Objectives: The present study was done to ascertain the presentations of dengue fever in a North Indian tertiary care Hospital, and to compare the clinical and laboratory features among patients with and without warning signs in dengue fever.
Methods: A total of 600 patients of dengue admitted to medical wards were included in the study. A detailed history as well as a general and systemic clinical examination were carried out. Haematological profiles and biochemical investigations were done at the time of admission and were followed daily or at times twice a day. Signs of plasma leakage were assessed by chest radiograph and abdominal ultrasonography, serum albumin etc. Patients were classified as dengue fever without warning signs and with warning signs and laboratory diagnosis of dengue was established by demonstration of NS1 antigen and specific antibodies to dengue in serum.
Results: Of the 600 dengue positive patients, 421 (70.2%) were males and 179 (29.8%) were females. Mean age of the patients was 27.35±11.43 years. Among all patients of dengue, 21 (3.5%) presented with bleeding from any site. Out of these, only 7 of those presenting without warning signs had bleeding episodes whereas, 22 (34.3%) of patients presenting with warning signs had bleeding and this difference was statistically significant (p=0.01). Haematocrit was an important factor to predict severity of dengue. Whereas the mean haematocrit among all patients was 39.79±3.23%, it was 39.49±4.25% among those without warning signs and 42.22±3.54% among those with warning signs of dengue, and this was significant statistically, with a p-value of 0.002.
Conclusion: Early diagnosis, monitoring and prompt supportive management can reduce mortality in dengue. In the present study, it was found that newer signs and symptoms are emerging and may cause delay in the diagnosis. It was found that the mortality rate was significantly higher in patients of dengue with warning sign.
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