Predictors for Severity of Dengue Infection during Early Days of Infection

Riffat MEHBOOB; Adnan Shahzad SYED; Mulazim Hussain BUKHARI; Asad Aslam KHAN; Fridoon Jawad AHMAD

Authors

Riffat MEHBOOB Molecular Cell Biology and Genetics Center, Department of Pathology, King Edward Medical University, Lahore
Adnan Shahzad SYED Institute for Genetics, University of Cologne, Cologne
Mulazim Hussain BUKHARI Molecular Cell Biology and Genetics Center, Department of Pathology, King Edward Medical University, Lahore
Asad Aslam KHAN Department of Pathology, King Edward Medical University, Lahore
Fridoon Jawad AHMAD Molecular Cell Biology and Genetics Center, Department of Pathology, King Edward Medical University, Lahore

Keywords:

Predictors of dengue infection, dengue, serum biomarkers, liver function tests, renal function tests

Abstract

Hepatorenal dysfunction has been implicated in dengue virus infection due to the obvious effects of dengue virus infection on the hepatorenal organs. This study was undertaken to establish the possible role of different serum biomarkers involved to have roles in the liver and kidney to see the pathology and prognosis of dengue virus infection. It is an observational, descriptive and retrospective study conducted on 74 sero positive cases during the early days of dengue virus infection (1 - 7 days) confirmed by Real time PCR (CDC Atlanta) who, in the period of August to November 2011 visited a tertiary care hospital in Lahore. Patients of both genders and all age groups were included. Patients were divided into 3 age groups i.e. 11 - 30, 31 - 50, 51 - 70 years. The tests analysed were platelet count, serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), urea, creatinine and albumin, protein concentrations. This article assesses the value of these serum biomarkers and its association with age, gender, platelet count and bleeding tendencies in dengue patients. Most of these parameters were normal in dengue infected patients except for albumin, urea and creatinine. Hypoalbuminemia was observed in (54.05 %) of patients, low creatinine (95.94 %) and raised urea (41.89 %) values were observed in patients with dengue virus infection. No association was observed between these serum biomarkers and bleeding. More dengue patients had declined platelet counts (< 50,000/µl). Dengue infection was more in males and in age group 11 - 30 years but hemorrhagic signs were more in females and in older patients of more than 50 years. From the study, impaired hepatorenal function, found to be common in dengue infected patients, was associated with declining levels of serum albumin, creatinine and raised levels of urea. Hence serum albumin, creatinine and urea can be used as predictive markers for the severity of dengue virus infection during early infection while it cannot help in differentiating dengue fever from dengue hemorrhagic fever. Our study is among the few to report involvement of the kidney along with liver during dengue infection.

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Author Biography

Fridoon Jawad AHMAD, Molecular Cell Biology and Genetics Center, Department of Pathology, King Edward Medical University, Lahore

Professional Experience:

2005-Present   Visiting Faculty,
Lahore University of Management Sciences, School of Science and Engineering (LUMS-SSE, Lahore, Pakistan.

2005-Present   Foreign faculty professor, Higher Education Commission
King Edward Medical University, Lahore, Pakistan (July 1, 2006-Present).
Center for Excellence in Molecular Biology Lahore, Pakistan (Feb 4,2005-June 30,2006).
2001-2005 Consultant.
Drexel University College of Medicine, Philadelphia
Pennsylvania.

Professional Experience (Continued):

2002-2003 Consultant.
Northwestern University, Medical School Chicago, Illinois.

1998-2000 Scientist.
The Medical School, The University of
Wisconsin-Madison.

1991-1994 Research Specialist.
The Medical School, The University of
Wisconsin-Madison.

Education:
2000-2001  Post Graduate Training in Medical
Cytogenetics, State Laboratory of Hygiene,
Madison Wisconsin.

1994-1998   PhD Cellular and Molecular Biology,
The University of Wisconsin-Madison.

1987-1991   B.S. Genetics,
The University of Wisconsin-Madison.

