Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Palau Penang, Malaysia.
Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan.
BMC Infect Dis. 2024 May 17;24(1):500. doi: 10.1186/s12879-024-09384-z.
Dengue Viral Infection (DVI) has become endemic in Pakistan since the first major outbreak in Karachi in 1996. Despite aggressive measures taken by relevant authorities, Pakistan has been dealing with a worsening dengue crisis for the past two decades. DHF is severe form of dengue infection which is linked with significant morbidity and mortality. Early identification of severe dengue infections can reduce the morbidity and mortality. In this context we planned current study in which we find out the different factors related with DHF as well as clinical laboratory features of DHF and compare them to DF so that patients can be best evaluated for DHF and managed accordingly at admission.
Retrospective study conducted over a period of 6 years (2013-2018) in two tertiary care hospitals in Pakistan. Data were collected by using a pre-structured data collection form. Data were statistically analyzed to determine the clinical and laboratory characteristics of DVI and risk factors of dengue hemorrhagic fever (DHF).
A total 512 dengue cases (34.05 ± 15.08 years; Male 69.53%) were reviewed. Most common clinical manifestations of DVI were fever (99.60%), headache (89.1%), chills (86.5%), rigors (86.5%), myalgia (72.3%). Less common clinical manifestations were vomiting (52.5%), arthralgia (50.2%) and skin rashes (47.5%). Furthermore, nasal bleeding (44.1%), gum bleeding (32.6%), pleural effusion (13.9%) and hematuria (13.1%) were more profound clinical presentations among DHF patients. Mortality rate was 1.5% in this study. Logistic regression analysis indicated that delayed hospitalization (OR: 2.30) and diabetes mellitus (OR:2.71), shortness of breath (OR:2.21), association with risk groups i.e., living near stagnant water, travelling to endemic areas, living in endemic regions (OR:1.95), and presence of warning signs (OR:2.18) were identified as risk factors of DHF. Statistically we found that there is strong association of diabetes mellitus (DM) with DHF while the patient suffering from DM individually had higher odds (2.71) of developing DHF than patients without disease.
The current study demonstrated that the clinical and laboratory profiles of DF and DHF are significantly distinct. Significant predictors of DHF were advanced age, diabetes mellitus, ascites, pleural effusion, thick gallbladder and delayed hospitalization. The identification of these factors at early stage provides opportunities for the clinicians to identify high risk patients and to reduce dengue-related morbidity and mortality.
自 1996 年卡拉奇首次爆发以来，登革热病毒感染（DVI）已在巴基斯坦流行。尽管有关当局采取了积极措施，但在过去的二十年中，巴基斯坦一直面临着日益严重的登革热危机。登革出血热（DHF）是一种严重的登革热感染，与较高的发病率和死亡率相关。早期识别严重登革热感染可以降低发病率和死亡率。在此背景下，我们计划进行目前的研究，以发现与 DHF 相关的不同因素以及 DHF 的临床实验室特征，并将其与 DF 进行比较，以便对 DHF 患者进行最佳评估并在入院时进行相应的管理。
这是一项在巴基斯坦两家三级护理医院进行的为期 6 年（2013-2018 年）的回顾性研究。使用预构的数据收集表收集数据。对数据进行统计分析，以确定 DVI 的临床和实验室特征以及登革出血热（DHF）的危险因素。
共回顾了 512 例登革热病例（34.05±15.08 岁；男性 69.53%）。DVI 最常见的临床表现为发热（99.60%）、头痛（89.1%）、寒战（86.5%）、肌痛（86.5%）。不太常见的临床表现为呕吐（52.5%）、关节痛（50.2%）和皮疹（47.5%）。此外，鼻出血（44.1%）、牙龈出血（32.6%）、胸腔积液（13.9%）和血尿（13.1%）是 DHF 患者更严重的临床表现。本研究的死亡率为 1.5%。Logistic 回归分析表明，延迟住院（OR：2.30）和糖尿病（OR：2.71）、呼吸急促（OR：2.21）、与风险群体相关，即居住在死水附近、前往流行地区、居住在流行地区（OR：1.95）和出现警告信号（OR：2.18）被确定为 DHF 的危险因素。统计学上，我们发现糖尿病（DM）与 DHF 之间存在很强的关联，而患有糖尿病的患者发生 DHF 的几率（2.71）高于没有疾病的患者。
本研究表明，DF 和 DHF 的临床和实验室特征有显著差异。DHF 的显著预测因子是年龄较大、糖尿病、腹水、胸腔积液、胆囊增厚和延迟住院。早期识别这些因素为临床医生提供了机会，可以识别高危患者，并降低登革热相关的发病率和死亡率。
