A preliminary study of early clinical and laboratory indicators of acute dengue illness
Sigera PC1, De Silva NL2, Weerathunga P3, Rajapaksha S4, Jayasinghe KSA5, Handunneththi S6, Fernando D5.
1National Intensive care Surveillance, Sri Lanka; 2 Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka; 3National Hospital of Sri Lanka; 4Post Graduate Institute of Medicine, Sri Lanka; 5 Faculty of Medicine, University of Colombo, Sri Lanka; 6The Institute of Biochemistry, Molecular Biology and Biotechnology, Sri Lanka
Dengue presents a major challenge for public health services worldwide. Early identification of dengue is important to reduce the morbidity and mortality of dengue. This study aims to determine early clinical and laboratory indicators of acute dengue illness. A prospective observational study was conducted in four medical wards at the National Hospital of Sri Lanka, from 15th October 2017 to 15th June 2018. Patients with clinically suspected dengue included. Patients with clinical or laboratory evidence of co-infection was excluded. Dengue NS 1 antigen test was used to confirm dengue infection at three or four days after onset of fever. Ethics approval for the study was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo (EC-17-080). STATA version 13.1 was used to analyze data. Proportional data were tested using chi-squared test or Fisher's exact test. Continuous data were tested using the t test when data shows a normal distribution; otherwise the Mann-Whitney rank sum test was used. Majority of patients were males (65.8%). The mean age was 33 years. Out of 155 patients, 70 patients had dengue while 85 patients had other febrile illnesses. On admission, dengue patients reported headache more commonly than other febrile illnesses. There were no significant associations of other clinical symptoms with dengue infection. Dengue patients had low WBC, low absolute neutrophil count, low absolute lymphocyte count and low platelet count when compared to other febrile illness patients. AST and ALT levels of dengue patients were higher than other patients. This study concludes that differentiating dengue from other acute febrile illnesses is difficult due to lack of specific clinical features. However Leucopaenia, thrombocytopaenia and high transaminases suggest dengue fever over other febrile illnesses.
Funding: University of Colombo (grant number: AP /3/2/2017/CG /25).