Research Article | Open Access
Praful S. Patil1, Dhruba Hari Chandi1, Smita Damke1, Shital Mahajan1,
R. Ashok2 and Silpi Basak1
1Department of Microbiolgy, JNMC, Sawangi( Meghe) Wardha – 442 004, Maharashtra, India.
2Govt. Medical College, Dungarpur – 314 001, Rajasthan, India.
J Pure Appl Microbiol. 2020;14(3):1935-1939 | Article Number: 6283
https://doi.org/10.22207/JPAM.14.3.32 | © The Author(s). 2020
Received: 02/05/2020 | Accepted: 24/07/2020 | Published: 29/09/2020
Abstract

Dengue disease is caused by dengue virus which is a vector born viral infection. The prevalence of dengue has increased dramatically from past few decades. The clinical symptoms vary from asymptomatic to severe hemorrhagic fever leads to high morbidity and mortality.  Method- This retrospective study was carried out during January 2019 to December 2019. The laboratory test was done by using J Mitra & Co on Day 1 of their visit to the hospital which shows NS1, IgM and IgG reactivity towards dengue fever.  The clinical profile information data was collected from patient records. Out of 640 samples 62.18% (398) was positive. The percentage of positive males and females were 60.78%, 64.23% respectively. The highest prevalence of dengue infection was observed more in age group between 31-40 years (81.69%) and least prevalence in age group 71-80 years (36.36%).  Most of the patients were positive for NS1Ag121 (30.4%) followed by IgM positive 87 (21.9%) & 59 (14.8%) positive for both IgM and NS1 Ag The highest number of infections was seen during October (75.8%) post monsoon season. All patients had a fever, followed by head ache (82%) and body pains (66.4%), 64.84% stayed in the hospital less than 5 days. In tropical and sub-tropical regions dengue is still a leading public health problem especially during rainy and post monsoon seasons. Both NS1 Ag and IgM detection in early acute phase has potential diagnostic value. So, to reduce mortality there need to initiate community-based cohort studies to predict the pace of dengue spread based on clinical presentation and laboratory findings during epidemics in India. Aedesaegypti is a common vector for transmission of DENV, CHIKV and ZIKV, so there is a need to screen for these infections in endemic areas.

Keywords

Dengue, (NS1)Nonstructural Protein I, Immunoglobulin G( IgG), Immunoglobulin M (IgM)

Introduction

Dengue feveris an acute arboviral infection cause by a dengue virus,there are four distinct serotypes (DENV1, DENV2, DENV3, and DENV4)of this virus transmitted by Aedesaegypti1.The clinical symptoms vary from asymptomatic to severe hemorrhagic fever leads to high morbidity and mortality(20%) if left untreated. The prevalence of dengue has increased dramatically from past few decades and now about half of the population of world areis at risk2,3,4.Dengue transmission occurs throughout the year in endemic tropical areas; however, in most countries there is a distinct seasonal pattern, with increased transmission usually associated with the monsoon and post monsoon season5,6. Lack of specific anti viral drug for the treatment of dengue and had variable clinical presentation which is a very big challenge to the clinicians to prevent the complications and death7. So to reduce morbidity and mortality of dengue infection, it is better to understand the clinical profile of disease along with the laboratory parameters of dengue fever. This current retrospective study was carried out to determine, the seasonal distribution, demographic variation with clinical manifestations of all laboratory tested dengue cases.

Materials and Methods

This retrospective study was carried out during January 2019 to December 2019, in the department of microbiology, at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. A total of 640 patients with the clinically suspected cases were included in the study. The laboratory test was done by using a rapid solid phase immuno- chromatographic test(J Mitra & Co. Pvt. Ltd.) on Day 1of their visit to the hospital which shows NS1, IgM and IgG reactivity towards dengue fever. The patient clinical profile such as fever, head ache and length of hospital stay were collected from patient records at MRD (Medical Record Department).

RESULTS

A total of 640 patient’s were included in the study. ,The distributions of patient demographic results were shown in the table: 1, Seropositivity Pattern in dengue fever was shown in the table: 2. Length of hospital stay, Seasonal Variation and clinical profile of dengue infections were shown in the tables: 3, 4, &5 respectively. The mean age was 35.03±5.07 years old and Standard deviation σ is 16.6188. Mean Length of hospital Stay (Mean±SD) =3.65±1.39, Range:2-7 days

Table (1):
Demographic characteristic of Patient (n=640).

Characteristics Total no of patients Positive Percentage
Gender
Male       380 231 60.78
Female       260 167 64.23
Age group in years
01-10 35 15 42.85
11-20 92 42 45.65
21-30 132 98 74.24
31-40 142 116 81.69
41-50 124 70 56.45
51-60 70 39 55.71
61-70 23 10 43.47
71-80 22 08 36.36
Geographical distribution
Urban 415 274 66
Rural 225 124 55.1
Total 640 398 62.2

Table (2):
Seropositivity Pattern in dengue fever.

