An epidemic of dengue fever in Karachi - Associated clinical manifestations

Dengue is a mosquito borne disease with worldwide distribution. Depending on virulence factors and host immune status, infection can manifest as a severe but non fatal viral syndrome or a rapidly progressive and a frequently fatal haemorrhagic fever. During the course of an outbreak of viral fever in Karachi, Pakistan from June, 1994 to September, 1995, we studied 145 cases admitted at the Aga Khan University Hospital. 43% of the cases were between the age group of 20-30 years, majority of these being male (75%). Amongst the clinical signs and symptoms, the most frequent findings were fever, vomiting and abdominal pain. Spontaneous hemorrhagic manifestations occurred in 66 patients and of these petechiae and mucosal bleed were the commonest, that is, 42% and 38% respectively. At presentation thrombocytopenia (platelet count ≤50,000) per cubic millimeter) was present in 78%, leucopenia (white cell count <4,000 per cubic millimeter) in 34%. Apart from one patient who died from hemorrhagic shock on the 5th day of admission, the remaining patients recovered and their platelet counts normalized on an average in 9 days. This is the first reported epidemic in Karachi of dengue infection.