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International Journal of Virology & Infectious Diseases
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 001
Research Article
Characterization of Dengue Infections by Using
Hematological and Serological Markers -
Saira Salim, Riaz Ahmad, Wajid Hussain, Kamran Afzal, Tehmina Munir
and Sundus Shabbir
National university of medical science Rawalpindi Pakistan
*Address for Correspondence: Saira Salim, National university of medical science Rawalpindi
Pakistan, Tel: 033-615-824-94; ORCID: 000-000-030-319-1263; E-mail:
Submitted: 27 January 2020; Approved: 18 February 2020; Published: 26 February 2020
Cite this article: Salim S, Ahmad R, Hussain W, Afzal K, Munir T, et al. Characterization of Dengue
Infections by Using Hematological and Serological Markers. Int J Virol Infect Dis. 2020;5(1): 001-004.
Copyright: © 2020 Salim S, et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
International Journal of
Virology & Infectious Diseases
International Journal of Virology & Infectious Diseases
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 002
INTRODUCTION
Dengue is febrile illness caused by four Dengue Viruses (DENV
1-4). This illness is transmitted by Aedes aegypti, Aedes albopictus
[1,2]. World Health Organization (WHO) in 1997 first published
3 categories of classification of this disease as symptomatic dengue
infection, Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF)
and Dengue Shock Syndrome (DSS) [3]. DF is break bone fever. The
main symptoms of this fever are headache, myalgia retro-orbital pain,
arthralgia, rash, leukopenia, hemorrhagic manifestations (petechial,
Purpura, gum bleeding, epistaxis, hematuria, hematemesis, stool and
vaginal bleeding) [4]. DHF is plasma leakage due to increase vascular
permeability (hematocrit rise above baseline). DHF is classically
characterized by fever, thrombocytopenia and hemorrhagic
manifestation [4]. DSS is characterized by DHF plus circulatory
failure manifestation by weak pulse, pulse pressure < 20mmhg and
shock with hypotension. Dengue is also classified without warning
signs as vomiting / nausea, rash, headache, myalgia, retro-orbital pain
and leukopenia. And With warning signs of dengue areas abdominal
pain, persistent vomiting, mucosal bleed, and fluid accumulation
(ascites and pleural effusion), increase in hematocrit due to decrease
in platelet count and organ failure [3]. Dengue fever is an infection
effecting millions of people around the globe, particularly South
East Asia. According to WHO, 2.5 billion people have DF and 1.3
billion people are at risk of DHF and DSS [5]. Aedes aegypti is
widely distributed in South East Asia specially Pakistan, India and
Sri Lanka where hyper endemic distribution of all dengue serotypes
has been established [6]. Factors effecting transmission of DF are
over population, poor urbanization, poor sanitation and increase
in vector breeding places [7]. Diagnosis of DENV is done clinically
and by laboratory testing. Clinical diagnosis is made by febrile illness
manifestation and relevant epidemiological exposure (travelling from
vector borne transmission area for week or 2). Laboratory diagnosis
of DENV direct by viral component seen in serum (RT - PCR) and
indirectly by serology (IgM and IgG). Non Structural Protein 1 (NS1)
is positive in first week of infection and start declining after resolution
of viremia [8,9]. Our research study is based on clinical assessment of
dengue virus by using hemodynamic and serologic marker causing
the epidemic in Pakistani population. We recently analyzed the
dengue virus among local population in Pakistan and providing the
better outcomes of patient management and disease control.
MATERIALS AND METHODS
This study was carried out at District Head Quarter Hospital
(DHQ) Attock after approval by ethical research committee, DHQ
Attock. The time duration was 10 months from January 2019 to
October 2019.
All the suspected dengue patients confirmed by serology (NS1,
IgM /IgG) were included in this research study as cases (dengue
group) and, all other febrile illness (<7 days) like malaria, enteric
fever, pyrexia of unknown origin were included in control group.
Patients having prolonged fever (more than7 days) due to other
viral/bacterial illness were excluded. Sampling technique was non
probability random sampling.
Sample size according to WHO calculator was 300 as further
divided 154 as cases and 146 as control group. Data including
demographic data, clinical symptoms and hematological parameters
including platelets count, WBC count and hematocrit (Pre and post
treatment) were collected and compared between dengue group and
control group patients admitted at DHQ Attock.
