Research Article
Open Access
Gender and age based evaluation of clinical signs and
symptoms of dengue: A secondary data analysis
Abubakr Momin1*, Imtiaz Manzoor2, Natasha Mustafa3, Zarghoona Wajid4, Ahsan Ali Siddiqui5,Fareha Haleem6, Kanwal Niazi7 and Adnan Anwar8*
1MBBS, Post Graduate trainee, Internal medicine, Medicine Department, Ziauddin hospital.
2MBBS, FCPS, Consultant Physician, Chiniot General Hospital, Karachi.
3MBBS, Lecturer, Department of Forensic Medicine, Altibri Medical College, Karachi.
4MBBS, M Assistant, Musavvir Stem cell Clinic and Pathology Laboratory, Pakistan
5MBBS, Msc Public Health, Specialist Family Medicine, Ministry of Health, Riyadh.
6MBBS, Women Medical Officer, Department of ENT, Civil Hospital, Karachi.
7BS Research Fellow, Clinical Pathology, Dow University of Health Sciences
8MBBS, M.Phil, Assistant Professor, Department of Physiology, Al Tibri Medical College, Karachi
2MBBS, FCPS, Consultant Physician, Chiniot General Hospital, Karachi.
3MBBS, Lecturer, Department of Forensic Medicine, Altibri Medical College, Karachi.
4MBBS, M Assistant, Musavvir Stem cell Clinic and Pathology Laboratory, Pakistan
5MBBS, Msc Public Health, Specialist Family Medicine, Ministry of Health, Riyadh.
6MBBS, Women Medical Officer, Department of ENT, Civil Hospital, Karachi.
7BS Research Fellow, Clinical Pathology, Dow University of Health Sciences
8MBBS, M.Phil, Assistant Professor, Department of Physiology, Al Tibri Medical College, Karachi
*Corresponding author: Abubakr Momin, MBBS, Post Graduate trainee, Internal medicine, Medicine Department, Ziauddin hospital; Email:
@
Received: 12 January, 2019; Accepted: 14 February, 2019 ; Published: 15 February, 2019
Citation: Momin A, Anwar A, Imtiaz M, Mustafa N, et al. (2019)Gender and age based evaluation of clinical signs and symptoms of dengue: A secondary data analysis. SOJ Microbiol Infect Dis 7(1):1-4.
Abstract Top
Background: The global incidence of dengue, a mosquito-borne viral infection, has grown dramatically in recent decades with about half of the world’s population is now at risk. Its clinical manifestations include headache, fever, skin rashes, leukopenia and arthralgia. Local data evaluating age and gender based differences in clinical signs and symptoms of dengue are scarce at best.
Objective: To compare the clinical signs and symptoms of dengue across gender and age based groups.
Methods: A secondary data analysis of a randomized controlled trial on the effects of silymarin on hepatic enzymes and clinical manifestation of dengue was conducted. The clinical signs and symptoms of the dengue patients were recorded at the baseline before giving trial intervention. Chisquare test was used to make desired comparisons across gender and age based groups whereas the significance level was set at 0.05.
Results: The study results showed that rash (p=0.047) and infected conjunctiva (p=0.013) were significantly associated with gender of the patients whereas nausea and vomiting (p=0.01), headache (p=0.016), retro-orbital pain (p=0.049) and infected conjunctiva (p=0.032) were significantly associated with age of the patients.
Conclusion: A significant association of rash and injected conjunctiva with gender of dengue patients and of nausea and vomiting, headache, retro-orbital pain and injected conjunctiva with age of dengue patients was found. Further evaluation of study findings because of their potential implications for the symptomatic management of dengue patients is recommended.
Key words: Gender; Age; Signs and symptoms; Dengue; Secondary data analysis.
Objective: To compare the clinical signs and symptoms of dengue across gender and age based groups.
Methods: A secondary data analysis of a randomized controlled trial on the effects of silymarin on hepatic enzymes and clinical manifestation of dengue was conducted. The clinical signs and symptoms of the dengue patients were recorded at the baseline before giving trial intervention. Chisquare test was used to make desired comparisons across gender and age based groups whereas the significance level was set at 0.05.
