The Association of Co-Morbidities and Severity of Dengue Fever and Organ Specific Complications in Trivandrum District in Urban Kerala

BACKGROUND Dengue fever (DF) is caused by a flavivirus and is transmitted to humans by the vector Aedes aegypti. Industrialization and unplanned urbanization have led to an increase in incidence of DF. DF can lead to organ-specific complications especially in those with co-morbidities. The present study was done to estimate the prevalence of organ-specific complications in DF and determine the association of comorbidities and development of organ-specific complications. METHODS This is a prospective cross-sectional observational study. 148 participants with DF as confirmed by NS1 antigen or dengue IgM presenting to medicine outpatient department of Government Medical College, Trivandrum were enrolled in the study after obtaining written informed consent and obtaining Institutional Ethics Committee approval. Examination findings, laboratory investigations [complete blood count (CBC), liver & renal function tests (RFT)], chest radiograph, ultrasonography (USG), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) examination were done as routine procedures wherever necessary, and the details were collected in case record forms. Data was analysed using Rafter assessment of normality and homogeneity and chi square test was used to determine the association between parameters and organ specific complications. P < 0.05 was considered statistically significant. RESULTS Acalculous cholecystitis (29.1), hepatitis (4.7 %), aseptic meningitis (4.1 %), encephalopathy (4.1 %), myocarditis (3.4 %), encephalitis (2.7 %), acute kidney injury (2 %), acute respiratory distress syndrome (2 %), pericardial effusion (1.4 %), pleural effusion (1.4 %) and conduction anomalies of heart (0.7 %) were the organ specific complications associated with DF. Participants with co-morbidities were at a higher risk of developing organ-specific complications when compared to the healthier individuals. CONCLUSIONS Acalculous cholecystitis was the most common complication associated with DF and the presence of co-morbidities was a significant risk for development of complications. Proper planning for vector control measures especially during highrisk seasons would reduce the transmission of the disease and reduce the healthcare burden, mortality and morbidity associated with dengue fever. KEY WORDS Dengue Fever, Organ Specific Complications, Acalculous Cholecystitis, Hepatitis, Meningitis