Dengue fever is a differential diagnosis in patients with fever and abdominal pain in an endemic area

Abstract

Human infections with dengue virus are endemic in India. Such infections may be asymptomatic or present as undifferentiated fever classical dengue fever (DF) dengue haemorrhagic fever (DHF) or non-haemorrhagic hypovolaemic shock [i.e. dengue shock syndrome (DSS)]. Abdominal pain is a frequently reported symptom in patients with DF. For the present study each of the 40 patients who between the August and November of 2003 (i.e. during the last dengue epidemic in New Delhi) presented at the Pushpawati Singhania Research Institute for Liver Renal and Digestive Disease in New Delhi with fever and abdominal pain was checked for DF. A probable diagnosis of DF was made if the patient presented with an acute febrile illness and two or more of the following: headache retro-orbital pain myalgias arthralgias rash haemorrhagic manifestations and leucopenia. Serum from each suspected case of DF was then checked for IgM antibodies against dengue virus using a commercial kit (ImmunoComb® II Dengue Bispot IgM and IgG; Suyog Diagnostics Delhi India) that is based on a solid-phase enzyme immunoassay and is 97.5% sensitive and 97.9% specific for dengue-virus infection. DF was confirmed by seropositivity in this assay. (excerpt)