Changing Trends in Clinical Presentation and Biochemical Spectrum of Dengue Fever: An Observation of a Tertiary Care Centre

Objectives: Cases of dengue are on the rise and India experienced its worst epidemic during 2015. There was almost a 2 times rise in the number of cases. This study was done to understand the varied presentation and manifestation of dengue at a tertiary care centre of Haryana, India. Methods: This was an observational cross sectional study undertaken at PGIMS Rohtak, Haryana, India. One hundred and one patients aged >= 14 years, who had positive test results for dengue, as NS1/IgM, were included in the study. Clinical presentations, haematological, and biochemical markers were studied and analyzed. Results: Out of 101 patients, 63.3% were males. Overall, 95% had fever followed by headache (62.3%), rash (53.4%), retrorbital pain (43.5%), and abdomenal pain (43.5%). Furthermore, 31.8% of patients had bleeding manifestation, of which the commonest was petechiae (12.8%) followed by malena (7.9%) and bleeding gum (6.9%). All patients had raised liver enzymes. Platelet count of < 50,000/mm(3) was present in 79.2%. Leucopenia was found in 43.5% of patients. Ultrasonography suggestive of free fluid was found in 44.5%. Hypokalemia was seen in 21.7% of patients. Complications, such as acute respiratory distress syndrome (ARDS) and DIC, were seen in 2.9% and 5.9% cases. Overall mortality rate was 2.97%. Conclusions: Dengue could have varied presentations ranging from a simple febrile illness to fatal multiorgan failure. It is crucial to understand the features, which predict the progress of dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Considering that the treatment of dengue is relatively simple, early institution of appropriate therapy with close monitoring of vital signs and laboratory parameters could help prevent morbidity and mortality related to dengue.