Relationship between asymptomatic anicteric hepatitis and asymptomatic myositis in a cohort of adult Sri Lankan dengue patients admitted to a medical unit of a tertiary referral centre
Abstract
Objective: To study the relationship between asymptomatic anicteric hepatitis and asymptomatic myositis in a cohort of adult Sri Lankan dengue patients admitted to a medical unit of a tertiary care centre.
Methods: Case notes of 88 consecutive confirmed dengue patients admitted to the principal authors unit at Sri Jayewardenapura Teaching Hospital, Kotte, Sri Lanka from January 2012 to June 2012 were retrospectively analyzed to obtain the required information. Clinical criteria defined for suspected dengue fever were a confirmed viral infection with a platelet count less than 100000/cumm3 during the epidemic.
Results: Age ranged from 13 to 64 years with a mean age of 28.6+/- 8.62 SD. Sex distribution was male: female = 56:32 (6:4). An elevated AST level (>37u/l) and elevated ALT level (>40 u/l) were found in 95% and 90.9% of the instances respectively. AST levels were above ALT levels in 86.2% of the instances. Elevated CPK levels were seen in 87.5% patients. There was no linear relationship between asymptomatic transaminitis and elevated CPK levels. Hypocalcaemia was noted in 72% as described in the literature, without any relationship to either tramsaminitis or myositis.
Conclusions: Immunological mechanisms resulting in anicteric hepatitis and asymptomatic myositis in dengue seem to differ. Elevation in AST and ALT levels seem to differ from other viral infections mimicking what is seen in acute alcoholic liver disease. The role of hypocalcaemia was uncertain.
