title: A retrospective analysis of dengue fever case management and frequency of co-morbidities associated with deaths.
abstract: BACKGROUND
  Dengue epidemic in Lahore (2011) resulted in hundreds of deaths and affected thousands. As most of the studies were focused on its diagnosis and treatment, scanty data is available on associated diseases/co-morbidities in these patients that could have contributed to a higher mortality. There were no local guidelines available on recording, reporting and management of these co-morbidities. The objective of this study was to analyze the initial presentations of dengue cases and to estimate the frequency of co-morbidities in dengue patients.
  
  
  METHODS
  Data of 556 dengue cases was retrieved from 2 major public sector tertiary-care hospitals for patients who were admitted during 2011 epidemic and a case record analysis was done. Data was retrieved from patient's information reports which included demography, signs and symptoms and the laboratory investigations. In addition verbal autopsy of deceased cases was also done from their relatives using standardized WHO verbal autopsy form after making modifications as per needed.
  
  
  RESULTS
  Of 556 cases studied, 390 (70%) were males. The mean age was 36 years and 30% of the cases were between 20-29 years. Average duration of the hospital stay was 6 days. Out of the total, 435 (78%) were dengue fever (DF) cases followed by dengue hemorrhagic fever (DHF) in 95 (17%) and dengue shock syndrome (DSS) in 26 (4%) cases. A total of 40 cases died and among them 17 were diagnosed with DSS, 13 DF and 10 DHF. Further the verbal autopsy from relatives of deceased cases showed 29 (60%) deceased had co-morbid diseases which included hypertension, diabetes etc. DSS was common in patients who had hypertension (27) either alone or associated with other illnesses.
  
  
  CONCLUSIONS
  Co-morbidities with dengue infection were seen in 60% deceased cases indicating the reasons for high dengue related complications and death.
authors.affiliation: Pakistan Medical Research Council (PMRC), Head Office, Shahrah-e-Jamhuriat, G-5/2, Islamabad, Pakistan. arif289@gmail.com.
authors.forename: Muhammad Arif Nadeem
authors.initials: MA
authors.lastname: Saqib
authors.forename: Ibrar
authors.initials: I
authors.lastname: Rafique
authors.forename: Saira
authors.initials: S
authors.lastname: Bashir
authors.forename: Arsalan Ahmad
authors.initials: AA
authors.lastname: Salam
mesh_terms: D000328:Adult; D019090:Case Management; D015897:Comorbidity; D003715:Dengue / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003716:Dengue Virus / Q000302:isolation & purification; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index