Publication:

A study of dengue and hepatopathy

Background Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. It is 2nd most common arthropod borne disease in India. There are certain clinical features that are associated with Dengue in addition of the classical features. Previously organ impairment has been only considered under set up of severe disease. On the recent years, several studies have suggested the possibility of early involvement of the liver in dengue. Further due to its atypical presentation often dengue missed out as a differential diagnosis.

Methods A total of 50 patients were selected to be a part of study after applying inclusion and exclusion criteria. Only those patients were included in the study who had classical features of dengue- fever with chills, body ache, headache, rash, bleeding manifestations and thrombocytopenia and had a positive ELISA test i.e. IgM antibodies against dengue virus. Patients who had malaria and enteric fever were excluded from the study. All patients were subjected to a detailed history and a thorough clinical examination. A complete blood count, liver function tests, renal function tests, chest X-ray and USG abdomen were also done.

Results An analysis of 50 patients suffering from dengue showed liver dysfunction was present in all patients. Vomiting was an important symptom present upto 70% of patients. SGOT levels were higher than SGPT levels. Hepatosplenomegaly and ascitis were also present in significant number of patients. An analysis of these patients revealed that patients typically demonstrate high grade fever, body ache, rash, thrombocytopenia and bleeding tendency, there were other features such as liver dysfunction including a preferential rise of SGOT, hepatosplenomegaly, ascitis, pleural effusion and leucopoenia.

Conclusions This study showed that dengue fever was seen in the third decade and that AST and ALT levels were raised in the majority of these patients. It was also found that AST levels were more than ALT levels. So, AST and ALT can be a useful early marker to assess the severity of the disease which can thus lead to early recognition of high risk cases. The presence of raised liver enzymes in all patients, ascitis, hepatosplenomegaly, elevation of SGOT more than SGPT, should be kept in mind when evaluating patients with suspected dengue.