Clinical Profile of Dengue in Adult patients aged more than 13 years

Dengue Fever, known commonly as Break bone fever is the most common Arboviral mosquito borne disease in the world. This dengue virus is spread by the bite of infected Aedes mosquito, most commonly Ae. aegypti. Many countries especially the countries of the Indian subcontinent have suffered at the hands of this disease Dengue has a varied and wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. This study is an attempt to derive the clinical profile of Dengue infection from the current epidemic that stormed Tirunelveli District. To identify some peculiar features that may help in early recognition and appropriate case management. The present study is an observational study where we studied the clinical profile of 251 serologically proven dengue patients admitted in the Department of Medicine, Tirunelveli Medical College from April 2012 - March 2013. Out of 251 cases, 149 patients (59.40%) belonged to DCF, DHF in 76 patients (30.30%), where as 26 patients (10.40%) belonged to more severe variety of DSS. Majority of cases 40.20% occurred in young adult 60 years of age. DCF (44.30%) and DSS (42.30%) was more common in the younger age group 60 years in this study. Distribution of dengue in females was slightly higher 51.40% when compared to males 48.60%. In this study all patients had fever 100%. Followed by headache 61%, Myalgia 54.60%, chills 46.20%, abdominal pain 43.40%, vomiting 42.20%.The characteristic feature of dengue like bone pain and retro-orbital pain was present in only 3.20% and 32.70% respectively. Atypical clinical feature like seizure was present in 1.20%. Most common sign observed in this study was conjunctival congestion 23.90%, followed by Hepatomegaly 12%, Ascites 10%, Rashes 10%, Pleural effusion 9.60%, Puffiness of the face and Splenomegaly 8.40%. Most common bleeding manifestation encountered was malena 27.50% followed by petechiae 8.40% and gum bleeding in 4.80% less frequent was bleeding manifestation hemoptysis 0.40%. BP is the most important clinical monitor in a case of dengue for identifying onset of complications like shock. Pulse pressure is more important than BP in identifying early stage shock. Narrowed pulse pressure (< 20 mm of Hg) is the most sensitive sign. 87 cases showed enzyme abnormalities in 100% cases with LFT abnormality which was similar to our study. This could be due to direct injury to liver cells by the virus or due to immunological response. Ischemic hepatitis in patients especially in shock could be another possible etiology USG was more sensitive in picking up Pleural effusion. Out of 251 patients mortality rate was 0.8% Recovery rate was 99.20%. The cause of death was intra cerebral bleed/ encephalopathy/seizures/DSS/DIC/Refractory shock in one case. The other case succumbed due to massive malena/ encephalopathy/DSS/DIC/refractory shock