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Volume 4 No. 2, April 2009 |
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Dengue Fever in Makkah: Clinical Manifestations Including Skin Changes and Laboratory Data Ahmad H Nassar, Wael A Shahin1, Mamdouh H Kalakattawi2, Hassan A Bukhari2
Dermatology, Andrology, and Sexually Transmitted Diseases
Department, Tanta University;
Tropical Medicine, Gastroenterology and Hepatology Department, Benha
University1;
Egypt and
Internal Medicine Department, Alnoor Specialist Hospital2;
the Holy Makkah, Saudi Arabia
Background/Aim: Dengue virus infection is increasingly recognized as
one of the world’s major emerging infectious diseases. Outbreaks
have been more common in the Middle East in the 1990s. A major
epidemic occurred in Jeddah, Saudi Arabia, in 1994. No reports were
issued about dengue fever (DF) from Makkah up till now. The aim of
this work is to report the clinical manifestations of DF including
skin manifestations and laboratory data along with the disease
outcome in all confirmed cases of DF in Makkah, Saudi Arabia during
the last three years (2006-2008). Patients and methods: During the
last three years, 159 patients with fever with/without skin rash
were admitted to Alnoor Specialist Hospital in Makkah, Saudi Arabia.
Patients were clinically evaluated and fully investigated and found
to have DF. Results: 61% of patients were admitted during 2007.
77.4% of patients were admitted during spring and early summer
months. 67% of patients were Saudis. The mean age was 25.6±16.1
years. 79.6% of patients below 30 years were Saudis. The ratio of
males to females was 2:1. High grade fever and severe bodyaches were
the main presenting symptoms. 26 patients had skin rash (morbilliform
in 57.7%, white spots in a red dress-type of skin rash in 30.8%, and
facial sunburn-like erythema with clear periorbital sparing in
11.5%). 12 (7.5%) patients presented with hemorrhagic
manifestations. Leukopenia, and thrombo-cytopenia were prominent
among patients. Hemoglobin mean level was significantly higher in
classic dengue fever (CDF) patients than in dengue hemorrhagic fever
(DHF) patients (P<0.027) and hematocrit value was significantly
higher in DHF patients than in CDF patients (P<0.025). Partial
thromboplastin time (PTT) was prolonged in all DF patients (100%).
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
were high in patients with DF. AST to ALT ratio was 1.63:1 in DF,
1.38:1 in CDF, and 1.76:1 in DHF. AST, ALT, and PTT were
significantly high in DF patients without rash than in those with
rash. 92.4% of patients were diagnosed as CDF and 7.6% were
diagnosed as DHF. One (0.63%) patient with DHF developed dengue
shock syndrome (DSS) and died. Conclusions: This study confirms the
endemic occurrence of DF in Makkah. Physicians have to be alert and
have to have a high suspiciousness index for the disease in patients
presenting with fever with or without skin rash, leucopenia,
thrombocytopenia, and elevated hepatic aminotransferases especially
in an endemic area. All the concerned authorities have to apply all
possible measures to prevent the spread of this potentially serious
disease. |
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