Study on clinical and paraclinical characteristics of dengue fever at E Hospital in 2021

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

NGUYEN THI VAN ANH

RESEARCH ON CLINICAL AND PARACLINICAL CHARACTERISTICS OF DENGUE HEMORRHAGEAL FEVER

AT E HOSPITAL IN 2021

UNIVERSITY THESIS IN GENERAL MEDICINE

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

Performer: NGUYEN THI VAN ANH

RESEARCH ON CLINICAL AND PARACLINICAL CHARACTERISTICS OF DENGUE HEMORRHAGEAL FEVER

AT E HOSPITAL IN 2021

UNIVERSITY THESIS IN GENERAL MEDICINE

KEY: QH.2016.Y

INSTRUCTOR: DR. BUI THI THU HOAI

ACKNOWLEDGEMENTS

First of all, I would like to express my respect and deep gratitude to Dr. Bui Thi Thu Hoai - who has wholeheartedly guided, corrected errors, commented and shared valuable clinical experiences during the process of implementing the topic as well as in completing this thesis.

I would also like to sincerely thank the leaders of the Department of Tropical Diseases - E Hospital and all the officers and employees in the department for creating favorable conditions to help me in the process of collecting data, especially during the complicated period of the COVID-19 epidemic.

At the same time, I would like to express my deep gratitude to the School Board, teachers at the University of Medicine and Pharmacy, Vietnam National University, Hanoi and especially the teachers in the Interdisciplinary Department who have supported, guided and taught me valuable lessons during the past six years of study.

Finally, I would like to thank my family and friends - those who have always been there to encourage and help me during my studies and thesis completion.

Due to limited time and level, the thesis cannot avoid shortcomings. We sincerely hope that teachers and doctors will guide and contribute ideas to make the thesis more complete.

Thank you very much!

Hanoi, June 6, 2022 Student

Nguyen Thi Van Anh

LIST OF ABBREVIATIONS

AST

Alanine aminotransferase
ALT	Aspartate aminotransferase
BYT	Ministry of Health
BMI	Body Mass Index
DENV	Dengue virus
DHCB	Warning signs
HCT	Hematocrit
HGB	Hemoglobin
NS-1	Non-structural protein 1
SXHD	Dengue fever
WHO	World Health Organization

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PHOTO LIST

Figure 1.1: Chart of number of cases and incidence of dengue fever using WHO dengue fever data for the period 2005-2017 4

Figure 1.2: Chart of number of deaths and mortality rate due to dengue fever using WHO dengue fever data for the period 2005-2017 4

Figure 1.3: Chart of the number of cases and deaths due to dengue fever in Vietnam from 1980 to 2020[3] 5

Figure 1.4: Drawing of Aedes aegypti mosquito 7

Figure 1.5: Transmission of Dengue virus in nature [21]. 8

Figure 1.6: Progression of dengue hemorrhagic fever [2] 9

Figure 1.7: Mechanism of liver damage in Dengue virus infection [23] 13

Figure 1.8: Time of appearance and persistence of dengue biomarkers in patients with primary and secondary infections [37] 15

Figure 1.9: Step-by-step approach to management of DHF according to WHO [1] 18

LIST OF TABLES AND CHARTS

Table 1.1: Dengue fever grading [2] 16

Table 3.1: General characteristics of the two groups of subjects participating in the study 24

Table 3.2: Clinical characteristics of study participants 26

Table 3.3: Paraclinical characteristics of study participants 28

Table 3.4: Characteristics of AST, ALT values in 30 patients with dengue fever

Table 3.5: Deritis index in DHF patients 33

Table 3.6: Degree of thrombocytopenia and AST, ALT values 34

Figure 3.1: Percentage of two groups of patients participating in the study 23

Chart 3.2: Rate of increased AST, ALT in patients with DHF 31

Figure 3.3: AST increase pattern in two groups of dengue 32

Figure 3.4: ALT increase pattern in two groups of dengue 32

INDEX

ACKNOWLEDGEMENTS

LIST OF ABBREVIATIONS LIST OF IMAGES

LIST OF TABLES AND CHARTS

PROBLEM STATEMENT 1

Chapter 1 OVERVIEW 3

1.1. Epidemiology of Dengue fever 3

1.1.1. Dengue fever situation 3

1.1.2. Dengue Virus 6

1.1.3. Disease vectors 7

1.1.4. Host 7

1.1.5. Transmission of Dengue virus. 7

1.1.6. Vaccines and preventive measures 8

1.2. Pathogenesis of dengue hemorrhagic fever 8

1.3. Progression of Dengue fever 9

1.3.1. Clinical 10

1.3.2. Paraclinical 11

1.4. Changes in liver function in patients with DHF 13

1.4.1. Changes in liver function index 13

1.4.2. Clinical impact of liver function changes 14

1.5. Diagnosis and treatment of DHF 15

1.5.1. Diagnosis of Dengue fever 15

1.5.2. Treatment of Dengue fever 17

Chapter 2 RESEARCH SUBJECTS AND METHODS 19

2.1. Research subjects, locations and time 19

2.1.1. Research subjects 19

2.1.2. Research location 19

2.1.3. Research time 19

2.2. Research methods 19

2.2.1. Research design 19

2.2.2. Sample size and sampling method 19

2.2.3. Research content 20

2.3. Data processing and analysis methods 21

2.4. Ethics in research 22

Chapter 3 RESEARCH RESULTS 23

3.1. General characteristics of research participants 23

3.1.1. Ratio between the two groups with DHCB and without DHCB 23

3.1.2. Some general characteristics of research participants 24

3.1.3. Clinical characteristics of study participants 26

3.1.4. Some paraclinical characteristics of the subjects participating in the study 28

3.2. Characteristics of AST, ALT indexes and some related factors 30

3.2.1. Characteristics of AST, ALT index 30

3.2.2. Level of increase in AST, ALT in study subjects 31

3.2.3. Correlation between platelet count and AST, ALT index in DHF patients 34

Chapter 4 DISCUSSION 35

4.1. General characteristics of research participants. 35

4.2. Characteristics of clinical and paraclinical symptoms of study participants. 36

4.2.1. Clinical symptoms 36

4.2.2. Subclinical symptoms. 38

CONCLUSION 42

RECOMMENDATION 43

Study on clinical and paraclinical characteristics of dengue fever at E Hospital in 2021 - 1

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