Results: The study results showed that rash (p=0.047) and infected conjunctiva (p=0.013) were significantly associated with gender of the patients whereas nausea and vomiting (p=0.01), headache (p=0.016), retro-orbital pain (p=0.049) and infected conjunctiva (p=0.032) were significantly associated with age of the patients.
Conclusion: A significant association of rash and injected conjunctiva with gender of dengue patients and of nausea and vomiting, headache, retro-orbital pain and injected conjunctiva with age of dengue patients was found. Further evaluation of study findings because of their potential implications for the symptomatic management of dengue patients is recommended.
Key words: Gender; Age; Signs and symptoms; Dengue; Secondary data analysis.
Introduction
Dengue, a mosquito-borne viral infection, is found in tropical
and sub-tropical climates worldwide, mostly in urban and semiurban
areas. Its global incidence has grown dramatically in recent
decades with about half of the world’s population is now at risk
[1]. In Pakistan, its epidemics have become increasingly larger
over the last decade.
It has four viral strains i.e. DEN-1, DEN-2, DEN-3, and DEN-4 [2]. Majority of the cases of dengue have been estimated to be caused by DEN-2 and DEN-3 viral strains [3, 4].The symptoms of dengue begins with flu like illness and may lead to severe manifestations such as bleeding, sudden loss of consciousness and even loss of life [5]. Its clinical manifestations include headache, fever, skin rashes, leukopenia and arthralgia with dermatological manifestations occurring in almost 50% of cases [6, 7].
Diagnosis is confirmed upon detection of IgM and IgG antibodies in the patient’s blood whereas ELISA is used to differentiate between primary and secondary dengue infections [8]. For rapid diagnosis of the dengue virus, NS1 antigens are detected in the patient’s blood [9]. The treatment of the infection is decided on the basis of severity of clinical features and level of fluids in the body.
Dengue is prevented by mosquitoes control and by protecting the subjects from mosquito bite [10]. Viral prevention strategies include properly disposing of waste, up gradation of water storage system and proper usage of repellents [8].
To the best of author’s knowledge, local data evaluating age and gender based differences in clinical signs and symptoms of dengue are limited at best. The current study was therefore designed to compare the clinical signs and symptoms of dengue across gender and age based groups by performing a secondary data analysis.
It has four viral strains i.e. DEN-1, DEN-2, DEN-3, and DEN-4 [2]. Majority of the cases of dengue have been estimated to be caused by DEN-2 and DEN-3 viral strains [3, 4].The symptoms of dengue begins with flu like illness and may lead to severe manifestations such as bleeding, sudden loss of consciousness and even loss of life [5]. Its clinical manifestations include headache, fever, skin rashes, leukopenia and arthralgia with dermatological manifestations occurring in almost 50% of cases [6, 7].
Diagnosis is confirmed upon detection of IgM and IgG antibodies in the patient’s blood whereas ELISA is used to differentiate between primary and secondary dengue infections [8]. For rapid diagnosis of the dengue virus, NS1 antigens are detected in the patient’s blood [9]. The treatment of the infection is decided on the basis of severity of clinical features and level of fluids in the body.
Dengue is prevented by mosquitoes control and by protecting the subjects from mosquito bite [10]. Viral prevention strategies include properly disposing of waste, up gradation of water storage system and proper usage of repellents [8].
To the best of author’s knowledge, local data evaluating age and gender based differences in clinical signs and symptoms of dengue are limited at best. The current study was therefore designed to compare the clinical signs and symptoms of dengue across gender and age based groups by performing a secondary data analysis.
Methods
A secondary data analysis of a randomized controlled trial,
conducted at Ziauddin Hospital, Clifton, Karachi, on the effects
of silymarin on hepatic enzymes and clinical manifestation of
dengue was conducted after taking ethical approval. The clinical
signs and symptoms of the dengue patients (n=92), aged 18 to 70
years, diagnosed clinically with a positive serological test, were
recorded at the baseline before giving trial intervention. The
relevant data were analyzed on SPSS version 20. Chi-square test
was used to make desired comparisons across gender and age
based groups whereas the significance level was set at 0.05.