OPERATIONAL DEFINITION
Thrombocytopenia was defined as total platelets less than
100,000/ cu, mm. Leukopenia was defined as WBC less than 4000/ cu,
mm. hematocrit determined when haemoconcentration is rise >20%
above normal range.
The Hematological parameters collected from the patient samples
at 1st day and 7th
day of fever whereas performed at DHQ hospital
laboratory Attock by using automated hematology analyzer (Siemen’s
ADVIA 2120).
The serological tests NS1, Dengue IgM/IgG were performed by
using rapiGEN BIOCREDIT (an in vitro immunochromatographic
assay) as per manufacturer instruction. Serological confirmation of
dengue is done by positive NS1 antigen or seroconversion of IgM or
fourfold rise in IgG.
ABSTRACT
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,
hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare
categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using
SPSS version 21.
Results: A total of 154 cases of dengue (by using WHO calculator 154 suspected cases were defined fever >2 days and < 10days
having hematologic and NS 1positive in earlier phase of disease) and 146 control cases were observed. Serology markers using NS1
dengue were detected positive in (85/154) 55%, dengue IgM in (46/154) 30% and both NS1 and dengue IgM in 15%(23/154) cases.
Control group included malaria, enteric fever and febrile illness 103(71%), 30(20%), 13(9%) respectively. In cases 70(45%) were females
and 85(55%) males with significant p value, while in control group 80(55%) were females and 66(45%) males with p value of < 0.05. For
Hematological markers including platelets count, hematocrit and WBCs, paired sample T test showed high significant difference in value
of platelets counts and hematocrit , while no significant difference in WBCS was observed.
Conclusion: Serological markers (NS1, IgM and IgG) greatly helps in diagnosis as well as prognosis of dengue infection, thereby
helping not only in reducing the morbidity and mortality in patients but also helps controlling the epidemic by observing early preventive
measures by using Hematological markers in earlier phase of disease. These marker will make utilized by other Asian and tropical African
countries.
Keywords: Dengue fever; serologic markers; hematologic markers; Dengue infection; NS-1 antigen; IgM; IgG
International Journal of Virology & Infectious Diseases
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 003
RESULTS
Out of total of 154 patients in cases group, 55%(85/154) were
positive for NS 1 antigen, 30%(46/154) for dengue IgM antibody
and 15%(23/154) for both NS1 and IgM antibody. The control
group included 71%(103/146) patients having malaria followed by
20%(30/146) enteric fever and 9%(13/146) were febrile illness other
than these.
(Table1) Illustrates the clinical characterization of Dengue and
control groups according to age and gender. Slightly high male ratio
with low mean age with some significant difference were seen in
case (dengue) group as compared to control group and mean ages in
groups with higher in males and lower in females.
When compared the clinical symptoms between cases and control
groups, dengue group and control group had Headache (48.7% vs
6%), Myalgia (34% vs 1%), Abdominal pain (6% vs 4%), Diarrhea (2%
vs 4%), Chills 2(1% vs 34%), sore throat (9% vs 51%) as shown in
table 2.
In table 3 statistical analyses of paired samples taken before and
after treatment for hematological markers including platelet count,
hematocrit and WBC count is shown. Mean, standard deviation,
standard error of mean, T test of paired samples and p value for
platelets, hematocrit and white blood cells were also shown in table
3. Statistically significant p value for platelets and hematocrit was
obtained, while non-significant p value was noted for WBC count.
DISCUSSION
Dengue is one of the big challenges in tropical regions specially
under developed countries, while travel-associated infections occur
in developed countries like America [10].
It is most widely and rapid spreading disease in south East Asia
specially Pakistan, Bangladesh region where tropic season is very
common among July to September. The World Health Organization
(WHO) reports it as emerging challenge of public health awareness
[11].
The present study conducted at DHQ hospital Attock, Pakistan.
Dengue patients and control patients were checked for both
hematologic markers (Platelets, Hematocrit, WBCS) before and after
treatment) and serologic markers to confirm dengue in clinical course
of illness. Using demographic data of this research study, most of
patients of dengue were male 84(55%) and less frequent were female
70(45%). In contrast to control group where female patients 80(55%)
were observed more than males 66(45%) with high significant p value
that was <0.005 in both groups.
