Dengue Virus Infection: Clinical and Laboratory Characteristics; and Outcomes of Patients Admitted Due to Dengue in Mombasa-kenya a Multicenter Retrospective Study

Abstract

Background: Dengue infection is an acute vector-borne viral disease. The annual incidence is estimated at 390 million infections per year, with approximately 20,000 annual deaths worldwide. Clinical and laboratory characteristics have demonstrated geographical and regional variation. The clinical spectrum of the disease is heterogenous. Dengue poses a diagnostic challenge, partly due to its atypical presentation and overlap of symptoms with other febrile illness, especially in endemic regions with limitation of rapid diagnostic kits. Prolonged hospitalization, cost of care, morbidities and mortalities related to dengue has imposed substantial economic, social, and personal burden. This retrospective study describes the clinical and laboratory characteristics, treatment modalities, disease severity and complications among patients admitted due to dengue infection. Objectives: To determine the clinical and laboratory characteristics and outcomes of patients admitted with dengue infection between February 2018 and January 2020 in three selected hospitals at the coastal city of Mombasa, Kenya. Methods: This was a multicenter retrospective descriptive study. We included consecutive patients admitted due to laboratory confirmed dengue infection, from February 2018 to January 2020. Clinical and laboratory characteristics and socio-demographics data were extracted from patients’ files and recorded into a study proforma. Data on dengue-related complications, length of hospital stay, and mortality during hospitalization period were summarized. Results: Out of 601 dengue cases, 319 (53.1%) were males. The mean age was 36.2 years, with 65% of the study participants between 13-40 years. Average duration of the hospital stay was 4 days. Approximately 90% of the patients were admitted with non-severe dengue, while 26.9% had evidence of warning signs. The most common clinical presentation followed by fever (92.3%) were myalgia 467 (77.7%), headaches 439 (73.0%) and retro-orbital pains 112 (18.6%). Among the clinical warning signs, mild muco-cutaneous bleeding was recorded in 62 patients. The common hematological findings were thrombocytopenia in 441 (73.3%), followed by leucopenia in 366 (60.8%), and hemoconcentration in 76 (12.6%) of the cases. Mild to moderate elevation of AST in 247 (43.1%) and ALT 177 (30.8%) were the commonest biochemical findings. Sixty-six (10.9%) patients presented with severe dengue. AKI was the commonest complication observed in 37 (6.3%), followed by myocarditis 11 (2.9%), DSS 10 (1.7%) CNS dengue 8 (1.4%), ARDS 8 (1.4%), severe hepatitis 6 (1.0%) and severe hemorrhage 4 (1.0%). Among the patients with severe dengue, four died.