Retrospective Study of Fatal Dengue Hemorrhagic Fever in Lahore City

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DOI: 10.21522/TIJPH.2013.04.04.Art058

Authors : Samra Ashraf


Dengue fever is one of the most common mosquito-borne viral diseases of human beings. It has become a major reason for public health concern internationally over the recent years because of disease morbidity and mortality. Globally around 2.5 billion people are living in areas where dengue viruses can be transmitted. Spread of mosquito vectors & viruses in geographical distribution are two main reasons of rise in incidence and prevalence of dengue fever & appearance of dengue hemorrhagic cases. Urban areas of the tropics have been identified to be highly endemic. According to estimates made by WHO around 50–100 million infections of dengue are prevalent every year globally. (Deen et al. 2006) In Pakistan first dengue outbreak was reported in Karachi in 1994 as environmental conditions are conducive to Aedes mosquito breeding. Economic and security related migration introduced virus to Lahore as well. According to Punjab Health Department 590339 suspected cases were reported in Lahore & 21685 confirmed by serology. It has been observed that 5-10% of these cases develop DHF.(Mahmood et al. 2013)

Dengue is mainly transmitted by mosquito vector i.e. Aedesaegypti and can also be transmitted by A. albopictus to a lesser extent. Virus that causes dengue has four different types that are closely related to each other. Infected female mosquitoes transmit this virus to human beings through bite. An infected mosquito can transmit this virus to humans for the rest of its life. Symptoms of dengue range from very mild fever to very high fever including intense headache, retro-orbital pain, muscular and joint pain, and rashes. There is no vaccine or any specific medicine to treat dengue. Patients having dengue fever are advised to take rest and drink ample fluids. They are advised to use paracetamol in order to reduce high grade fever or visit the physician if fever persists. Recovery from infection by one provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. There have been enough proofs showing that subsequent infection increases the risk of severity of disease which can result in DHF (WHO).

Leaking of plasma, fluid accumulation, respiratory distress, and intense bleeding and organ impairment makes severe dengue a fatal complication. Warning signs includes decrease in temperature (below 38°C/ 100°F), severe abdominal pain, rapid breathing, bleeding gums, malaise, and restlessness, continuous vomiting and hematemesis. These can occur three to seven days after first symptom recognition. In order to prevent complications and minimize the risk of death adequate and timely health care is required in next 1-2 critical days.(Halstead 1980)


[1]. Ahmed S, Mohammad W, Hamid F, Akhter A, Afzal RK, Mahmood A.2011. The 2011 dengue haemorrhagic Fever outbreak in lahore-an account of clinical parameters and pattern of haemorrhagic complications. J Coll Physicians Surg Pak. 23 (7): 463-467.

[2]. Chairulfatah A, Setiabudi D, Agoes R, van Sprundel M, Colebunders R. 2001. Hospital based clinical surveillance for dengue haemorrhagic fever in Bandung, Indonesia 1994-1995. Acta tropica. 80 (2): 111-115.

[3]. Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, Dung NM, Hung NT, Hien TT, Farrar JJ. 2006. The WHO dengue classification and case definitions: time for a reassessment. The Lancet. 368 (9530): 170-173.

[4]. DeRoeck D, Deen J, Clemens JD. 2003. Policymakers' views on dengue fever/dengue haemorrhagic fever and the need for dengue vaccines in four southeast Asian countries. Vaccine. 22 (1): 121-129.

[5]. Drosten C, Göttig S, Schilling S, Asper M, Panning M, Schmitz H, Günther S. 2002. Rapid detection and quantification of RNA of Ebola and Marburg viruses, Lassa virus, Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, dengue virus, and yellow fever virus by real-time reverse transcription-PCR. J. clin microbiol. 40 (7): 2323-2330.