Using clinical symptoms of cases and control group fever,
myalgia, chills, headache, sore-throat, diarrhea and abdominal pain
were 100% each, 34% and 1%. 1% and 34%, 48.6% and 6%, 9% and
51%, 2% and 4%, 6% and 4% respectively. Myalgia, headache and
retrorbital pain were most common observed symptoms in dengue
case group as compared to control group with other febrile illnesses
in our study. Similar symptoms/findings has also been reported in
patients with dengue fever in other retrospective study conducted at
Thailand in 2018 by Juthatip [12].
In our study, serologic markers for diagnosis of dengue patients,
including NS1antigen and IgM antibodies were detected positive
either alone in 53% and 29% respectively or both (15%) in same
patient. Similar results were also reported in other study conducted
at Indonesia [13].
In this research study, control group comprised malaria cases
(71%), enteric (21%) and febrile illness cases.
Hematologic markers platelets count, hematocrit and WBCs
analysed before and after treatment revealed thrombocytopenia in
dengue cases before treatment that recovered after treatment during
convalescence and become within normal ranges. Mean, standard
deviation, standard error of mean for platelets, hematocrit and,
WBCs were observed and paired sample T test applied. The p value
was observed significant for platelets and hematocrit (< 0.05) but
not for WBCS (> 0.05). Similar results were also observed by other
studies conducted at Indonesia by Alametal [14] and at Thailand
by Chaloewong J, et al. [12] with significant p value or platelets
and hematocrit. At the end we conclude that by evaluating dengue
infection using simple, easily available serological and hematologic
markers before and after treatment not only helps in diagnosis and
Table 1: Comparison of clinical characterization between cases and control
groups.
Cases (Dengue)
Group (n = 154)
Control Group
(n = 146)
p Value
Gender
Female
Male
70 (45%)
84(55%)
80(55%)
66 (45%)
<0.05
Mean age (years) 27(15-67) 45(15-83) <0.001
Table 2: Comparison of clinical presentation / symptoms between cases and
control groups.
Dengue (Cases) (n
= 154)%Ages
Control Groups
(n = 146)% Ages
Fever 154(100%) 146(100%)
Myalgia 53(34%) 2(1%)
Chills 2(1%) 53(34%)
Headache/Retro-
Orbital Pain
75(48.7%) 10(6%)
Sore Throat 14(9%) 75(51%)
Diarrhea 4(2%) 3(4%)
Abdomen Pain 10(6%) 3(4%)
Table 3: Statistical Analysis by SPSS.
Mean
Standard
Deviation
Standard
Error of
Mean
95%
Confidence
Interval Lower
95%
Confidence
Interval
Upper
T Dif p Value
Platelets counts -192921 114904 9259 -211213 -174628 -20 153 0.00
Hematocrit -6.5 33.57 2.7 -11.9 -1.253 -2.4 153 .016
WBCS -1608766 4675 376.73 -905.39 583.3 -427 153 .670
International Journal of Virology & Infectious Diseases
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 004
prognosis of patients but also indirectly helps in limiting its spread by
observing early preventive measures thereby reducing the epidemic
and decreasing the.
REFERENCES
1. Suzarte E, Gil L, Valdes I, Marcos E, Lazo L, Izquierdo A, et al. A novel
tetravalent formulation combining the four aggregated domain III-capsid
proteins from dengue viruses induces a functional immune response in mice
and monkeys. International immunology. 2015; 27: 367-379. PubMed: https://
www.ncbi.nlm.nih.gov/pubmed/25795768
2. Chen B, Liu Q. Dengue fever in China. The Lancet. 2015; 385: 1621-1622.
http://bit.ly/2vLkxls
3. Horstick O, Jaenisch T, Martinez E, Kroeger A, See LLC, Farrar J, et al.
Comparing the usefulness of the 1997 and 2009 WHO dengue case
classification: A systematic literature review. Am J Trop Med Hyg. 2014; 91:
621-634. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24957540
4. Hadinegoro SRS. The revised WHO dengue case classification: does the
system need to be modified? Paediatr Int Child Health. 2012; 32: 33-38.
