anorexia (31% to 44%) [16,17,18] . The frequency of hepatomegaly in adult patients ranged from 4% to 52%.…”

“…16.3% cases had serum bilirubin>5 mg/dl in the study by Saha AK et al [19] Literature review revealed that raised transaminase levels was the commonest biochemical abnormality. Increased AST levels was seen in 63% -97% of patients, while raised ALT levels in 45 -96% of patients [5,17,18,22,23] . Elevation in AST was more than ALT, more during the first week of infection, with a tendency to decrease to normal levels within three weeks [5,23] .…”

“…Study by Soni A et al also found, the degree of rise of AST, ALT and serum bilirubin was significantly higher in DHF and DSS, as compared to DF [12] . A study was done by Prashant VN et al involving 100 patients, GI bleed, ascites, jaundice and correlated with elevation of transaminases and thus, severity of dengue fever [18] . Study by Ahmad A et al revealed increasing trend in complications like septicemia, hepatic failure, hemorrhage, renal failure and mortality with higher grades of hepatic dysfunction [26] .…”

Gastrointestinal Manifestations of Dengue Fever among Children: A Multicenter Cross-Sectional Study in Bangladesh

“…For infecting cells, the major rate limiting step is the viral attachment to the receptors present on surface of host cell. An eventual outcome of hepatocyte infection by DENV is cellular apoptosis, a phenomenon demonstrated both in vivo and in vitro 10 . This study was aimed to describe the gastro intestinal manifestations of dengue infected children during 2019 dengue outbreak in Dhaka city.…”