Results
The mean age of the study participants was 37.36±15.54
years, 65.2% of them were males whereas 73.9% of them were
up to 45 years old.
The study results showed that rash (p=0.047) and infected conjunctiva (p=0.013) were significantly associated with gender where male patients were more likely to have rash and infected conjunctiva than female patients (88.3% vs. 71.9% and 61.7% vs. 34.4% respectively) (Table 1).
The study results showed that rash (p=0.047) and infected conjunctiva (p=0.013) were significantly associated with gender where male patients were more likely to have rash and infected conjunctiva than female patients (88.3% vs. 71.9% and 61.7% vs. 34.4% respectively) (Table 1).
Table 1: Signs and Symptoms of Dengue: Gender based Comparison.
Variables |
Gender |
P |
|
Male (n=60) |
Female (n=32) |
||
Frequency (%) |
Frequency (%) |
||
Nausea and Vomiting |
|||
Yes |
43(71.7) |
22(68.8) |
0.77 |
No |
17(28.3) |
10(31.2) |
|
Body ache |
|||
Yes |
59(98.3) |
31(96.9) |
>0.999* |
No |
1(1.7) |
1(3.1) |
|
Headache |
|||
Yes |
50(83.3) |
24(75.0) |
0.337 |
No |
10(16.7) |
8(25.0) |
|
Retro-orbital Pain |
|||
Yes |
38(63.3) |
16(50.0) |
0.216 |
No |
22(36.7) |
16(50.0) |
|
Rash |
|||
Yes |
53(88.3) |
23(71.9) |
0.047 |
No |
7(11.7) |
9(28.1) |
|
Petechiae |
|||
Yes |
2(3.3) |
1(3.1) |
>0.999* |
No |
58(96.7) |
31(96.9) |
|
Facial Flushing |
|||
Yes |
46(76.7) |
21(65.6) |
0.257 |
No |
14(23.3) |
11(34.4) |
|
Infected Conjunctiva |
|||
Yes |
37(61.7) |
11(34.4) |
0.013 |
No |
23(38.3) |
21(65.6) |
|
*Fisher’s Exact Test
The study results further showed that nausea and vomiting
(p=0.01), headache (p=0.016), retro-orbital pain (p=0.049) and
infected conjunctiva (p=0.032) were significantly associated with
age where patients who were up to 45 years of age were more
likely to have nausea and vomiting, headache, retro-orbital pain
and infected conjunctiva than patients who aged 46 years or
above (77.9% vs. 50.0%, 86.8% vs. 62.5%, 64.7% vs. 41.7% and
58.8% vs. 33.3% respectively) (Table 2).
Table 2:Signs and Symptoms of Dengue: Age based Comparison.
Variables |
Age |
p |
|
Up to 45 Years (n=68) |
46 Years or Above (n=24) |
||
Frequency (%) |
Frequency (%) |
||
Nausea and Vomiting |
|||
Yes |
53(77.9) |
12(50.0) |
0.01 |
No |
15(22.1) |
12(50.0) |
|
Body ache |
|||
Yes |
67(98.5) |
23(95.8) |
0.456* |
No |
1(1.5) |
1(4.2) |
|
Headache |
|||
Yes |
59(86.8) |
15(62.5) |
0.016* |
No |
9(13.2) |
9(37.5) |
|
Retro-orbital Pain |
|||
Yes |
44(64.7) |
10(41.7) |
0.049 |
No |
24(35.3) |
14(58.3) |
|
Rash |
|||
Yes |
59(86.8) |
17(70.8) |
0.115* |
No |
9(13.2) |
7(29.2) |
|
Petechiae |
|||
Yes |
3(4.4) |
Nil |
0.565* |
No |
65(95.6) |
24(100) |
|
Facial Flushing |
|||
Yes |
53(77.9) |
14(58.3) |
0.063 |
No |
15(22.1) |
10(41.7) |
|
Infected Conjunctiva |
|||
Yes |
40(58.8) |
8(33.3) |
0.032 |
No |
28(41.2) |
16(66.7) |
|
*Fisher’s Exact Test
Discussion
The study results showed that rash and infected conjunctiva
were significantly associated with gender (p< 0.05 for both)
where male patients were more likely to have them than female
patients. The study results further showed that nausea and
vomiting, headache, retro-orbital pain and infected conjunctiva
were significantly associated with age (p< 0.05 for all)where
patients who were up to 45 years of age were more likely to have
them than patients who aged 46 years or above.
