STUDY OF INCIDENCE OF ACALCULOUS CHOLECYSTITIS IN DENGUE PATIENTS OF SOUTHERN ODISHA

Abstract

Background: Dengue is an acute febrile disease of viral etiology common in tropics and subtropics. In recent years, dengue has become a global public health concern. There are certain rare atypical presentations in dengue like encephalopathy, encephalitis, hepatitis, AKI, cardiomyopathy, ARDS, GBS, rhabdomyolysis and acalculous cholecystitis. Acute acalculous cholecystitis accompanying dengue fever has been underreported.

Aims and Objectives: To study incidence and prognosis of acalculous cholecystitis in dengue and to correlate acalculous cholecystitis with severity of dengue.

Materials and Methods: 200 seropositive dengue patients admitted to dengue ward of MKCG medical college hospital, Berhampur, Odisha, India, were studied during the period Oct 2016-Oct 2018. Acalculous cholecystitis was diagnosed on basis of clinical feature and ultrasound findings.

Results: Out of 200 patients, 170 (85%) were classified as dengue fever, 19 (9.5%) as dengue hemorrhagic fever and 11 (5.5%) as dengue shock syndrome. Fever was the main presenting symptom (100%) in all our patients followed by headache (98.5%), myalgia (92.5%), rash (24.5%), retro-orbital pain (22%), arthralgia (21.5%), pain abdomen(19%) and bleeding manifestation (15%). The clinical examination revealed pallor (2%) and icterus (0.5%). Features of shock was present in 5.5%. 19 out of 200 patients of dengue had acalculous cholecystitis. The incidence was found to be 9.5%. Out of the 19 cases of acalculous cholecystitis , the incidence in Dengue fever (DF), Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) groups were 5.88%, 26.31% and 36.36 % respectively. Out of the 19 acalculous cholecystitis patients, 18 patients (94.7%) recovered with conservative treatment.

CONCLUSION: Dengue patients with multiorgan dysfunction have poor clinical outcome. Acalculous cholecystitis in dengue is not uncommon and is usually self limiting and resolves with conservative management. It is more often manifested in severe forms of dengue.

KEYWORDS : Acalculous cholecystitis, Dengue fever (DF), Dengue hemorrhagic fever(DHF), Dengue shock syndrome(DSS).