Parameters
Number
Percentage
NS1 Ag
59
14.82
IgM Abs
87
21.86
IgG Ab
44
11.06
NS1 Ag and IgM Ab
121
30.40
NS1 Ag and IgG Ab
40
10.05
IgM and IgG Abs
47
11.81
Total
398
100

Table (3):
Length of hospital stay in In-patients.

Length of hospital stay
 Study population
  %
≤ 5 days
200
83.68
>5 days
39
16.32
Total
239
100

Table (4):
Seasonal Variation of dengue Infections.

Months Total number of patients Number of positive patients percentage
Wards OPD IPD
January 07 01 14.28
February 18 0
March 11 0
April 08 0
May 01 0
June 01 0
July 05 0
August 16 06 03 13.63
September 45 36 53 65.43
October 95 62 119 75.79
November 96 75 121 70.76
December 98 60 101 63.92
Total 401 239 398 62.18
640

Table (5):
Symptoms distribution in dengue patients.

Symptoms
No. of cases (n=640)
%
Fever
640
100
Headache
525
82
Body ache
425
66.4
Retro orbital pain
240
37.5
Abdominal pain
180
28.1
Nausea/ vomiting
121
18.9
Conjunctival congestion
100
15.6
Generalised weakness
95
14.8
Joint pain
65
10.2
Anorexia
41
6.4
Diarrhea
41
6.4
Dry cough
32
5
 Skin Rash
24
3.8
Bleeding
20
3.1
Bradycardia
16
2.5
DISCUSSION

According to WHO, in last 5 decades dengue infections has shot up 30 fold, because of its complex patho-physiological, ecological as well as economical problems8. In current study majority of patients were males (380 males out of 640 patients)than females, this may due to males are more exposed to mosquitoes in outdoor activity similar findings were reported in Gupta et al. and Dar es Salaam 2014 outbreak9,10.

In the current study large number i.e. 81.69% of dengue cases are from age group between 31 to 40 years which is similar to the study MM Kauser et al.11. Kaushik M. et al.4Dhruba et al.1 , Ghouth et al.12 and PadhiS et al.13 reported that most common affected age group was 11-20 years, the difference may be the study population and sample size. In the present study positive rate was high in urban population compared to the rural population. Urbanization tends to increase the number of habitats suitable for Aedesaegypti. The Aedesaegypti mosquito population was highest in slum houses, shop houses and multistoreyed flats.

In the current study highest number of dengue cases were reported in the post-monsoon period similar results were found in study done by Lata R. patel et al.14 During monsoon period heavy rains leads to stagnation of large amount of water. These are the favourite breeding places for vector mosquito. This may be the cause for more number of cases in post-monsoon season.

Single stranded RNA virus belonging to genus flavivirus, is responsible for acute illness in dengue. 4 to 10 days was the incubation period for dengue fever. Febrile phase, critical phase and recovery phase are these conditions seen in dengue infection9 &10. Overall sero-positivity rate was 62.2% (398/640). In the current study over all NS1 detection was 220 (49.7%) patients were positive, Results were correlating with other study by Anitha Chakravarti 35(39.7%). In dengue infection the role of NS1 Ag for early detection is currently being assess by many investigators, without the requirement of paired sera (Two serum samples taken from a patient usually at 1 week apart)and it circulates uniformly in all serotypes of dengue and there is no cross reaction of dengue NS1 antigen with other flaviviruses 13-15. The NS1 is produced in high concentration in the serum during acute phase (0-6 days) of infection. The sensitivity varies between 85.5 and 95.9% and specificity between 95.0 and 100% using the viral isolation as a reference test16,17.

Dengue IgM can be detected within 3-5 days in 50% people after onset of symptoms, and 80% after day 5 and to 99% on day 10they and not detected after 2–3 months. IgM is not specific, they can cross-reaction with other flaviviruses and also with rheumatoid factor17. So if the patient sample is reactive for NS1 Ag and IgM antibodies instead of IgM only, that is more specific. At end of the first week of onset symptoms, IgG antibodies will detect and remain life-long in some patients. Detection of NS1 and IgG, IgM and IgG detection indicates the seroconverstion stage of infection. If only IgG Abs detection in serum, it indicates past infection, secondary infection or cross-reaction with other flaviviruses antigen17. In the current study fever was present in all the patients (100%), followed by headache and body pains which is similar to the other studies18-20. Only 16.32% were stayed in the hospital more than 5 days which is similar to the other study carried out by Solanke SN et al. at Jalna20. In the current study no mortality was found.

CONCLUSION

In tropical and sub-tropical regions, dengue is still a leading public health problem especially during rainy and post monsoon seasons. An increased urbanization and behavior change in vector is also one cause for increase in dengue cases. Males were most commonly affected. BothNS1 Ag and IgM detection in early acute phase has potential diagnostic value. So, to reduce mortality there need to initiate community-based cohort studies to predict the pace of dengue spread based on clinical presentation and laboratory findings during epidemics in India. Aedesaegyptiis a common vector for transmission of DENV, CHIKV and ZIKV, so there is a need to screen for these infections in endemic areas.

Declarations

ACKNOWLEDGMENTS
None.

CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.

AUTHORS’ CONTRIBUTION
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

FUNDING
None.

