Profile of common tropical infections in a temperate community (dengue, malaria, chikungunya)

Abstract

Background: Kashmir being a temperate region does not have indigenous Dengue ,Malaria and Chikngunya ,hence our patients have a definite history of travel to outside Kashmir and their clinical profile,complication profile,drug effects,  and outcome are different from rest of the country.

Objective: Study the pattern of common Tropical infections like Dengue,Malaria and Chikungunya in our community. Compare complication profile ,drug effects and outcome of such infections in our community. Concomitant occurrence of these infections and their combined impact.

Study Design : Prospective Observational Study.

Participants: The study population consisted of 104 patients with age ≥ 18 years out  of  which 74(71.15%) were Dengue, 25(24.04%) were Malaria and 5(4,81%) were Coinfection.In our  study 81(78%) were males and 23(22%) were females.

Materials and Methods: The study was a hospital based prospective  observational study included patients who were admitted in the Department of internal Medicine SKIMS  confirmed for Dengue,Malaria and Chikungyunya were taken as subjects for the study.Blood samples were collected from all the patients with the symptoms and signs of dengue,malaria and chikungunya, The samples were examined for CBC, KFT, LFT and Serology of Dengue , malaria and chikungunya. The results were being interpreted as being significant and insignificant. The categorical variables were analysed by Pearsons chi square and Fishers exact test using SPSS software version 22.P value less than 0.05 was considered to be statistically significant.

Results: This study enrolled a total no.of 104 patients who were admitted in the department of General Medicine SKIMS. Out of 104 cases 74(71.15%) were Dengue, 25(24.04%) were malaria and 5(4.81%) were coinfection.81(78%)  patients were males and 23(22%) were females.The most common clinical presentation was Fever 104(100%) in all three groups. In Dengue group the most common clinical presentation after fever was disturbing myalgias/arthralgias in 72(97.3%) followed by retro-orbital pain in 49(66.2%).In malaria group ,the most common clinical presentation after fever was disturbibg myalgias/arthralgias  in 25(100%) patients ,chills /rigors in 23(92%) patients. The most common clinical sign  in dengue  patients was  maculopapular rash in 48(64.9%) and the most common clinical sign in malaria patiens was also maculopapular rash in 4(16%) patients.The most common haematological abnormality in all dengue,malaria and coinfection patients was Thrombocytopenia followed by Leukopenia.The Thrombocytopenia and leukopenia was more severe in dengue and coinfection patients as compared to malaria patients.The mean AST was higher than ALT in all patients.Coagulopathy was present in 8(10.8%) dengue patients.The mean CRP level was high in dengue and coinfection group but it was normal in all malaria patients.The CPK and LDH levels were more raised in dengue and coinfection group as compared to malaria patients. The most severe complication in our study in dengue patients was critical thrombocytopenia followed by hypotension.

Conclusion: Our study is the first study in a temperate region in Kashmir on tropical infections.This study sheds light on clinical presentation of tropical infections in a temperate region.It was found the most common symptom in our patients was fever.70% 0f our patients have multiorgan involvement and some develop critical complications like critical thrombocytopenia, pleural effusion, hypotension, hypoxemia, mild proteinuria with hematuria and gall bladder wall thickening, hence our patients need more close clinical and laboratory monitoring during the first 2 weeks of clinical coursein order to treat and prevent dangerous complications.

Implication: Our patients infected with tropical infections need more close clinical and laboratory monitoring in order to prevent dangerous complications in these patients.