CHANGING CLINICAL SPECTRUM AND CORRELATION BETWEEN PLATELET COUNT AND BLEEDING TENDENCIES IN DENGUE PATIENTS AT A TERTIARY CARE CENTRE.

INTRODUCTION:Dengue infection is recognized worldwide as the most important arthropod vector borne disease in the last four decades and a major public health problem, assuming epidemic proportion in urban areas of tropical countries in South east Asia.It is caused by one of the four dengue virus serotypes DEN-1, DEN-2, DEN-3 and DEN-4.Aedes aegypti is the main mosquito vector.Dengue infection can be asymptomatic or can cause two clinical entities: dengue fever (DF) and dengue haemorrhagic fever/ dengue shock syndrome (DHF/DSS).Dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome.Thrombocytopenia may be frequently observed in DF, but is a constant feature and one of the diagnostic criteria of DHF/DSS.There is a need to identify various clinical presentations, complications and treatment outcome of Dengue patients.Hence, this study was undertaken to ascertain all the above mentioned clinical parameters in proven dengue patients who were admitted to this tertiary care hospital, with a special emphasis on correlation between platelet count and bleeding manifestations.MATERIALS AND METHODS: This cross sectional study was conducted for a period of 2 years from October 2010 to September 2012.100 hospitalized and confirmed dengue cases were included and they were classified as having dengue fever (DF), dengue hemorrhagic fever (DHF)/ dengue shock syndrome (DSS) as per WHO criteria.A detailed clinical evaluation with appropriate laboratory investigations were done.All the patients were treated and followed up with clinical assessment and serial platelet counts.Data was analyzed with suitable software and appropriate statistical methods.RESULTS: There were 57 males and 43 females, with majority in the age group 21 to 40 years.Fever was the most common symptom present in all the patients (100%), followed by vomiting (24%), myalgia (23%), headache (21%), and pain abdomen (20%).Bleeding manifestation were noted in 18 patients (18%), out of which 5 patients had platelet count <20,000, 4 patients had 21,000-30,000, 2 patients 31,000-40,000, 5 patients 41,000-50,000 and 2 patients had >61,000 platelet count.There was no correlation between platelet count and bleeding manifestations (p value > 0.05).CONCLUSION: Dengue remains an important differential diagnosis for all acute fevers in India.Dengue should be suspected even in patients without classical presentation of dengue as many Dengue patients present with atypical manifestations.Due to lack of direct correlation between low platelet count and bleeding tendencies, low platelet count alone is not an indication for platelet transfusion and a close monitoring for bleeding manifestation and hemodynamic stability with reasonable judgment should be exercised in deciding the need for transfusion in Dengue patients.Prevention of uncomplicated Dengue fever going on for DHS and DSS will be crucial and will decrease the overall mortality and morbidity.