Respiratory Manifestation of Dengue Fever in a Tertiary Care Hospital in Bangladesh

Objective

To investigate the respiratory signs observed in individuals hospitalized due to dengue infection.

Methods

This observational study encompassed a cohort of 50 individuals diagnosed with dengue fever, as confirmed by the presence of NS1 antigen, who were hospitalized to Shaheed Captain Mansur Ali Medical College Hospital in Uttara, Dhaka, Bangladesh. Participants were enrolled from the Intensive Care Unit (ICU) and respiratory medicine ward over the period of June 2022 to October 2022. The screening process involved doing a physical examination and obtaining a comprehensive clinical history from the patients. Dengue fever was diagnosed through clinical suspicion, which was determined by the presence of many symptoms such as febrile sickness, headache, low platelet count, myalgia, retro-orbital discomfort, bleeding, haemoptysis, shock, cough, dyspnoea, and chest pain. The collected data were entered into the computer and analyzed by using SPSS (version 20.1)

Results

Out of the 50 instances examined, most patients (36%) were above the age of 55, while 34% of cases fell within the age range of 25-55 years old. Most of the patients, accounting for 70%, were identified as male, while 64% of them were classified as urban residents. Both diabetes and hypertension were present in 4% of the patients. Chronic kidney disease (CKD) and Cardiac disease (CD) were observed in a subset of 2% of the individuals. Dengue fever in 42% of the patients, Dengue hemorrhagic fever (DHF) in 50% of the patients, and Dengue shock Syndrome in 8% of the patients. Acute Respiratory Distress Syndrome (ARDS) and pneumonia were observed as the predominant respiratory manifestations in a total of 11 cases, while pleural effusion was identified in 7 instances among all individuals diagnosed with dengue. Among the total of 25 cases of dengue with dengue hemorrhagic fever (DHF), it was observed that 32% of these cases presented with acute respiratory distress syndrome (ARDS) and pneumonia. A total of 16% of the participants exhibited pleural effusion. Likewise, a notable incidence of Acute Respiratory Distress Syndrome (ARDS) was seen, accounting for 50% of the total four cases of Dengue Shock Syndrome (DSS). This was followed by 25% of individuals presenting with pneumonia and pleural effusion. Regardless of pulmonary problems, fever and general pain were seen in all patients. Among the cohort of individuals (n=28) with dengue cases who experienced pulmonary problems, the prevalence of clinical manifestations such as cough was found to be 64.29%, whereas the occurrence of haemoptysis was observed in 46.43% of cases. Additional symptoms observed in the study population were fever (100.0%), bodily pain (100.0%), vomiting (25%), dyspnoea (42.86%), drowsiness (21.43%), shock (14.29%), and bleeding from other places (21.43).

Conclusion

The frequency of respiratory complications in severe cases of dengue, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), is significantly higher in comparison to milder forms of dengue. Therefore, it may be inferred that the presence of certain indicators may suggest a more severe manifestation of dengue in affected individuals.