ETHICS STATEMENT
Not applicable.

AVAILABILITY OF DATA
All datasets generated or analyzed during this study are included in the manuscript.

References
  1. Chandi DH. Prevalence of dengue virus infection among population of Bhaili visiting tertiary health institution; Chhattisgarh. Asian J Med Sci. 2020;11(2):30-4. https://doi.org/10.3126/ajms.v11i2.27345
  2. World Health Organization, Regional Office for South-East Asia, 2016. Dengue Bulletin. Vol-39. World Health Organization, Regional Office for South-East Asia. Available at: http://www.who.int/iris/handle/10665/255696. Accessed December 2016.
  3. Park K. The Dengue Syndrome. Text book of preventive and social medicine 23rd ed. Jabalpur, India: M/s Banarsidas Bhanot. 2015:246-54.
  4. Mid Term Plan for prevention and control of Dengue and Chikungunya. Directorate of National Vector Borne Diseases Control Programme, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India. 2011. Available at: https://mohfw.gov.in/sites/default/files/5201617.pdf Accessed 10 April 2018.
  5. Biswas A, Pangtey G, Devgan V, et al. Indian national guidelines for clinical management of dengue fever. Journal of the Indian Medical Association. 2015;113(12).
  6. Yacoub S, Ferrar J. Dengue. In: Farrar J, Hotez P, Junghanss T, Kang G, Lallo D, White N, editors. Manson’s Tropical Diseases, Elsevier Limited; 2014;23:162-70.
  7. World Health Organization. Global strategy for dengue prevention and control 2012-2020. World Health Organization. 2012. Available at: http://www.who.int/iris/handle/10665/75303. Accessed 10 April 2018.
  8. Gubler DJ. The economic burden of dengue. Am J Trop Med Hyg. 2012;1:86(5):743. https://doi.org/10.4269/ajtmh.2012.12-0157
  9. Gupta E, Dar L, Kapoor G, Broor S. The changing epidemiology of dengue in Delhi, India. Virology Journal. 20061;3(1):92.https://doi.org/10.1186/1743-422X-3-92
  10. Vairo F, Mboera LE, De Nardo P, et al. Clinical, virologic, and epidemiologic characteristics of dengue outbreak, Dar es Salaam, Tanzania, 2014. Emerg Infect Dis. 2016;22(5):895.
    https://doi.org/10.3201/eid2205.151462
  11. Kauser MM, Kalavathi GP, Radadiya M, et al. Study of Clinical and Laboratory Profile of Dengue Fever in Tertiary Care Hospital in Central Karnataka, India, Global Journal of Medical Research: B Pharma, Drug Discovery, Toxicology and Medicine. 2014;14(5).
  12. Ghouth AS, Amarasinghe A, Letson GW. Dengue outbreak in Hadramout, Yemen, 2010: an epidemiological perspective. Am J Trop Med Hyg. 2012;86(6):1072-6.https://doi.org/10.4269/ajtmh.2012.11-0723
  13. Padhi S, Dash M, Panda P, et al. A three year retrospective study on the increasing trend in seroprevalence of dengue infection from southern Odisha, India. Indian J Med Res. 2014;140(5):660.
  14. Patel LR. Sero prevalence of Dengue NS-1 Antigen in Tertiary care hospital, Ahmedabad. Ind J Basic and Applied Med Res. 2013;2(7):694-701.
  15. Bhatia R, Dash AP, Sunyoto T. Changing epidemiology of dengue in South-East Asia. WHO South-East Asia Journal of Public Health. 2013;2(1):23. https://doi.org/10.4103/2224-3151.115830
  16. Kumarasamy V, Chua SK, Hassan Z, Wahab AH, Mohamad M, Chua KB. Evaluating the sensitivity of a commerical dengue NS1 antigen-capture ELISA for early diagnosis of acute dengue virus infection. Singapore Med J. 2007;48(7):669. https://doi.org/10.1016/j.jviromet.2006.11.001
  17. Herencia JSS. Laboratory Tests Used in the Diagnostic and Research of Dengue Virus: Present and future; chapter 4, November 5th 2018. http://dx.doi.org/10.5772/intechopen.80519. https://doi.org/10.5772/intechopen.80519
  18. Anand KSS, Bettegowda S. Clinical and laboratory pattern of dengue fever: a retrospective study from rural hospital. Galore International Journal of Health Sciences & Research. 2019;4(3):44-46.
  19. Nimmagadda SS, Mahabala C, Boloor A, Raghuram PM, Nayak UA. Atypical Manifestations of Dengue Fever-Where Do We Stand to Day?. J ClinDiagn Res. 2014;8(1):71-3. https://doi.org/10.7860/JCDR/2014/6885.3960
  20. Solanke SN, Pohekar AS, Pohekar JA. Clinical and laboratory profile of dengue fever: a retrospective study. Int J Adv Med. 2019;6:1254-8. https://doi.org/10.18203/2349-3933.ijam20193280

Article Metrics

Article View: 95

Share This Article

© The Author(s) 2020. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License which permits unrestricted use, sharing, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.