Capillary Leak Syndrome in Hospitalized Cases of Dengue Fever - Is It Really a Marker of Severity?

Abstract

Background: Dengue is a mosquito-borne viral infection spread by the Aedes aegypti mosquito and is caused by one of the four dengue viruses of arbovirus family. This study was undertaken to analyze detailed findings in capillary leak syndrome (CLS) among hospitalized dengue fever (DF) cases and its relation to severity of dengue illness. Since the first reported dengue fever outbreak in Madras (now Chennai) in India in 1780, recurrent outbreaks have been reported [1]. However, not many studies from India have addressed to the issue of capillary leak syndrome in these cases. This is the largest case series on 164 cases of CLS in DF. Materials and Methods: The present study was done at Narayana Multispecialty hospital, Jaipur and had been approved by the institute ethical committee. It is a four year retrospective observational study comprising of 264 indoor patients of confirmed DF out of which 164 cases had CLS and 100 cases were without CLS. The presenting symptoms, dengue NS1 antigen and antibody tests, co-infection, co-morbidities, laboratory investigation, mortality, duration of hospital stay were recorded, tabulated and analyzed. Results: Besides fever, hepato-splenomegaly, chills, vomiting, abdominal pain, body-ache, and bleeding manifestations, isolated gall bladder (GB) wall edema was present in 26 (15.9%) cases, ascites in 8 (4.9%) cases, and pleural effusion in 11 (6.7%) cases respectively. Pleural effusion was right sided in 8 (4.9%) cases, bilateral in 3 (1.8%) cases and only left sided in none of the cases. Both ascites and pleural effusion was present in 9 (5.5%) cases and triad of ascites, GB wall edema and pleural effusion was seen in 76 (46.3%) cases respectively. None of the case had pericardial effusion. Conclusion: We conclude that CLS is as common in primary as in secondary dengue fever patients and that it probably appears to be a universal finding at microscopic level.