Inter. J. of Pharmacotherapy / 7(2), 2017, 56-58.

International Journal of Pharmacotherapy

www.ijopjournal.com
ISSN 2249 - 7765
Print ISSN 2249 - 7773
CASE STUDY ON DENGUE FEVER WITH THROMBOCYTOPENIA
M. Nizamudin, A. Arshath, C. Ajay sai, P. Arun, S. Vedha pal Jeyamani*
Department of Pharmacy Practice, Jaya College of Paramedical Sciences, College of Pharmacy, Chennai, India.

ABSTRACT
Dengue is the most common mosquito borne viral infection (caused by Dengue type 1, Dengue type 2, Dengue
type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus) in Chennai, which had an outbreak due to
seasonal and monsoon changes. Infection with one of the serotype provides immunity to only that serotype of life, to a
person living in a Dengue-endemic area can have more than one Dengue infection during their lifetime. Its increasing
prevalence is due partially to increased awareness and better diagnostic methods, because if it’s untreated, it can lead to
fatal effects. We report a case of severe dengue fever with thrombocytopenia where the patient showed remarkable
improvement upon treatment along with patient counseling.

Key words:Dengue, Thrombocytopenia, Public Awareness.

INTRODUCTION
Dengue is a mosquito borne disease caused by
dengue virus. Symptoms include high fever, headache,
rash, muscle and joint pain, Treatment includes fluids and
pain killers. Each year between 50 and 528 million people
are infected and fatal reports were approximately 10,000
to 20,000 reported [1-4].
CASE REPORT
An 18 years old male patient was admitted in the
male general ward of Thiruvallur General Hospital,
Chennai with the chief complaints of fever, vomiting and
loose stools for 4 days. The patient seems to be lethargic,
conscious and oriented with fluctuated vitals.
DISCUSSION
The patient was observed with low platelet count
and low blood count at the time of admission. The patient
hematology and biochemical parameters are observed at
regular intervals. The serological findings such as IgM
and IgG were found positive, which confirms the
presence of Dengue. The patient was diagnosed with
dengue fever and advised for proper dehydration therapy.
The patient was initiated with IV fluids,
InjTaxim1gm/IV/BD, Tab Flagy 500mg BD, cap Doxy
Corresponding Author:-S. Vedha pal Jeyamani
100mg BD, Tab Rantac 150mg Bd as prophylactic
therapy.The
patient was counseled accordingly as regular sit-ups, with
points focusing disease condition, Therapy prescribed.
The patient counseling points includes life style changes
along with dietary restrictions. There is no vaccine to
prevent dengue [5].
Prevention centers on avoiding mosquito bites
when traveling to areas where dengue occurs and when
low sanitation, where dengue might occur. Eliminating
mosquito breeding sites in these areas is another key
prevention measure.
 Avoid mosquito bites when traveling in tropical
areas:
 Use mosquito repellents on skin and clothing.
 When outdoors during times that mosquitoes are
biting, wear long-sleeved shirts andlong pants tucked into
socks.
 Avoid heavily populated residential areas.
 When indoors, stay in air-conditioned or screened
areas.
 Use bed nets if sleeping areas are not screened or air-
conditioned.
Email: swetha21112000@gmail.com

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 Eliminate mosquito breeding sites in areas where especially old tires.

dengue might occur: Regularly change the water in outdoor bird baths
 Eliminate mosquito breeding sites around homes. and pet and animal water containers [6].
 Discard items that can collect rainor run-off water,

Table 1. Classification of Dengue

Severe, Frank type Flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock
and terminating in recovery or death
Moderate with high fever but less hemorrhage, no shock present
Mild with slight fever, with or without petechial hemorrhage but epidemiologically related to typical
cases usually discovered in the course of invest or typical cases

Table 2. Grading the severity of dengue fever

Grade 1 Fever non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain absence of
spontaneous bleeding positive tourniquet test
Grade 2 Signs and symptoms of Grade 1 plus presence of spontaneous bleeding: mucocutaneous,
gastrointestinal
Grade 3 Signs and symptoms of Grade 2 with more severe bleeding: plus evidence of circulatory failure: cold,
clammy skin, irritability, weak to compressible pulses, narrowing of pulse pressure to 20 mmhg or less,
cold extremities, mental confusion
Grade 4 Signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial blood
Pressure = 1 mmhg (Dengue Syndrome/DS)

Table 3. Symptoms of Dengue

S.No Symptoms Patient condition
1. loose stools +
2. Fever +
3. Vomiting +
4. Melena +
5. Dehydration + (Some degree)
6. Abdominal pain -
*+ denotes presence and absence of symptoms with accordance with peculiar symptoms of Dengue. On examination, the
patient pulse rate and BP were found decreased. The abdomen evaluation revealed that p/a was soft, and other observed
parameters are normal.

Table 4. Relevant hematology and Lab parameters by day of admission

S.No Lab parameters Units Day 1* Day2 (afternoon) Day2 (Evening) Day 3
3
1. WBC 10 /µl 2.41 2.9 3.4 4.9
2. RBC 106/µl 4.86 4.29 4.45 5.15
3. HCT % 41.9 36.8 36.7 44.6
4. HGB gm/dl 14.9 12.8 13.3 15.4
5. MCV fL 86.2 85.8 82.5 86.6
6. MCH Pg 30.7 29.8 29.9 29.9
7. MCHC g/dl 35.6 34.8 36.2 34.5
8. PLT 103/µl 132 104 107 125
9. LYM 103/µl 0.9 1.4 1.6 2.5
10. LYM % % 27.8 49.0 47.7 51.4
11. RDW -SD fL - 40.7 40.2 43.4
12. RDW – CV % - 12.11 12.3 12.7
13. PDW fL - 11.3 12.3 12.9
14. MPV fL - 9.8 10.0 9.9
15. P- LCR % - 23.7 25.5 25.3
16. PCT % - 0.10 0.11 0.12
*Day of admission, pg represents picograms, fL represents femtolitres,

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CONCLUSION ACKNOWLEDGEMENT
The present case was aimed to focus on the We thank Dr. Nagendra Prasad, Medical officer
counseling points for dengue, which made a remarkable for his support and cooperation in this work. And we are
improvementin the patient and we take this measure as a grateful to the patient who cooperated for this study.
community awareness perspective to spread awareness
which can avoid the outbreak of Dengue. CONFLICT OF INTEREST
The authors declare no conflict of interest.
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severe dengue infection. PLoS ONE, 11, 2016, e0161696.
3. Medagoda K, Gunathilaka SB, De Silva HJ. A case of self-limiting Coombs’ negative hemolytic anemia following
dengue shock syndrome. Ceylon. Med, 48, 2003, 147–148.
4. Kulkarn D, Sharma B. Dengue fever-induced cold-agglutinin syndrome. Ther. Adv. Infect Dis, 2, 2014, 97–99.
5. Radakovic S, Graninger W, Müller C, Hönigsmann H, Tanew A. Dengue hemorrhagic fever in a British travel guide. J.
Am. Acad. Dermatol, 46, 2002, 430–433.
6. Liao B, Tang Y, et al. Serum levels of soluble vascular cell adhesion molecules may correlate with the severity of
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