Objective: To determine the ultrasound findings in patients with dengue fever and to evaluate their relationship with laboratory parameters.
Study Design and Setting: This prospective cross-sectional study was conducted at –removed for blind review---from September 2020 to August 2021.
Methodology: Total of 248 patients diagnosed with dengue fever, fulfilling the exclusion and inclusion criteria, were included in the study. Demographic data was recorded on a structured proforma. Serological confirmation along with complete blood counts and liver function tests were obtained. Abdominal and chest ultrasounds were conducted in all patients. The ultrasonographic features of these patients were analyzed with laboratory investigations through SPSS version 23. Student’s t-test and Chi-square tests were used assessingess the association between the ultrasonographic findings and laboratory features. A P-value of <0.05 was considered significant.
Results: The most common ultrasonographic feature among dengue patients was acalculous cholecystitis (49.6%) followed by hepatomegaly (47.2%), splenomegaly (46.8%), altered echotexture of the liver (46.4%), ascites (37.5%) and pleural effusion (7.3%).
Acalculous cholecystitis and ascites were significantly associated with severe thrombocytopenia and increasing hematocrit. Acalculous cholecystitis, ascites, pleural effusion and altered echotexture of the liver were associated with raised transaminases.
A low platelet count showed the strongest relationship with sonographic features of capillary leak syndrome.
Conclusion: Ultrasound is a useful investigation to diagnose severe, critical dengue. The development of ultrasonographic features should prompt proactive management of these patients in order to prevent emergence of severe complicated dengue.
Mehmood A, Khalid Khan F, Chaudhry A, Hussain Z, Laghari MA, Shah I, et al . Risk Factors Associated with a Dengue Fever Outbreak in Islamabad, Pakistan: Case-Control Study. JMIR Public Health Surveill 2021;7(12):e27266
doi: 10.2196/27266PMID: 34967753
Dehghani R, Kassiri H. A Review on Epidemiology of Dengue Viral Infection as an Emerging Disease. Research Journal of Pharmacy and Technology. 2021; 14(4):2296-1. doi: 10.52711/0974-360X.2021.00406
Fatima SH, Atif S, Rasheed SB, Zaidi F, Hussain E. Species Distribution Modelling of Aedes aegypti in two dengue-endemic regions of Pakistan. Trop Med Int Health 2016; 21: 427-436. https://doi.org/10.1111/tmi.12664
Ahmed S, Ali N, Tariq WU. Neurological manifestations as presenting feature in dengue Fever. J Coll Physicians Surg Pak. 2007 Apr;17(4):236-7. PMID: 17462188.
Weeratunga PN, Caldera MC, Gooneratne IK, Gamage R, Perera P. Neurological manifestations of dengue: a cross sectional study. Travel Med Infect Dis. 2014 Mar-Apr;12(2):189-93. doi: 10.1016/j.tmaid.2013.11.001. Epub 2013 Nov 27. PMID: 24332761.
Rajapakse S, Wattegama M, Weeratunga P, Sigera PC, Fernando SD. Beyond thrombocytopaenia, haemorrhage and shock: the expanded dengue syndrome. Pathog Glob Health. 2018 Dec;112(8):404-414. doi: 10.1080/20477724.2018.1552645. Epub 2018 Dec 3. PMID: 30507366; PMCID: PMC6327626.
Trieu HT, Khanh LP, Ming DKY, Quang CH, Phan TQ, Van VCN, et al. The compensatory reserve index predicts recurrent shock in patients with severe dengue BMC Medicine 2022; 20:109 https://doi.org/10.1186/s12916-022-02311-6
Subbiah A, Mahajan S, Yadav RK, Agarwal SK. Intravenous immunoglobulin therapy for dengue capillary leak syndrome in a renal allograft recipient. BMJ Case Rep. 2018 Jun 19;2018:bcr2018225225. doi: 10.1136/bcr-2018-225225. PMID: 29925559; PMCID: PMC6011578.
Padyana M, Karanth S, Vaidya S, Gopaldas JA. Clinical Profile and Outcome of Dengue Fever in Multidisciplinary Intensive Care Unit of a Tertiary Level Hospital in India. Indian J Crit Care Med. 2019 Jun;23(6):270-273. doi: 10.5005/jp-journals-10071-23178. PMID: 31435145; PMCID: PMC6698353.
Padmaprakash KV, Jha VK, Sowmya Karantha C, Anurag Singh C, Kamal D, Jambunathan P. Rescue therapy with intravenous immunoglobulin in severe refractory dengue: A pilot study. Med J Armed Forces India. 2022 Apr;78(2):204-212. doi: 10.1016/j.mjafi.2020.12.036. Epub 2021 Mar 26. PMID: 35463535; PMCID: PMC9023533.
