|Year : 2017 | Volume
| Issue : 1 | Page : 43-45
Dengue fever in a joint family of Belgaum
Mahantesh Babanna Nagamoti1, Vijaylaxmi Kulgod2, SL Hoti3
1 Department of Microbiology, JN Medical College, KLE University, Belagavi, Karnataka, India
2 Consultant Pediatrician, Lakeview Hospital, Belagavi, Karnataka, India
3 Deputy Director, RMRC, ICMR, Belagavi, Karnataka, India
|Date of Web Publication||20-Mar-2017|
Mahantesh Babanna Nagamoti
Department of Microbiology, JN Medical College, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Dengue has emerged as a global health problem, as evidenced by epidemics year after year, throughout the tropical and subtropical regions of the world. In India, it has been reported from all the regions, and all four serotypes are circulating with varied severity. Herewith, we are reporting dengue fever in large united family involving six members of the family suffering from den serotype 3.
Keywords: Dengue, dengue hemorrhagic fever, serotype 3
|How to cite this article:|
Nagamoti MB, Kulgod V, Hoti S L. Dengue fever in a joint family of Belgaum. J Sci Soc 2017;44:43-5
| Introduction|| |
Dengue is considered to be the most important arthropod-borne viral infection due to high rates of morbidity and mortality. The clinical spectrum of this infection ranges from asymptomatic infection through severe hemorrhage and sudden fatal shock. The endemicity of dengue fever (DF) in India is proven, and there is a constant threat that dengue may resurface periodically because of very high vector breeding sites in the thickly populated areas in India., Dengue hemorrhagic fever (DHF) was first reported in India from Calcutta in 1964. Subsequently, it was reported from other parts of India., All the four serotypes are prevalent in India since 1963. Belgaum situated in North Karnataka, adjacent to Maharashtra and Goa states, is a moderately populated urban district. Here, we report evidence of dengue virus etiology in a large family and circulating serotypes in this area.
| Case Report|| |
A 12-year-old boy was referred to KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. He is uneducated and belongs to middle class large joint family of 74 members residing in Belgaum. All the family members are engaged in the leather processing in the house. He presented with fever and headache of 6 days duration, history of vomiting and pain abdomen for 2 days and altered sensorium with cold extremities since a day. In the emergency ward, pediatrician examined the patient and found that the boy is delirious and restless. With these findings, the patient was shifted to pediatric Intensive Care Unit (ICU) ward. A rapid cardiopulmonary assessment revealed that he is in hypotensive shock. In the superficial examination of abdomen, it was found that guarding is present and deep examination revealed that significant hepatomegaly along with free fluid was present (Grade I). Respiratory examination revealed right side pleural effusion. There was no skin rash or bleeding from any site. With these findings, the patient was suspected of having dengue hemorrhagic shock. Blood samples were collected from patient and sent for hemogram, dengue serology and biochemical (renal profile and blood gas analysis) parameter analysis. Dengue IgG and IgM antibodies were checked by ELISA (J. Mitra and Co., New Delhi, India), and also by dengue a rapid immunochromatography test (Pan bio, brisbane, Australia), which showed positive. Thus, the patient was diagnosed as having dengue shock syndrome (DSS) and immediately resuscitated with fluid and high flow oxygen by intravenous fluids and mask, respectively. Along with other supportive therapy, four units of platelets were transfused. He continued to be in compensated shock and dobutamine was added. At the end of 24 h, the patient was improved having blood pressure 110/70 mmHg and pulses well felt. After fluid therapy, the hematocrit was dropped to 46% and renal parameters improved.
At the end of 48 h, the patient condition was stale and drug doses lowered slowly. With this ascites, edema, and pleural effusion were gradually decreased. On the 6th day, the ventilator was weaned off and extubated. The patient was discharged on the 10th day of the admission.
During the same period, the patient's uncle was admitted to medical ICU ward with the diagnosis of DHF Grade 2 and his two younger sisters were also admitted to pediatric ward with DSS Grade 1. All these three patient's sera were found to be positive for dengue by both ELISA and immunochromatographic test as mentioned above. These patients were discharged after 6 days of admission. Patient's cousin brother and aunt had features of uncomplicated DF, whose sera were also found to be positive for anti-dengue IgM and IgG antibodies. Sera from all these patients were subjected to serotyping by multiplex reverse transcription-polymerase chain reaction (RT-PCR) at Vector Control Research Centre, Puducherry. The two-step RT-PCR assay was performed as per the method reported by Harris et al. RNA was extracted from serum samples using Tri-Reagent-R (MRC Inc., USA). The dengue serotype-specific primers located at capsid region of the dengue viruses are presented in [Table 1]. The amplicons were resolved in 2% agarose gel in 1X TAE buffer, and the identity of the serotype of the virus was determined by the size of the amplicons observed. The results indicated that the samples contained Den 3 serotype with the presence of a diagnostic band of 290 bp [Figure 1].
|Figure 1: The Positive (lane 1,3,5) and Negative samples (lane 2,4) with 100 bp mol wt marker (lane 6)|
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| Discussion|| |
After HIV, DF is now the emerging viral disease globally. It may present with severe symptoms and sometimes it may be of asymptomatic with cyclical and seasonal variations. It is also associated with a wide variety of risk factors to promoting and maintaining it in nature.
In India, dengue outbreaks occurred mostly during or after the rainy season and also reported in dry summer months, because of widespread storage of water for domestic purpose. In Belagavi, conditions favorable for dengue outbreaks to occur, especially in July, which is the peak rainy month. This study discusses the occurrence of dengue in six patients of a single large joint family. The family lives in a twelve-roomed house, sharing common toilets and is overcrowded with 72 members. This family deals with leather industry in which all the members are involved in the leather processing unit in the house itself. Residence of this family has most of the risk factors, which favors the breeding of the vector, like pooling of water on muddy floor and continuous usage of water for cleaning of the leather, etc.
In this study, dengue presented with central nervous system (CNS) involvement in one of our patient, two with Grade 2 DHS and two with only DF. Dengue with CNS involvement has been reported in few instances earlier.
Even though dengue is one of the serious health problems of India, the research in this aspect is very low. This is because of serotypic identification of dengue needs sophisticated laboratories and expertise. Only a few centers of India reported the genotypic distribution of dengue. In the Vellore (1969) serotype 3 was responsible for the outbreak. In Delhi outbreak, 273 cases of dengue caused by 1 and 3 serotype. In the recent years, in the majority of cases, dengue-3 was identified., The present study reports the presence of Dengue-3 in Belgaum, with various stages of the diseases as mentioned by others. Even though the present study includes very few cases, but our findings are also project that the on-going epidemic of dengue around Belgaum is due to Den seroyype-3.
The highlight of this study is involvement of several individuals putting major portions of family members to the risk of communicable diseases such as dengue. Human crowding in such families favors the biting of vectors on many individuals. Especially shy feeding Aedes species tend to take multiple feeds thus ensuring faster transmission of dengue in the crowded families.
Further, this study also highlights the necessity of formulating guidelines for preventing transmission of dengue in joint families, which are common in many rural areas of India. The study also indicates the necessity of urgency of health education to the community and the health administration authorities should be more proactive to control such epidemics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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