Journal of Clinical and Diagnostic Research. 2018 Mar, Vol-12(3): OC01-OC04 1 1 DOI: 10.7860/JCDR/2018/35200.11260 Original Article Internal Medicine Section Clinicobiochemical Difference of Patients Presenting with Dengue and Chikungunya during Post-Monsoon Season INTRODUCTION In the 21 st century, as nations all over the world make bold strides in the eradication of vector-borne diseases, India still continues to bear a heavy burden of the cases. Epidemics of dengue and chikungunya occur frequently in the region, and take a huge toll on the infected people. Dengue is a mosquito-borne viral infection [1]. There are four serotypes of Dengue Virus (DENV-1, DENV-2, DENV-3, and DENV-4), which produce similar clinical presentations [2], like headache, abdominal pain, vomiting, rash, and cutaneous hypersensitivity. Haemorrhagic manifestations are present in a few. There are two types of dengue recognised by the WHO-dengue fever; and severe dengue fever [3]. Chikungunya is another mosquito-borne viral disease. It is caused by the transmission of an alpha-virus called Chikungunya Virus (CHIKV) [4]. In Chikungunya, patients usually present with sudden- onset high-grade fever, severe arthralgia, myalgia, and skin rash [5]. It is usually benign, but sometimes may cause severe neurological illness [6]. Both viruses are spread by the Aedes aegypti mosquito, which is well-adapted to the urban environment [4,7]. It commonly breeds in artificial containers filled with water, leading to a sharp rise in its population during monsoon [8]. A recent WHO estimate indicates approximately 50-100 million cases of dengue per year worldwide [9]. Similarly, since 2005, countries in the South-East Asian Region of WHO alone have reported over 1.9 million cases of chikungunya [10]. Currently, both the diseases are diagnosed using serological tests. For dengue, diagnostic tests available detect either NS1 antigen of the DENV, or the IgM antibodies produced in the body as a result of the infection [11]. NS1 antigen is detectable in serum till 4-5 days after infection. Around the 5 th day, IgM antibodies appear in blood [11,12]. Similarly, for the diagnosis of Chikungunya, serological methods are used to detect either the presence of RNA CHIKV through Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR), or IgM antibodies produced by its interaction with the host’s immune system, which appear in the blood after one week of illness has elapsed. RT-PCR has highest reactivity during the first 4-5 days [10]. RT-PCR and NS1 antigen tests, although highly sensitive, are expensive tests, which diminishes their acceptability. On the other hand, performing ELISA to detect IgM antibodies delays the diagnosis of the two diseases. Moreover, 83.3% of the Indian population lives in rural areas [13], and may not have an access to such complex diagnostic procedures. Therefore, an attempt was made to distinguish between the two diseases by elucidating patterns in the clinical, haematological, radiological and biochemical profiles, which may be considered diagnostic. This can save crucial time in beginning the prompt treatment of the patients. Eliminating the need for serological testing would prevent an unnecessary economic burden on the infected patients. Also, it would ensure that even workers in peripheral health centers can diagnose and differentiate the two diseases, and adequately prevent complications. Therefore, this study aims to compare clinical profiles (history, examination) and laboratory VINEET JAIN 1 , JYOTSANA 2 , ARUSHI CHOPRA 3 , KHUSHBOO AHMAD MIR 4 , CHAND BABU 5 , SUNIL KOHLI 6 , PREM KAPUR 7 , SMITA MANJAVKAR 8 Keywords: Chikungunya fever, Dengue fever, Post-viral arthralgia/arthritis ABSTRACT Introduction: India plays host to a number of vector-borne diseases, including dengue and chikungunya. Both diseases demonstrate a synchronised peak, and present with similar findings. An early accurate distinction between them is valuable for effective treatment and prevention of complications. Currently used diagnostic methods estimate either antibodies or antigens; the former are absent in the first week of disease, and testing for the latter is expensive. Aim: To compare clinical profiles (history, examination) and laboratory parameters of patients with dengue fever and chikungunya fever. Materials and Methods: Pre-diagnosed patients of dengue (50) and chikungunya (50) were studied to elicit patterns in clinical, haematological and biochemical profiles which may be used for differentiation. The time taken for resolution of symptoms, and complications, were studied prospectively. The data were analysed using Z-test. Results: In both the diseases, patients present with short pyrexia (<1 week). The study found abdominal pain and bleeding significantly (p-value <0.001) more common in dengue than in chikungunya. It was discovered that joint pain and swelling was significantly (p-value <0.05) more common in chikungunya. Furthermore, leukopenia (<4000 WBCs/cumm) as well as moderate (50,000-100,000 platelets/microL) and severe (<50,000 platelets/microL) thrombocytopenia was significant for dengue. Milder (up to 3 times) SGOT and SGPT elevations were significant for chikungunya, whereas larger (>3 times) elevations were significant for dengue. Conclusion: It may be concluded that the two diseases, despite their synchronised peak during post-monsoon season, and overlapping presenting symptoms, can be distinguished on the basis of clinical profiles of the patients, and a few basic laboratory tests. On studying a larger sample size, the presence of these associations could be determined with more certainty.