[6]. Fernandez-Mestre MT, Gendzekhadze K, Rivas-Vetencourt P, Layrisse Z. 2004. TNF-alpha-308 Aallele, a possible severity risk factor of hemorrhagic manifestation in dengue fever patients. Tissue Antigens. 64:469–72

[7]. Figueiredo MAA, Rodrigues LC, Barreto ML, Lima JWO, Costa MC, Morato V, Blanton R, Vasconcelos PF, Nunes MR, Teixeira MG. 2010. Allergies and diabetes as risk factors for dengue hemorrhagic fever: results of a case control study. PLoS neglected tropical diseases. 4 (6): e699.

[8]. Gibbons RV, Vaughn DW. 2002. Dengue: an escalating problem. BMJ: British Medical Journal. 324 (7353): 1563.

[9]. Gonzalez D, Castro OE, Kouri G, Perez J, Martinez E, Vazquez S, Rosario D, Cancio R, Guzman MG. 2005. Classical dengue hemorrhagic fever resulting from two dengue infections spaced 20 years or more apart: Havana, Dengue 3 epidemic, 2001-2002. Int J Infect Dis. 9 (5): 280-285.

[10]. Gubler DJ 2002. Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol. 10 (2): 100-103.

[11]. Guzman MG, Alvarez M, Rodriguez R, Rosario D, Vazquez S, Valdes L, Cabrera MV, Kouri G. 1999. Fatal Dengue Hemorrhagic Fever in Cuba, 1997. IJID. 3 (3): 130-135.

[12]. Halstead S 1980. Dengue haemorrhagic fever—a public health problem and a field for research. Bulletin of the World Health Organization. 58 (1): 1.

[13]. Halstead SB 2007. Dengue. The Lancet. 370 (9599): 1644-1652.

[14]. Humayoun MA, Waseem T, Jawa AA, Hashmi MS, Akram J.2008. Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virus outbreak in Punjab, Pakistan. Int J Infect Dis. 14 e54-e59.

[15]. Jennifer L. Kyle, Eva Harris. 2008. Global Spread and Persistence of Dengue. Annu. Rev. Microbiol.62:71-92

[16]. Khan MIH, Anwar E, Agha A, Hassanien NSM, Ullah E, Syed IA, Raja A. 2013. Factors Predicting Severe Dengue in Patients with Dengue Fever. Mediterr J Hematol Infect Dis. 5 (1).

[17]. Libraty DH, Young PR, Pickering D, Endy TP, Kalayanarooj S, Green S, Vaughn DW, Nisalak A, Ennis FA, Rothman AL. 2002. High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue hemorrhagic fever. J. Infect. Dis. 186 (8): 1165-1168.

[18]. Mahmood K, Jameel T, Aslam HF, Tahir M. 2009. Incidence of dengue haemorrhagic fever in local population of Lahore, Pakistan. Biomedica. 25 93-96.

[19]. Mahmood S, Hafeez S, Nabeel H, Zahra U, Nazeer H. Does Comorbidity Increase the Risk of Dengue Hemorrhagic Fever and Dengue Shock Syndrome? ISRN Tropic Med. 2013.

[20]. Pang J, Salim A, Lee VJ, Hibberd ML, Chia KS, Leo YS, Lye DC. 2012. Diabetes with Hypertension as Risk Factors for Adult Dengue Hemorrhagic Fever in a Predominantly Dengue Serotype 2 Epidemic: A Case Control Study. PLoS Negl Trop Dis. 6 (5): e1641.

[21]. Pinheiro FP, Corber SJ. 1997. Global situation of dengue and dengue haemorrhagic fever, and its emergence in the Americas. World Health Stat Q. 50 161-169.

[22]. Shahzad MK, Ijaz T, Ijaz S, Younus M. 2007. Lab Based surveillance of Dengue Hemorrhagic Fever during 2006 Epidemic in Lahore. Int J Agro Vet Med Sci. 1 (0): 13-16.

[23]. Wahid S, Sanusi S, Zawawi MM, Ali RA. 2000. A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue fever.