One hundred and fifty consecutive patients who were admitted to the medical ward of teaching hospital with clinically suspected dengue fever tested for NS1Ag as they had duration of illness ≤ 5 days. Out of 150 patients, 78 patients were positive (male -54 and female - 24) for dengue NS1 Ag. Among the 78 patients 37 patients got admitted on febrile phase (mean age 29.11 ± 14.69, Male – 23, Female -14) and 41 patients on critical phase (mean age 30.61 ± 15.06, Male – 30, Female -11). The common symptoms found in both phases were fever, headache, myalgia, anorexia and vomiting.
Table 1: Clinical characteristics of the dengue NS1 patients (Day 1 – Day 5)
Symptoms/Signs
|
Viremic Phase (N= 37)
|
Critical Phase (N=41)
|
Total
|
Fever
|
37
|
41
|
78 (100%)
|
Headache
|
31
|
32
|
63 (80.7%)
|
Retro orbital pain
|
08
|
06
|
14 (17.9%)
|
Myalgia
|
19
|
20
|
39 (50%)
|
Arthralgia
|
06
|
06
|
12 (15.3%)
|
Back pain
|
04
|
03
|
7 (8.9% )
|
Anorexia
|
18
|
24
|
42 (53.8 %)
|
Nausea
|
20
|
24
|
44 (56.4 %)
|
Vomiting
|
19
|
22
|
41 (52.5 %)
|
Abdominal pain
|
11
|
12
|
23 (29.4% )
|
Evidence of leakage found in 9 patients (07 male and 02 female) in that 3 patients from day -3 and 6 patients from day- 4 onset of illness. Most of the leaking patients had symptoms such as Fever, head ache, persistent vomiting, abdominal pain and anorexia. For the dengue NS1 positive patients, in febrile phase leucopenia (< 5 x 109/L) was observed in 30 out of 37 patients (81.1%) and in critical phase 37 out of 41 patients (90.2%). The mean WBC count 3.95 x 109/L and 3.11x 109/L were observed between viremic phase and critical phase which is statistically significant (Table. 3). Neutropenia (<2 x 109/L) was observed on 11 patients had neutropenia in febrile phase and 23 had in critical phase the mean value of neutrophil in febrile phase 2.69 and critical phase 1.85 which is statistically highly significant. Lymphocytopenia (<1x 109/L) was widely observed in both febrile phase and critical phase and there was no statistical significance observed febrile phase group and critical phase group. In the analysis of day 3-5 NS1 positive patients and leaking patients they had no statistical significance in leukocytes count, neutrophil count and lymphocyte count (Table 3).
Table 2: Distribution of laboratory dengue feature of dengue NS1 positive patients
Parameters
|
Febrile phase (Day 1-3)
|
Critical phase (Day 2-5)
|
Total
|
Leukocytes (<5 x109/L)
|
30/37
|
37/41
|
67/78 (85.8%)
|
Neutrophil (< 2 x 109/L)
|
11/37
|
23/41
|
34/78 (43.5%)
|
Lymphocytes (<1 x 109/L)
|
28/37
|
30/41
|
58/78 (74.3%)
|
Hb (>16 mg/dL)
|
1/37
|
3/41
|
4/78 (5.1%)
|
HCT
(39-38 %)
|
20% Increase
|
1/37
|
2/41
|
3/78 (3.8%)
|
10%Increase
|
4/37
|
13/41
|
17/78 (21.7%)
|
Platelets
|
(<150 x109/L)
|
12/37
|
13/41
|
25/78 (32%)
|
(<100 x109/L)
|
15/37
|
26/41
|
41/78 (52.5%)
|
ALT (>63 U/L)
|
15/37
|
17/41
|
32/78 (41%)
|
AST (>37 U/L )
|
27/37
|
36/41
|
63/78 (80.7%)
|
In the laboratory parameter, Only 4 patients had the hemoglobin above 16 mg/dL (Table:2 ). There were 17 patients who had raised hematocrit concentration by 10%, in them 4 from febrile phase and 13 from critical phase, 03 leakers had increased hematocrit percentage by 20% from the normal range (Table 2). In statistical analysis for Hb and HCT% there was no significance found between febrile phase and critical phase but when comparing 4-5 days group without leakage and leaking patients Hb and HCT were the only parameters which has statistical significance (Table. 3)
Thrombocytopenia (< 150x 109/L) was the most common abnormal laboratory parameter which was observed in febrile phase and all 37 patients were suffered from thrombocytopenia in them 15 patients had severe thrombocytopenia (<100 x 109/L). In critical phase 39 out of 41 patients had thrombocytopenia and in them 26 had severe thrombocytopenia. The mean value of platelet count of febrile phase and critical phase were 121.6 x 109/L and 80.63 x 109/L which has strong statistical significance (<0.001) (Table:3).
When elevated mean serum transaminase levels (ALT >63 U/L and AST > 37 U/L) taken into consideration, altogether 32 patients had elevated ALT level above reference range 15 of them are from febrile phase and 17 from critical phase and 63 patients had elevated AST level above the reference range 27 from febrile phase and 36 patients from critical phase. For leaking patients the mean ALT and AST level were 108.3 U/L and 149.6 U/L respectively but had no statistical significance in comparison.
Table 3: Distribution of laboratory parameters between group A and B (t – test)
Parameters
|
Febrile phase (Day 1-3) (N=37)
|
Critical phase (Day 4-5)
(N=41)
|
P value
|
Day (4-5)
(N=35)
|
Leakage
(N=09)
|
P value
|
Mean leukocytes x109/L
|
3.95± 1.66
|
3.11± 1.51
|
0.02
|
2.981 ± 1.51
|
3.85 ± 1.28
|
0.11
|
Mean neutrophil x109/L
|
2.69 ± 1.26
|
1.85 ± 0.90
|
0.00
|
1.77 ± 0.9
|
2.43 ± 0.91
|
0.06
|
Mean lymphocytes x109/L
|
0.82 ± 0.51
|
0.91 ± 0.58
|
0.56
|
0.86 ± 0.75
|
1.06 ± 0.68
|
0.47
|
Mean Hb (mg/dL)
|
12.91 ± 1.90
|
13.56 ± 1.75
|
0.12
|
13.34 ± 1.63
|
14.99 ± 1.85
|
0.01
|
Mean HCT%
|
38.29 ± 4.85
|
40.01 ± 4.96
|
0.12
|
39.21± 4.55
|
44.06 ± 4.48
|
0.01
|
Mean Plt x109/L
|
121.6 ± 63.37
|
80.63 ± 38.58
|
0.00
|
83.11± 39.69
|
59.0 ± 28.2
|
0.10
|
Mean ALT (U/L)
|
74.57 ± 58.51
|
91.54 ± 95.09
|
0.35
|
95.35 ± 97.63
|
108.0 ± 62.44
|
0.70
|
Mean AST (U/L)
|
69.27 ± 49.31
|
112.8 ± 96.87
|
0.02
|
110.6 ± 100.1
|
149.6 ± 70.46
|
0.28
|