Professional Memberships:
American Society for Cell Biology
American Society for Human Genetics

Current Grants:
Startup Research Grant for Faculty Hired under Foreign Faculty Program (PKR 1,000,000. Funded)

Development of “Stem Cell Therapy” for Patients Suffering from Heart Disease in Pakistan (PKR 4,106,333. Funded).

Umbilical cord blood Mesenchymal Stem Cells for Deep Burn Wounds: A novel approach in Tissue Engineering:(PKR 20,000,000 Applied).

References

M Hemungkorn, U Thisyakorn and C Thisyakorn. Dengue infection: a growing global health threat. Biosci. Trend. 2007; 1, 90-6.

WF Wright and BS Pritt. Update: The diagnosis and management of dengue virus infection in North America. Diagn. Microbiol. Iinfect. Dis. 2012; 73, 215-20.

P Gurugama, P Garg, J Perera, A Wijewickrama and SL Seneviratne. Dengue viral infections. Ind. J. Dermatol. 2010; 55, 68-78.

MS Lee, KP Hwang, TC Chen, PL Lu and TP Chen. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J. Microbiol. Immunol. Infect. 2006; 39, 121-9.

NA Khan, EI Azhar, S El-Fiky, HH Madani, MA Abuljadial, AM Ashshi, AM Turkistani and EA Hamouh. Clinical profile and outcome of hospitalized patients during first outbreak of dengue in Makkah, Saudi Arabia. Act. Trop. 2008; 105, 39-44.

KF Tang and EE Ooi. Diagnosis of dengue: an update. Exper. Rev. Anti-Infect. Therap. 2012; 10, 895-907.

Webmd, Available at: http://www.webmd.com/a-to-z-guides/total-serum-protein, accessed October 2012.

Wikipedia, Available at: http://en.wikipedia.org/wiki/Human_serum_albumin#cite_note-0, accessed October 2012.

M Mahmuduzzaman, AS Chowdhury, DK Ghosh, IM Kabir, MA Rahman and MS Ali. Serum transaminase level changes in dengue fever and its correlation with disease severity. J. Mymensingh. Med. 2011; 20, 349-55.

K Jagadishkumar, P Jain, VG Manjunath and L Umesh. Hepatic involvement in dengue Fever in children. Iran. J. Pediat. 2012; 22, 231-6.

MG Guzman and G Kouri. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J. Clin. Virol. 2003; 27, 1-13.

M Canals, C Gonzalez, A Canals and D Figueroa. Epidemiological dynamics of dengue on Easter Island. Rev. Chil. Infectol. 2012; 29, 388-94.

SK Ghosh, S De, U Sarkar, M Ghosh, MK Chatterjee and S Samanta. Clinical profile of dengue during 2005 outbreak in Kolkata and predictive markers of dengue haemorrhagic fever. J. Ind. Med. Ass. 2011; 109, 790-3.

T Tantawichien. Dengue fever and dengue haemorrhagic fever in adolescents and adults. Paed. Internat. Chld. Hlth. 2012; 32, 22-7.

L Banh. Serum proteins as markers of nutrition: what are we treating? Pract. Gastroenterol. 2006; 43, 46-64.

CR Parrish, J Krenitsky and S McCray. University of Virginia Health System Nutrition Support Traineeship Syllabus. University of Virginia Health System Nutrition Support Traineeship, 2003.

C Mueller. True or false: Serum hepatic proteins concentration measure nutritional status. Suppor. Lin. 2004; 26, 8-16.

DS Seres. Surrogate nutrition markers, malnutrition, and adequacy of nutrition support. Nutr. Clin. Pract. 2005; 20, 308-13.

N Francis and DA Warrell. Pathology and Pathophysiology of HumanMalaria. In: Giles HM and Warrell D (eds.). Bruce Chwatt’s Essential Malariology. 3rd ed. Arnold and Oxford University Press, New York, 1993, p. 50.

NJ White. The treatment of Malaria. New Eng. J. Med. 1996; 335, 800-6.

JI Ebele, EN Emeka, CM Ignatius, E Mamah, EE Fidelis, S Ufelle and KE Kelechi. Serum protein level and hepatitis-B surface antigen in malaria infection. Europ. J. Sci. Res. 2010; 39, 542-7.