LETTER TO EDITOR
Year : 2011  |  Volume : 36  |  Issue : 2  |  Page : 163

Pleural effusion and ultrasonography in dengue fever

Syed Ahmed Zaki
Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, India

Correspondence Address:
Syed Ahmed Zaki
Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0970-0218.84140

1. The authors have mentioned that breathlessness was present in 83 (17.8%) patients with dengue fever. Breathlessness in patients with dengue fever can occur due to pleural effusion, acute respiratory distress syndrome, pneumonia or metabolic acidosis and shock. As per "[Table 2]," only 66 children had complications in the form of pleural effusion, ARDS, pneumonia, encephalopathy or metabolic acidosis and shock. The authors have not discussed the reason for breathlessness in the remaining 17 children.
2. Only 20 (4.29%) of the 466 patients in the study had pleural effusion, and none had ascitis. The authors have not mentioned whether ultrasonography or chest X-ray was used to diagnose pleural effusion. They have also not mentioned after how many days of fever was the imaging done. Both the above points have clinical significance in the diagnosis of dengue fever. In a study performed by Balasubramanian et al., ultrasonography was found to be superior to radiography in detecting pleural effusion. ^[2] The authors also found that when the various parameters suggested by the World Health Organization as indirect evidences of capillary leak (hemoconcentration and hypoalbuminemia) were compared with ultrasonography and radiography, ultrasonography was found to have the highest sensitivity and negative predictive value in detecting pleural effusion They have suggested that ultrasonography would be ideal, owing to its safety, in that it is nonionizing and would assist detecting plasma leakage even before it manifests clinically. Similar findings have been reported in a study from Indonesia. ^[3] In a study performed by Venkata Sai et al., the yield of ultrasonography was found to be higher in the later stages of the disease. Repeat ultrasonography on the fifth to seventh days detected pleural effusion in a significantly higher number of patients with dengue fever. ^[4]

References

1.	Kumar A, Rao CR, Pandit V, Shetty S, Bammigatti C, Samarasinghe CM. Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka. Indian J Community Med 2010;35:386-90.   [PUBMED]
2.	Balasubramanian S, Janakiraman L, Kumar SS, Muralinath S, Shivbalan S. A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever. Indian Pediatr 2006;43:334-9.   [PUBMED]  [FULLTEXT]
3.	Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN. Dengue hemorrhagic fever: Ultrasound as an aid to predict the severity of the disease. Pediatr Radiol 1998;28:1-4.   [PUBMED]
4.	Sai PM, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol 2005;78:416-8.   [PUBMED]  [FULLTEXT]

This article has been cited by 1 Comparative study of ultrasound findings in seropositive pediatric and adult patients with dengue fever K.R. Dayananda Kumar,Rudresh S. Halawar Radiology of Infectious Diseases. 2018; 5(2): 59 [Pubmed] | [DOI] 2 Micro-anatomical changes in major blood vessel caused by dengue virus (serotype 2) infection Sivan Padma Priya,S. Sakinah,Mok Pooi Ling,Hui-Yee Chee,Akon Higuchi,Rukman Awang Hamat,Vasantha Kumari Neela,Abdullah A. Alarfaj,Murugan A. Munusamy,Ashraf A. Hatamleh,Ahmed E. Al-Sabri,Ibrahim Ahmad Abdulaziz Al-Suwailem,Mariappan Rajan,Giovanni Benelli,Giovanni Marlina,S. Suresh Kumar Acta Tropica. 2017; 171: 213 [Pubmed] | [DOI] 3 CORRELATION OF ULTRASOUND (USG) FINDINGS WITH SEROLOGICAL TESTS IN DENGUE FEVER Dayanand K.R,Kavitha K,Anilesh Pratap Singh,Chiranth N Journal of Evidence Based Medicine and Healthcare. 2016; 3(12): 371 [Pubmed] | [DOI]