http://bit.ly/3bQsE0I
5. WHO. Comprehensive guideline for prevention and control of dengue and
dengue hemorrhagic fever. SEARO Publications. 2011. https://bit.ly/2uOPYvi
6. Garg S, Chakravarti A, Singh R, Masthi NR, Goyal RC, Jammy GR, et al.
Dengue serotype-specific seroprevalence among 5-to 10-year-old children
in India: A community-based cross-sectional study. Int J Infect Dis. 2017; 54:
25-30. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27825949
7. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998;
11: 480-496. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9665979
8. Huits R, Soentjens P, Maniewski-Kelner U, Theunissen C, Van Den Broucke
S, Florence E, et al. Clinical utility of the nonstructural 1 antigen rapid
diagnostic test in the management of dengue in returning travelers with fever.
Open forum infectious diseases. 2017; 4. http://bit.ly/37FXeqk
9. Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, et al.
Evidence-based risk assessment and communication: A new global dengue-
risk map for travellers and clinicians. J Travel Med. 2016; 23. PubMed: https://
www.ncbi.nlm.nih.gov/pubmed/27625400
10. Mohammed HP, Ramos MM, Rivera A, Johansson M, Muñoz Jordan JL, Sun
W, et al. Travel associated dengue infections in the United States, 1996 to
2005. Journal of travel medicine. 2009; 17: 8-14. http://bit.ly/2HDtUXa
11. Halstead SB. Dengue: The syndromic basis to pathogenesis research.
Inutility of the 2009 WHO case definition. Am J Trop Med Hyg. 2013; 88: 212-
215. http://bit.ly/38FmYEF
12. Chaloemwong J, Tantiworawit A, Rattanathammethee T, Hantrakool S,
Chai-Adisaksopha C, Rattarittamrong E, et al. Useful clinical features and
hematological parameters for the diagnosis of dengue infection in patients
with acute febrile illness: A retrospective study. BMC Hematology. 2018; 18:
20. http://bit.ly/2SW1oW3
13. Lee Yong-seok. Passive fever surveillance for dengue in Nha Trang City,
Vietnam: Association between clinical and laboratory-confirmed diagnoses of
dengue. Seoul National University. 2018; http://bit.ly/39Erzaq
14. Alam A, Handayani I, Indrati A. Association of serologic and hematologic
test results in dengue infant patients in RSUP. Dr. Hasan Sadikin Bandung.
IOP Conference Series: Earth and Environmental Science. 2018. http://bit.
ly/37GgeoS

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International Journal of Virology & Infectious Diseases

  • 1. International Journal of Virology & Infectious Diseases SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 001 Research Article Characterization of Dengue Infections by Using Hematological and Serological Markers - Saira Salim, Riaz Ahmad, Wajid Hussain, Kamran Afzal, Tehmina Munir and Sundus Shabbir National university of medical science Rawalpindi Pakistan *Address for Correspondence: Saira Salim, National university of medical science Rawalpindi Pakistan, Tel: 033-615-824-94; ORCID: 000-000-030-319-1263; E-mail: Submitted: 27 January 2020; Approved: 18 February 2020; Published: 26 February 2020 Cite this article: Salim S, Ahmad R, Hussain W, Afzal K, Munir T, et al. Characterization of Dengue Infections by Using Hematological and Serological Markers. Int J Virol Infect Dis. 2020;5(1): 001-004. Copyright: © 2020 Salim S, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. International Journal of Virology & Infectious Diseases
  • 2. International Journal of Virology & Infectious Diseases SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 002 INTRODUCTION Dengue is febrile illness caused by four Dengue Viruses (DENV 1-4). This illness is transmitted by Aedes aegypti, Aedes albopictus [1,2]. World Health Organization (WHO) in 1997 first published 3 categories of classification of this disease as symptomatic dengue infection, Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) [3]. DF is break bone fever. The main symptoms of this fever are headache, myalgia retro-orbital pain, arthralgia, rash, leukopenia, hemorrhagic manifestations (petechial, Purpura, gum bleeding, epistaxis, hematuria, hematemesis, stool and vaginal bleeding) [4]. DHF is plasma leakage due to increase vascular permeability (hematocrit rise above baseline). DHF is classically characterized by fever, thrombocytopenia and hemorrhagic manifestation [4]. DSS is characterized by DHF plus circulatory failure manifestation by weak pulse, pulse pressure < 20mmhg and shock with hypotension. Dengue is also classified without warning signs as