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ocular manifestations in dengue fever

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on 29 September 2013

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Transcript of ocular manifestations in dengue fever

OCULAR MANIFESTATIONS IN DENGUE HAEMORRHAGIC FEVER
DEPARTMENT OF OPHTHALMOLOGY ,GGH,GUNTUR


Dr.CH.Mohan rao,Professor and HOD
Dr.M.Parni Kumar,Professor
Dr.G.Ravibabu,Associate Professor
Dr.L.J.Sandhyavali,Associate Professor
Dr.Y.Srinivas,Asst.Professor

INTRODUCTION
DIAGNOSIS
Purpose of our study
MATERIALS AND METHODS
Results
Mosquito borne disease –infected female Aedes aegypti mosquito

Flavi virus family-4 antigenically related serotypes
(DENV 1 to 4)

Acute infection-malaise, sore throat, rhinitis and cough,headache, muscle ache, retro-orbital pain, jointpain, abdominal discomfort, and rash

C/F-Related to bleeding diathesis from thrombocytopaenia.


Based on time of presentation


Polymerase chain reaction

Ig G and Ig M detection by ELISA

In recent years-spurt of publications on ocular manifestations in Dengue fever

Our study-to evaluate the same during the epidemic of dengue from Aug 2012 to Jan 2013 in Patients attending our hospital.

Patients were referred to our OPD from a separate ward set up for dengue cases,following ocular complaints

Each patient had....
Patients excluded out of our study are

1.Paediatric patients ( < 14 yrs )

2.Severely ill and those in shock , who needed intensive care set up.

Total number of Dengue +ve patients during the
epidemic =203 (by ELISA)

Number of patients who presented to our OPD with Ocular complaints = 86 ( 42 % )

No of Male patients = 52

No of Female patients = 34

Levels of platelet counts ranged between 50-100 x 10 times 9/L
Presenting complaints
All patients with significant posterior segment findings were followed on weekly basis initially and then depending on the response .

2 pts failed to follow up.

Majority of patients were treated conservatively.

Patients with severe fall of vision were treated with systemic steroids.

Spontaneous resolution of maculopathy was seen upon recovery from thrombocytopaenia.

Dry pigmentary changes were seen in a case with intial episode of inflammatory chorioretinitis.

All patients had resolution of symptoms with recovery of vision to preretinopathy levels with in 3 – 12 wks of follow up,except for mild central scotoma in few patients.


CONCLUSION
Ophthalmic complications were not typically reported in dengue infections in the past.

A myriad of Ocular complications relate to dengue infection now a days.

This typically affects young immunocompetent adults who often present at the nadir of thrombocytopaenia.



The mechanism is unknown,but speculated to be immune mediated process possibly associated with dengue serotyping

Molecular mimicry
T Cell mediated-interleukins release
Increased vascular permeability
Thrombocytopaenia leading to haemorrhages




Prognosis is good with improved visual acuity and resolution of ocular signs occurs in most patients with conservative mangement.

Further studies are needed to elucidate the mechanism to standardize investigations and determine the best form of treatment
Ophthalmologists and physicians should be aware and vigilant towards patients with dengue related ophthalmic complications as, a small minority of patients had poor visual acuity refractory to treatment in some studies.

Presented by


Dr.G.Sowjanya
In patients with C/O DV, Visual acuity ranged from 6/12 to CF 2 mts

27% of total patients had central or paracentral scotoma in Amsler Grid
Out of total 48 pts with DV
20 pts had non specific C/O eye strain, and some had near vision disturbance.

28 pts had significant posterior segment findings as below

AGE AT PRESENTATION

Mean time interval of presentation was 7 days after onset of illness

Mean age of presentation was 33 yrs (15-60 yrs)


References:

1.Ophthalmic Complications Of Dengue-Vol.12 No 2-Febraury 2006-EmergingInfectious Disease

2. Stephen Et Al, Eye Institute Dengue-Related Ophthalmic Complications Work Group

3.Ophthalmology And Therapy (2012) 1:2 DOI Ophthalmic Complications Of Denguefever A Systematic Review

4.World Health Organization. Dengue and dengue haemorrhagic fever—Fact sheet.2009; Available at:http://www.who.int/csr/disease/dengue/en.Accessed 19 May 2011.
 

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