1 Biohelikon: Immunity & Diseases, 2015 3:a11 Research Dengue outbreak 2013: Clinical profile of patients presenting at DHQ Burner and THQ Shangla, Khyber Pakhtunkhwa, Pakistan Jehangir Khan 1* , Waqas Munir 1 , Bakht Tarin Khan 1 , Zaheer Ahmad 1 , Waqas Ahmad Shams 1 , Asar Khan 1 1 Zoology Department, Abdul Wali Khan University Mardan (AWKUM), Buner Campus, Buner Khyber Pakhtunkhwa, Pakistan. * Corresponding author, Email: Abu_amna2013@hotmail.com Abstract We evaluated the clinical features, disease severity, laboratory findings and outcome of serologically confirmed cases of Dengue fever in Patients during the recent outbreak in two districts (Buner & Shangla) in 2013, Khyber Pkhtunkhwa, Pakistan. We encountered 320 cases of Dengue fever during 5 months period (July to November, 2013). The dengue infection rate in females (180: 56%.2) was higher as compared to males (140: 43.8%). The dengue infections were more frequently seen in the post-monsoon season than in the monsoon period. The death ratio in the overall weighted prevalence was 0%. All the patients suffered from fever but no specific pattern could be identified, degree was variable ranging from low to high grade. Abdominal pain was the next most common symptom followed by vomiting and diarrhea. Only (45%) patients complained of body aches and pains, (30%) patients had hemorrhagic manifestations in the form of gum bleed, and (05%) patients had melena while (15%) patient’s complained of skin rashes. The most common clinical sign was the Enlarged liver that was present in (75%) patients. There is critical need for molecular and entomological surveillance of dengue among the dengue epidemics-prone areas to eliminate the disease. Keywords Dengue fever, Splenomegaly (Enlarged liver), Dengue fever, Symptoms Introduction An estimated 2.5 billion people living in tropical and subtropical areas, distributed within 100 countries are at risk of epidemic of dengue virus transmission. Annually, more than 100 million cases of classic dengue fever and around 450,000 cases of dengue hemorrhagic fever is notified [1]. The dengue virus (DENV) belongs to flaviviruses having four distinct serotypes (DENV-1, DENV-2, DENV-3 & DENV-4) transmitted by Aedes aegypti (primary vector) and Aedes albopictus (secondary vector), Aedes aegypti a domestic mosquito that prefers to feed on humans. This is a highly urbanized mosquito; breeding in water stored for domestic use or collected rainwater [2]. The first outbreak of Dengue fever in Pakistan was documented in 1994-95 in Karachi. After that multiple outbreaks have been documented from different parts of the country especially Karachi and Lahore [3]. Later, a huge dengue outbreak occurred in Pakistan in 2006 which was due to the co-circulation of DENV-2 and DENV-3 serotypes respectively. Recently, a change in the pattern, clinical spectrum, and outcome of this disease has been reported, with an increased incidence of DHF in clinical practice [4]. Two devastating dengue outbreaks occurred in the country one in Lahore (2011), Punjab Province while the second largest in Swat, KPK Province in 2013 affecting more than 20000 thousands humans with approximately 4000 deaths [2,5,6]. In the current study we focused the two districts (Shangla and Buner, KPK) to whom less attention has been given during the epidemics, to evaluate the clinical features, disease severity, laboratory findings and outcome of serologically confirmed cases of Dengue fever in patients during the recent dengue epidemics in the two districts of KPK. Materials and Methods This study was conducted in 5 months period (July to November) of 2013, and the three largest hospitals of district Shangla and Buner were considered for the surveillance of dengue patients. The data/ record of dengue patients was obtained from THQ Besham and DHQ Alpori in district Shangla, and DHQ Daggar in district Buner, KPK. The study and associated protocols were designed based on national ethical legislative rules and approved by Local Ethic Committees of AWKUM, Buner Campus. With prior permission from the Medical Superintendents (MSs) of the hospitals, direct interviews and observations were also considered from the admitted patients who presented dengue infection symptoms and fulfilling the diagnostic criteria of dengue fever and dengue hemorrhagic having positive IgG, IgM and NS1 anti-dengue antibodies. All the infected patients were examined thoroughly for Petechiae, Headache, Abdominal