Mucocutaneous Manifestations of Dengue Viral Infection During 2011 Epidemic in Lahore, Pakistan

Abstract

Objective: To investigate the type and correlate the appearance of mucocutaneous signs and
symptoms with different stages and clinical types of Dengue viral infection.
Material & Methods: Two hundred patients of dengue virus infection admitted in the dedicated
Dengue Unit at Services Hospital, Lahore from 1st September to 31st October 2011 were
included in the study. Presenting features were noted. The patients were physically examined for
the presence of skin and mucosal lesions and findings were recorded. Serologic tests for antidengue immunoglobulin M (IgM) antibodies, Total and Differential Leukocyte Count (TLC and
DLC), Platelet count and Liver Function Tests (LFTs) were done in all the patients.
Results: Of the 200 patients with dengue infection, 83 (41.5%) were classified as dengue fever
(DF), 116 (58%) as dengue hemorrhagic fever (DHF) and one (0.5%) as dengue shock syndrome
(DSS). Cutaneous involvement was seen in 160 (80%) of patients. Of these 160 patients, 130
(81.25%) had single while 30 (18.75%) had multiple manifestations. The most common
cutaneous finding was pruritis (47.50%), followed by erythema (37.50%), flushing (23.35%),
eccyhmosis (18.13%), petechiae (16.88%), and macular/scarlatiniform eruption (13.7%).
Mucosal involvement was seen in 35.63% of patient, with dry tongue/ cracked lips being the most
common (39.7%), followed by mucosal bleed (36.6%), and conjunctival involvement (10.2%).
The most common initial presentation was flushing (27 patients) within 1-3 days followed by
mucosal involvement (47 patients) during 4-6 days and cracked lips (30 patients) in 7-10 days.
Cutaneous involvement was more common in DF (41.5%) while mucosal involvement was more
remarkable in DHF (58%).
Conclusion: This study describes the variety of mucocutaneous features associated with
dengue viral infection whichm may evolve during the course of the disease. There is a clear
correlation between various skin manifestations & stages of infection. Cutaneous signs &
symptoms are more commonly observed in DF & mucosal involvement in DHF