Pothapregada S, Kullu P, Kamalakannan B, Thulasingam M. Is ultrasound a useful tool to predict severe dengue infection? Indian J Pediatr 2016; 83: 500–504. doi: 10.1007/s12098-015-2013-y. Epub 2016 Feb 5. PMID: 26846603.
Santhosh VR, Patil PG, Srinath MG, Kumar A, Jain A, Archana M. Sonography in the Diagnosis and Assessment of Dengue Fever. J Clin Imaging Sci 2014;4:14-21.
Ahuja G, Shahnawaz S, Sheikh S, Zubairi A, Mansoor K, Khawaja S, et al. Prevalence of dengue in patients presenting to a tertiary care hospital of Karachi. PJMD 2016; 5 (04): 27-31.
Suwarto S, Nainggolan L, Sinto R, Effendi B, Ibrahim E, Suryamin M, Sasmono RT. Dengue score: a proposed diagnostic predictor for pleural effusion and/or ascites in adults with dengue infection. BMC Infect Dis. 2016 Jul 8;16:322. doi: 10.1186/s12879-016-1671-3. PMID: 27391122; PMCID: PMC4938904.
Iqtadar S, Akbar N, Huma N, Randhawa FA. Profile of hepatic involvement in dengue infections in adult Pakistani population. Pak J Med Sci. 2017 Jul-Aug;33(4):963-967. doi: 10.12669/pjms.334.13026. PMID: 29067074; PMCID: PMC5648973.
Anam AM, Rabbani R, Shumy F. Expanded dengue syndrome: three concomitant uncommon presentations in the same patient. Trop Doct. 2017;47 (2):167–170.
Egger JR, Coleman PG. Age and clinical dengue illness. Emerg Infect Dis. 2007 Jun;13(6):924-5. doi: 10.3201/eid1306.070008. PMID: 17553238; PMCID: PMC2792851.
Kumar M, Verma RK, Mishra B. Prevalence of Dengue Fever in Western Uttar Pradesh, India: A Gender-Based Study. Int J Appl Basic Med Res. 2020 Jan-Mar;10(1):8-11. doi: 10.4103/ijabmr.IJABMR_337_18. Epub 2020 Jan 3. PMID: 32002378; PMCID: PMC6967337.
Dewan N, Zuluaga D, Osorio L, et al. Ultrasound in Dengue: A Scoping Review. The American Journal of Tropical Medicine and Hygiene. 2021 Jan;104(3):826-835. DOI: 10.4269/ajtmh.20-0103. PMID: 33534759; PMCID: PMC7941833.
Chandey M, Kaur H, Kaur S. Acute acalculous cholecystitis in dengue fever patients. Int J Adv Med. 2017 Apr;4(2):375-377. doi:http://dx.doi.org/10.18203/2349-3933.ijam20170923
Agarwal A, Gupta V, Agarwal M. Capillary Leak Syndrome in Hospitalized Cases of Dengue Fever - Is It Really a Marker of Severity? IJTDH 2017; 27(2): 1-10. DOI:10.9734/IJTDH/2017/36883.
Mohanty B, Sunder A, Pathak S. Clinicolaboratory profile of expanded dengue syndrome – Our experience in a teaching hospital. J Family Med Prim Care. 2019 Mar; 8(3): 1022–1027. doi: 10.4103/jfmpc.jfmpc_12_19. PMID: 31041245; PMCID: PMC6482768.
Khan SP, Izhar S, Kadri S, Ghani R. High Incidence of Dengue Fever in Karachi and the Benefits of Ultrasound for Diagnosis of Complications. PJMD 2020; 9(03): 65-69.
Joshi P, Rathnam VG, Sharma S. USG findings in dengue haemorrhagic fever – Our experience in the recent epidemic. Indian J Radiol Imaging 1997;7:189 92
Shah S, Rolfe R, Henostroza G, Seas C. Ultrasound Findings of Plasma Leakage in Dengue Fever. Am J Trop Med Hyg. 2018 Dec;99(6):1362-1363. doi: 10.4269/ajtmh.18-0422. PMID: 30851024; PMCID: PMC6283506.
Xin Tian C, Baharuddin KA, Shaik Farid AW, Andey R, Ridzuan MI, Siti-Azrin AH. Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs. Med J Malaysia. 2020 Nov;75(6):635-641. PMID: 33219170.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2022 Kashif, Kashif, Lubna Meraj, Farhat