背景登革热,由登革病毒引起的蚊媒发热病,已成为公共卫生的主要问题之一。它可能只出现发烧,或者可能有出血性表现或感染性休克。由于没有针对登革热的特定治疗方法,疾病的早期发现,进展评估,通过研究实验室标志物来预测结果将有助于指导病例的管理,降低发病率和死亡率。方法学这项临床观察性研究是在加尔各答三级医院的微生物学系进行的,印度,从2020年2月至2022年8月,确定登革热患者的结果与病毒载量相关,NS1抗原,IgM和IgG抗体,铁蛋白水平,血小板计数,和其他实验室参数。结果316例发热患者样本中,103例(32.5%)为NS1抗原反应性。我们对登革热患者(n=103)进行了15天的随访,并根据其症状持续时间将其分为三组(A组≤5天,B组5~10天,和C组持续>10天),并根据WHO疾病严重程度分类,即没有警告标志的登革热(DOS),带有警告标志的登革热(DWS),和严重登革热(SD)。根据严重性,65例(63.1%)患者有DOS,而31例(30.09%)患者有DWS,7例(6.79%)患者有SD。C组83.33%的患者出现继发感染,71%的DWS病例,57%的SD病例,与肝酶呈正相关,病毒载量(继发感染的平均值102195与原发感染1195个拷贝/10μl),并与血小板计数呈负相关(继发感染的平均值60,213与1,25,516原发感染)。C组患者有较高的肝酶,血小板计数降低,并且初始病毒载量高于A组和B组。SD病例的铁蛋白水平较高(9215ug/l),较低的血小板计数(平均值23,250),和较高的初始病毒载量(平均值2,74,257个拷贝/10μl)。考虑到峰值及其基线值的血细胞比容值的增加是疾病严重程度的重要标记而不是其绝对值。结论登革热感染预后差,即,症状持续时间和疾病严重程度的增加取决于高血清铁蛋白之间的关联,血细胞比容水平升高,血小板减少症,继发感染,增加肝酶,和增加初始病毒载量。
Background Dengue, the mosquito-borne febrile disease caused by the dengue virus, has become one of the major concerns of public health. It may present with only fever, or there may be a hemorrhagic manifestation or septic shock. As there is no specific treatment for dengue, early detection of the disease, assessment of progression, and prediction of outcome by studying the laboratory markers will help guide the management of cases and lower morbidity and mortality. Methodology This clinico-observational study was conducted at the Department of Microbiology in a tertiary care hospital in Kolkata, India, from February 2020 to August 2022 to determine the outcome of dengue patients in correlation with viral load, NS1 antigen, IgM and IgG antibodies, ferritin level, platelet count, and other laboratory parameters. Results Out of 316 samples from fever patients, 103 (32.5%) were NS1 antigen reactive. We followed up the dengue patients (n = 103) for 15 days and divided them into three groups according to their duration of symptoms (group A suffered for ≤5 days, group B for 5 to 10 days, and group C for >10 days) and per the WHO classification of disease severity, namely dengue without warning signs (DOS), dengue with warning signs (DWS), and severe dengue (SD). Based on severity, 65 (63.1%) patients had DOS, whereas 31 (30.09%) patients had DWS, and seven (6.79%) patients had SD. Secondary infection was present in 83.33% of patients in group C, 71% of DWS cases, and 57% of SD cases, which positively correlates with liver enzymes, viral load (mean value 102195 in secondary infection vs. 1195 copies/10 µl in primary infection), and negatively correlates with platelet counts (mean value 60,213 in secondary infection vs. 1,25,516 in primary infection). Patients in group C had higher liver enzymes, a lower platelet count, and a higher initial viral load than groups A and B. Similarly, SD cases had a higher ferritin level (9215 ug/l), a lower platelet count (mean value 23,250), and a higher initial viral load (mean value 2,74,257 copies/10 µl). An increase in hematocrit value considering the peak value and its baseline value is an important marker for disease severity rather than its absolute value. Conclusion Poor outcome of dengue infection, i.e., an increase in the duration of symptoms and disease severity depends on concurrent associations between high serum ferritin, increased hematocrit level, thrombocytopenia, secondary infection, increasing liver enzymes, and increased initial viral load.