Xin Tian Chai, Ridzuan Dato’ Mohd Isa, Siti Azrin Ab Hamid, Kamarul Aryffin Baharuddin, Shaik Farid Abdull Wahab

LEARNING OBJECTIVE

Multiple studies focused on usage of ultrasound as an adjunct in clinical management of severe dengue fever. However the role of ultrasound in dengue fever without warning sign is yet to be explored.

The study evaluated early ultrasound findings in dengue fever without warning sign.

AIM

Dengue fever imposes significant health burden to populations living in tropical and subtropical country.

Multiple studies focused on usage of ultrasound as an adjunct in clinical management of severe dengue fever.

However the role of ultrasound in dengue fever without warning sign is yet to be explored. The study evaluated early ultrasound findings in dengue fever without warning sign.

METHODS

This is a prospective cohort study which included 83 patients with clinical symptoms of dengue fever without warning sign.

The diagnosis of dengue fever was subsequently confirmed by serology test.

Patient who fulfilled the pre-stipulated criteria were followed up daily with bedside thoraco-abdominal ultrasound.

Ultrasound protocol detected presence of pleural effusion, ascites (including perirenal fluid collection and/or rectovesicular/rectovaginal fluid collection), pericardial effusion or gallbladder wall thickening.

The gallbladder wall thickness of 3mm or more was considered as thickened gallbladder wall.

RESULTS

Gallbladder wall thickening was the most common ultrasound finding (35%) in dengue fever without warning sign, followed by pleural effusion (3%) and ascites (3%).

Gallbladder wall thickening was detected as early as day three of illness and generally lasted for 2 to 3 days before it resolved.

Majority of the patient recovered from the illness 2 to 3 days after the resolution of the thickened gallbladder wall.

CONCLUSIONS

Bedside ultrasound procedures can be used as an adjunct in suspected cases of dengue fever during the dengue outbreak.

In the case of diagnostic delay where dengue serology test is not immediately available, patients presented with undifferentiated fever and thickened gall bladder wall may suggest diagnosis of dengue fever.