Abdominal pain,rash and conjunctival congestion could be considered symptoms of dengue haemorrhagic fever (DHF),says a study conducted by the National Institute of Virology (NIV) in association with consultants from city hospitals. This has led a group of doctors at KEM Hospital to investigate whether dengue can be predicted on day three of the fever itself.
The study,which examined the clinical picture of dengue cases in the city,found that dengue haemorrhagic fever was seen in 27 per cent of cases with low severity despite the circulation of multiple serotypes of the virus. It said this meant abdominal pain,rash and conjunctival congestion could be considered warning symptoms for the development of dengue haemorrhagic fever. The study was published in PloS One,an online journal of peer-reviewed scientific research,in January this year.
The study assumes importance as doctors have again started seeing dengue cases in the city. Following intermittent rains and a long gap,there have been sporadic cases being reported from Bhosari,Nana Peth,Bhawani Peth and even areas outside Pune, says Dr Rajesh Gadia,consulting physician at KEM Hospital and one of the researchers.
One death has been reported this year while the Pune Municipal Corporation has reported more than 30 suspected dengue cases from April to July.
A facility-based study,Clinical findings and pro-inflammatory cytokines in dengue patients in western India,has indicated inflammatory markers in dengue, Gadia says.
Descriptions of dengue immunopathogenesis have largely relied on data from south-east Asia and America,while India was poorly represented. NIV experts said this study characterised dengue cases from Pune,Western India,with respect to clinical profile and pro-inflammatory cytokines.
In 2005,372 clinically suspected dengue cases were tested by MAC-ELISA and RT-PCR for dengue virus (DENV) aetiology. The clinical profile of patients was recorded at KEM,Yashwantrao Chavan Memorial Hospital and Deenanath Mangeshkar Hospital. Of the 372 individuals,221 were confirmed dengue cases. Three serotypes,DENV-1,2 and 3 were co-circulating and one case of dual infection was identified. Of 221 cases,159 had dengue fever (DF) and 62 dengue haemorrhagic fever (DHF); of these,six had severe DHF and one died of shock. There was a strong association of rash,abdominal pain and conjunctival congestion with DHF,the study points out, indicating that these could be prognostic symptoms for the fever.
Of the symptoms common to dengue-infected patients,joint pain,retro-orbital pain and itching were seen in a significantly higher proportion of DF cases. On the other hand,rash,abdominal pain and conjunctival congestion showed a positive association with DHF.