vomiting / nausea, rash, headache, myalgia, retro-orbital pain and leukopenia. And With warning signs of dengue areas abdominal pain, persistent vomiting, mucosal bleed, and fluid accumulation (ascites and pleural effusion), increase in hematocrit due to decrease in platelet count and organ failure [3]. Dengue fever is an infection effecting millions of people around the globe, particularly South East Asia. According to WHO, 2.5 billion people have DF and 1.3 billion people are at risk of DHF and DSS [5]. Aedes aegypti is widely distributed in South East Asia specially Pakistan, India and Sri Lanka where hyper endemic distribution of all dengue serotypes has been established [6]. Factors effecting transmission of DF are over population, poor urbanization, poor sanitation and increase in vector breeding places [7]. Diagnosis of DENV is done clinically and by laboratory testing. Clinical diagnosis is made by febrile illness manifestation and relevant epidemiological exposure (travelling from vector borne transmission area for week or 2). Laboratory diagnosis of DENV direct by viral component seen in serum (RT - PCR) and indirectly by serology (IgM and IgG). Non Structural Protein 1 (NS1) is positive in first week of infection and start declining after resolution of viremia [8,9]. Our research study is based on clinical assessment of dengue virus by using hemodynamic and serologic marker causing the epidemic in Pakistani population. We recently analyzed the dengue virus among local population in Pakistan and providing the better outcomes of patient management and disease control. MATERIALS AND METHODS This study was carried out at District Head Quarter Hospital (DHQ) Attock after approval by ethical research committee, DHQ Attock. The time duration was 10 months from January 2019 to October 2019. All the suspected dengue patients confirmed by serology (NS1, IgM /IgG) were included in this research study as cases (dengue group) and, all other febrile illness (<7 days) like malaria, enteric fever, pyrexia of unknown origin were included in control group. Patients having prolonged fever (more than7 days) due to other viral/bacterial illness were excluded. Sampling technique was non probability random sampling. Sample size according to WHO calculator was 300 as further divided 154 as cases and 146 as control group. Data including demographic data, clinical symptoms and hematological parameters including platelets count, WBC count and hematocrit (Pre and post treatment) were collected and compared between dengue group and control group patients admitted at DHQ Attock. OPERATIONAL DEFINITION Thrombocytopenia was defined as total platelets less than 100,000/ cu, mm. Leukopenia was defined as WBC less than 4000/ cu, mm. hematocrit determined when haemoconcentration is rise >20% above normal range. The Hematological parameters collected from the patient samples at 1st day and 7th day of fever whereas performed at DHQ hospital laboratory Attock by using automated hematology analyzer (Siemen’s ADVIA 2120). The serological tests NS1, Dengue IgM/IgG were performed by using rapiGEN BIOCREDIT (an in vitro immunochromatographic assay) as per manufacturer instruction. Serological confirmation of dengue is done by positive NS1 antigen or seroconversion of IgM or fourfold rise in IgG. ABSTRACT Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical, hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21. Results: A total of 154 cases of dengue (by using WHO calculator 154 suspected cases were defined fever >2 days and < 10days having hematologic and NS 1positive in earlier phase of disease) and 146 control cases were observed. Serology markers using NS1 dengue were detected positive in (85/154) 55%, dengue IgM in (46/154) 30% and both NS1 and dengue IgM in 15%(23/154) cases. Control group included malaria, enteric fever and febrile illness 103(71%), 30(20%), 13(9%) respectively. In cases 70(45%) were females and 85(55%) males with significant p value, while in control group 80(55%) were females and 66(45%) males with p value of < 0.05. For Hematological markers including platelets count, hematocrit and WBCs, paired sample T test showed high significant difference in value of platelets counts and hematocrit , while no significant difference in WBCS was observed. Conclusion: Serological markers (NS1, IgM and IgG) greatly helps in diagnosis as well as prognosis of dengue infection, thereby helping not only in reducing the morbidity and mortality in patients but also helps controlling the epidemic by observing early preventive measures by using Hematological markers in earlier phase of disease. These marker will make utilized by other Asian and tropical African countries. Keywords: Dengue fever; serologic markers; hematologic markers; Dengue infection; NS-1 antigen; IgM; IgG
