Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients

Author summary Dengue has become a significant public health concern worldwide in recent years especially for the South-East Asian, sub-Saharan African and Latin American countries. Bangladesh has experienced a number of outbreaks of dengue, the largest one occurred in 2019. Management of dengue cases during an epidemic is a major challenge for a limited resource country like Bangladesh. To predict the risk of developing severe dengue a combined evaluation of early symptoms and laboratory test profiles is necessary. Despite the fact, there is a lack of evidence of clinical and laboratory parameters of dengue patients in Bangladesh. Authors wanted to highlight the clinical features, and hematological and biochemical profiles of dengue patients diagnosed in Bogra district, a non-endemic zone situated in northern Bangladesh. The authors reported that fever, headache, and myalgia were the commonest presenting complaints of dengue patients whereas vomiting and abdominal pain was the most prevalent warning signs. Severe dengue was associated mostly with plasma leakage rather than hemorrhage and the rise of hematocrit during hospital stay was a predictor of severe dengue. These findings will guide physicians for prompt therapeutic management of dengue infection in the study area. Backgrounds Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic. Methods This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients' clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study. Results Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue. Conclusion The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.