Literature search revealed a few local studies where gender or age based differences in prevalence of dengue have been reported. Khan E et al., in 2007 reported male gender to be significantly associated with dengue fever (OR=14.7, P=0.003) [11]. Likewise, Ahmed S et al., in 2008reported that majority of children who suffered from 2006 outbreak of dengue fever in Karachi were males (54%) [12]. Khan E et al., in 2010 also reported that 61% of patients who tested positive for dengue IgM over the 5 years of study period were males and that dengue occurs in a younger age in females than in males (24.2 years vs. 25.9 years, p< 0.001) [13].
Locally in Pakistan, Humayoun MA et al., in 2010 reported the most common symptoms of dengue fever to be fever, myalgia, headache, nausea, skin rash, mucocutaneous hemorrhagic manifestations and ocular pain [14]. Similarly, Jahan F in 2011 reported the common clinical features of dengue to be high grade fever typically accompanied by chilliness, retro-orbicular pain, photophobia, backache, severe muscle ache, joint ache, nausea and vomiting and abdominal pain [15].
Although, as cited above, gender difference in prevalence of dengue have been reported earlier, any gender or age based differences in clinical presentation have not been reported yet. This study therefore was an attempt to evaluate whether such differences occur or not, and if they do, to what extent. Interestingly, two of the clinical features recorded showed significant association with male gender whereas four of them were found to be significantly associated with younger age. Unfortunately as a thorough search did not reveal any relevant published data, a meaningful comparison with the pertinent literature could not be made as intended. Nevertheless, the presence of such differences warrants further exploration as they could have potential implications for the symptomatic management of dengue patients.
Literature search revealed a few local studies where gender or age based differences in prevalence of dengue have been reported. Khan E et al., in 2007 reported male gender to be significantly associated with dengue fever (OR=14.7, P=0.003) [11]. Likewise, Ahmed S et al., in 2008reported that majority of children who suffered from 2006 outbreak of dengue fever in Karachi were males (54%) [12]. Khan E et al., in 2010 also reported that 61% of patients who tested positive for dengue IgM over the 5 years of study period were males and that dengue occurs in a younger age in females than in males (24.2 years vs. 25.9 years, p< 0.001) [13].
Locally in Pakistan, Humayoun MA et al., in 2010 reported the most common symptoms of dengue fever to be fever, myalgia, headache, nausea, skin rash, mucocutaneous hemorrhagic manifestations and ocular pain [14]. Similarly, Jahan F in 2011 reported the common clinical features of dengue to be high grade fever typically accompanied by chilliness, retro-orbicular pain, photophobia, backache, severe muscle ache, joint ache, nausea and vomiting and abdominal pain [15].
Although, as cited above, gender difference in prevalence of dengue have been reported earlier, any gender or age based differences in clinical presentation have not been reported yet. This study therefore was an attempt to evaluate whether such differences occur or not, and if they do, to what extent. Interestingly, two of the clinical features recorded showed significant association with male gender whereas four of them were found to be significantly associated with younger age. Unfortunately as a thorough search did not reveal any relevant published data, a meaningful comparison with the pertinent literature could not be made as intended. Nevertheless, the presence of such differences warrants further exploration as they could have potential implications for the symptomatic management of dengue patients.
Conclusion and Recommendation
A significant association of rash and injected conjunctiva
with gender of dengue patients and of nausea and vomiting,
headache, retro-orbital pain and injected conjunctiva with age of
dengue patients was found. The study findings warrant further
evaluation because of the potential implications they may have
for the symptomatic management of dengue patients.
Conflict of Interests
The authors report no conflict of interests
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