  • 3. International Journal of Virology & Infectious Diseases SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 003 RESULTS Out of total of 154 patients in cases group, 55%(85/154) were positive for NS 1 antigen, 30%(46/154) for dengue IgM antibody and 15%(23/154) for both NS1 and IgM antibody. The control group included 71%(103/146) patients having malaria followed by 20%(30/146) enteric fever and 9%(13/146) were febrile illness other than these. (Table1) Illustrates the clinical characterization of Dengue and control groups according to age and gender. Slightly high male ratio with low mean age with some significant difference were seen in case (dengue) group as compared to control group and mean ages in groups with higher in males and lower in females. When compared the clinical symptoms between cases and control groups, dengue group and control group had Headache (48.7% vs 6%), Myalgia (34% vs 1%), Abdominal pain (6% vs 4%), Diarrhea (2% vs 4%), Chills 2(1% vs 34%), sore throat (9% vs 51%) as shown in table 2. In table 3 statistical analyses of paired samples taken before and after treatment for hematological markers including platelet count, hematocrit and WBC count is shown. Mean, standard deviation, standard error of mean, T test of paired samples and p value for platelets, hematocrit and white blood cells were also shown in table 3. Statistically significant p value for platelets and hematocrit was obtained, while non-significant p value was noted for WBC count. DISCUSSION Dengue is one of the big challenges in tropical regions specially under developed countries, while travel-associated infections occur in developed countries like America [10]. It is most widely and rapid spreading disease in south East Asia specially Pakistan, Bangladesh region where tropic season is very common among July to September. The World Health Organization (WHO) reports it as emerging challenge of public health awareness [11]. The present study conducted at DHQ hospital Attock, Pakistan. Dengue patients and control patients were checked for both hematologic markers (Platelets, Hematocrit, WBCS) before and after treatment) and serologic markers to confirm dengue in clinical course of illness. Using demographic data of this research study, most of patients of dengue were male 84(55%) and less frequent were female 70(45%). In contrast to control group where female patients 80(55%) were observed more than males 66(45%) with high significant p value that was <0.005 in both groups. Using clinical symptoms of cases and control group fever, myalgia, chills, headache, sore-throat, diarrhea and abdominal pain were 100% each, 34% and 1%. 1% and 34%, 48.6% and 6%, 9% and 51%, 2% and 4%, 6% and 4% respectively. Myalgia, headache and retrorbital pain were most common observed symptoms in dengue case group as compared to control group with other febrile illnesses in our study. Similar symptoms/findings has also been reported in patients with dengue fever in other retrospective study conducted at Thailand in 2018 by Juthatip [12]. In our study, serologic markers for diagnosis of dengue patients, including NS1antigen and IgM antibodies were detected positive either alone in 53% and 29% respectively or both (15%) in same patient. Similar results were also reported in other study conducted at Indonesia [13]. In this research study, control group comprised malaria cases (71%), enteric (21%) and febrile illness cases. Hematologic markers platelets count, hematocrit and WBCs analysed before and after treatment revealed thrombocytopenia in dengue cases before treatment that recovered after treatment during convalescence and become within normal ranges. Mean, standard deviation, standard error of mean for platelets, hematocrit and, WBCs were observed and paired sample T test applied. The p value was observed significant for platelets and hematocrit (< 0.05) but not for WBCS (> 0.05). Similar results were also observed by other studies conducted at Indonesia by Alametal [14] and at Thailand by Chaloewong J, et al. [12] with significant p value or platelets and