DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20175106

Profile of serum transaminases in patients with dengue infection in a tertiary care hospital

Vijay Kulkarni, Bhavana Koppad, Manasa U. Shetty

Abstract


Background: Although dengue virus is a non hepatotropic virus, liver injury due to dengue infection is not uncommon. Atypical manifestations with liver involvement have frequently been reported, ranging from mild elevations of aminotransferase levels to fulminant hepatitis. The aim of the present study is to study the serum transaminases level in various forms of dengue infection and correlate with severity.

Methods: An analysis of 151 serologically confirmed cases (0-14 yrs) of dengue from June 2017 to July 2017 at a tertiary care hospital, Dharwad was made to assess the frequency and degree of hepatic dysfunction in children with dengue infection by analyzing serum transaminase levels. Patients were classified according to WHO as dengue without warning signs, with warning signs and severe dengue. Patients were divided into primary and secondary dengue based on serology and serum transaminases levels were assessed in each of the above groups. Patients with normal aminotransferase levels were categorized into Grade A, those with atleast one of the enzymes raised to less than 3 times the reference range as Grade B, those with atleast one of the enzymes elevated more than 3 times but less than 10 times as Grade C and those with elevations more than 10 times as Grade D. χ2 test was applied to check statistical significance.

Results: During the study period, the total number of serologically confirmed cases of dengue were 151 among which dengue fever without warning signs were 38, with warning signs were 91 and severe dengue were 22. Serum transaminase levels were significantly raised in severe dengue (χ2=14.228, df=6, p=0.027).It was also found that transaminases were significantly higher in secondary dengue infection than primary dengue ( χ2=10.155, df=3, p=0.017). Transaminases were significantly elevated in non-survivors (χ2=16.958, df=3, p<0.001).

Conclusions: Hepatic dysfunction was common in all forms of dengue infection, with AST rising significantly more than ALT. Transaminases were significantly elevated in severe dengue and secondary dengue infections. Patients with significantly high transaminases had a poor outcome. 


Keywords


Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Dengue infection, Hepatic dysfunction, Transaminases

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References


Souza RW, Cunha RV, Miagostovich MP. An outbreak of dengue virus infection in the state of Ceará, Brazil. Mem Inst Oswaldo Cruz. 1995;90(3):345-6

Vasconcelos PF, Menezes DB, Melo LP, Pessoa P, Eni TF, Rodrigues SG, et al. A large epidemic of dengue fever with dengue hemorrhagic cases in Ceará State, Brazil, 1994. Rev Inst Med Trop São Paulo. 1995;37:11-7.

Nogueira RM, Filippis AM, Coelho JM, Sequeira PC, Schatzmayr HG, Paiva FG et al. Dengue virus infection of the central nervous system (CNS): A case report from Brazil. SE Asian J Trop Med Pub Health. 2002;33(1):68-71.

George R, Liam CK, Chua CT, Lam SK, Pang T, Geethan R et al. Unusual clinical manifestations of dengue virus infection. SE Asian J Trop Med Pub Health. 1988;19(4):585-90.

Lum LC, Lam SK, George R, Devi S. Fulminant hepatitis in dengue infection. SE Asian J Trop Med Pub Health 1993;24(3):467-71.

Nimmannitya S, Thisyakorn U, Hemsrichart V. Dengue haemorrhagic fever with unusual manifestations. SE Asian J Trop Med Pub Health. 1987;18(3):398-406.

Souza LJ, Lopes AC, Bastos DA. Jaundice in hemorrhagic dengue: report of three cases. Rev Bras Clin Terap. 2002;28(5):198-201.

Nimmannitya S. Clinical spectrum and management of dengue haemorrhagic fever. SE Asian J Trop Med Pub Health. 1987;18(3):392-7.

Miagostovich MP, Dos Santos FB, De Simone TS, Costa EV, Filippis AM, Schatzmayr HG et al. Genetic characterization of dengue virus type 3 isolates in the State of Rio de Janeiro, 2001. Braz J Med Biol Res. 2002;35:1-4.

Díaz SV, Martínez MP, Saent-Félix FG. Hepatitis reactiva por virus del dengue hemorrágico. Rev Cubana Med Trop. 2001;53(1):28-31.

Mohan B, Patwari AK, Anand VK. Hepatic dysfunction in childhood dengue infection. J Trop Pediatr. 2000;46:40-3

Nguyen TL, Nguyen TH, Tieu NT. The impact of dengue haemorrhagic fever on liver function. Res Virol. 1997;148:273-7.

Wahid SF, Sanusi S, Zawawi MM, Ali RA. A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue Fever. SE Asian J Trop Med Pub Health. 2000;31(2):259-63.

Kuo CH, Tai DI, Chang-Chien CS, Lan CK, Chiou SS, Liaw YF. Liver biochemical tests and dengue fever. Am J Trop Med Hyg. 1992;47(3):265-70.

Sharma S, Sharma SK. Clinical profile of DHF in adults during 1996 outbreak in Delhi, India. Dengue Bulletin. 1998;22:20-27.

Daniel R, Rajamohanan, Philip AZ. A study of clinical profile of dengue fever in Kollam, Kerala, India. Dengue Bulletin. 2005;29:197-202.

Itha S, Kashyap R, Krishnani N, Saraswat VA, Choudhuri G, Aggarwal R. Profile of liver involvement in dengue virus infection. Natl Med J India. 2005;18(3):127-130.

Souza LJ, Gonçalves Carnerio H, Souto FilhoJT, Souza TF, Cortes VA, Neto CG et al. Hepatitis in dengue shock syndrome. Braz J Infect Dis. 2002;6(6):322-7.

Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayaorn S, Kunentrasai N et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176(2):313-21.