hematocrit. At the end we conclude that by evaluating dengue infection using simple, easily available serological and hematologic markers before and after treatment not only helps in diagnosis and Table 1: Comparison of clinical characterization between cases and control groups. Cases (Dengue) Group (n = 154) Control Group (n = 146) p Value Gender Female Male 70 (45%) 84(55%) 80(55%) 66 (45%) <0.05 Mean age (years) 27(15-67) 45(15-83) <0.001 Table 2: Comparison of clinical presentation / symptoms between cases and control groups. Dengue (Cases) (n = 154)%Ages Control Groups (n = 146)% Ages Fever 154(100%) 146(100%) Myalgia 53(34%) 2(1%) Chills 2(1%) 53(34%) Headache/Retro- Orbital Pain 75(48.7%) 10(6%) Sore Throat 14(9%) 75(51%) Diarrhea 4(2%) 3(4%) Abdomen Pain 10(6%) 3(4%) Table 3: Statistical Analysis by SPSS. Mean Standard Deviation Standard Error of Mean 95% Confidence Interval Lower 95% Confidence Interval Upper T Dif p Value Platelets counts -192921 114904 9259 -211213 -174628 -20 153 0.00 Hematocrit -6.5 33.57 2.7 -11.9 -1.253 -2.4 153 .016 WBCS -1608766 4675 376.73 -905.39 583.3 -427 153 .670
  • 4. International Journal of Virology & Infectious Diseases SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 004 prognosis of patients but also indirectly helps in limiting its spread by observing early preventive measures thereby reducing the epidemic and decreasing the. REFERENCES 1. Suzarte E, Gil L, Valdes I, Marcos E, Lazo L, Izquierdo A, et al. A novel tetravalent formulation combining the four aggregated domain III-capsid proteins from dengue viruses induces a functional immune response in mice and monkeys. International immunology. 2015; 27: 367-379. PubMed: https:// www.ncbi.nlm.nih.gov/pubmed/25795768 2. Chen B, Liu Q. Dengue fever in China. The Lancet. 2015; 385: 1621-1622. http://bit.ly/2vLkxls 3. Horstick O, Jaenisch T, Martinez E, Kroeger A, See LLC, Farrar J, et al. Comparing the usefulness of the 1997 and 2009 WHO dengue case classification: A systematic literature review. Am J Trop Med Hyg. 2014; 91: 621-634. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24957540 4. Hadinegoro SRS. The revised WHO dengue case classification: does the system need to be modified? Paediatr Int Child Health. 2012; 32: 33-38. http://bit.ly/3bQsE0I 5. WHO. Comprehensive guideline for prevention and control of dengue and dengue hemorrhagic fever. SEARO Publications. 2011. https://bit.ly/2uOPYvi 6. Garg S, Chakravarti A, Singh R, Masthi NR, Goyal RC, Jammy GR, et al. Dengue serotype-specific seroprevalence among 5-to 10-year-old children in India: A community-based cross-sectional study. Int J Infect Dis. 2017; 54: 25-30. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27825949 7. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998; 11: 480-496. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9665979 8. Huits R, Soentjens P, Maniewski-Kelner U, Theunissen C, Van Den Broucke S, Florence E, et al. Clinical utility of the nonstructural 1 antigen rapid diagnostic test in the management of dengue in returning travelers with fever. Open forum infectious diseases. 2017; 4. http://bit.ly/37FXeqk 9. Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, et al. Evidence-based risk assessment and communication: A new global dengue- risk map for travellers and clinicians. J Travel Med. 2016; 23. PubMed: https:// www.ncbi.nlm.nih.gov/pubmed/27625400 10. Mohammed HP, Ramos MM, Rivera A, Johansson M, Muñoz Jordan JL, Sun W, et al. Travel associated dengue infections in the United States, 1996 to 2005. Journal of travel medicine. 2009; 17: 8-14. http://bit.ly/2HDtUXa 11. Halstead SB. Dengue: The syndromic basis to pathogenesis research. Inutility of the 2009 WHO case definition. Am J Trop Med Hyg. 2013; 88: 212- 215. http://bit.ly/38FmYEF 12. Chaloemwong J, Tantiworawit A, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, et al. Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: A retrospective study. BMC Hematology. 2018; 18: 20. http://bit.ly/2SW1oW3 13. Lee Yong-seok. Passive fever surveillance for dengue in Nha Trang City, Vietnam: Association between clinical and laboratory-confirmed diagnoses of dengue. Seoul National University. 2018; http://bit.ly/39Erzaq 14. Alam A, Handayani I, Indrati A. Association of serologic and hematologic test results in dengue infant patients in RSUP. Dr. Hasan Sadikin Bandung. IOP Conference Series: Earth and Environmental Science. 2018. http://bit. ly/37GgeoS