The association of Obesity and Dengue severity in hospitalized adult patients
Journal of Microbiology, Immunology and Infection: April 2023
Of the four DENV serotypes (DENV-1
to DENV-4), DENV-2 and DENV-3 are frequently associated with severe secondary
dengue infections.
Obesity is commonly associated with
numerous comorbidities and is a major health burden. According to WHO
guidelines, the dengue patients who have underlying diseases (diabetes
mellitus, renal failure, and chronic haemolytic diseases), certain social
circumstances, warming signs (abdominal pain or tenderness, persistent
vomiting, clinical fluid accumulation, mucosal bleed, lethargy, restlessness,
liver enlargement >2 cm, increase in hematocrit level concurrent with rapid
decrease in platelet count) and risk factors (such as obesity, pregnancy, infancy,
and old age) are worthwhile referring to the hospital for further observation
and management.
In recent decades, the population
of obese adults has increased in Southeast Asia, where dengue is endemic; thus,
how obesity affects dengue severity should be determined.
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In this study, authors used a
retrospective design to investigate the association between obesity and dengue
severity in adult patients.
A total
of 1417 hospitalized patients with dengue were evaluated.
Obese
children had a more unusual dengue presentation, more fluid overload, higher
mean aminotransferase levels, and higher complication rates. Case fatality
rates were also higher in obese children than in normal-weight children.
Other
studies, however, have reported no association between obesity and dengue
hemorrhagic fever, dengue shock syndrome, or dengue severity among children.
Conclusion: In adult
patients with dengue, obese group had more petechiae, dyspnea, severe
hepatitis, lower nadir of platelet count, and higher peak hematocrit level.
Authors observed no difference in severe dengue or mortality between obese and nonobese group.
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Background: Obesity is
associated with unfavorable outcomes for infectious diseases. Most researches
exploring the association between nutritional status and dengue severity have
focused on pediatric populations, with only few studies assessing adult
patients.
Methods: Adult
patients with laboratory-confirmed dengue admitted to a tertiary hospital in
southern Taiwan between 2014 and 2015 were enrolled retrospectively.
Demographics, comorbidities, clinical presentation, laboratory findings, and
outcomes were obtained from case-record forms. Patients were categorized into
obese group and nonobese group. The obese group comprised patients with a body
mass index of ≥27.5 kg/m2.
Results: A total of
1417 hospitalized patients with dengue were evaluated. The mean age was 57.9
years (range: 18-92 years). The obese and nonobese groups comprised 333 (23.5%)
and 1084 (76.5%) patients, respectively. The obese group included more patients
with hypertension (85%), diabetes mellitus (33%), and congestive heart failure
(6.3%). Multivariate analysis revealed that the obese group had more petechiae,
more dyspnea, and more severe hepatitis. The obese group also had higher peak
hematocrit values (44.1%) and lower nadir platelet count (45.3 × 103/μL)
than the nonobese group.
Conclusion: In adult
patients with dengue, obese group had more petechiae, dyspnea, severe
hepatitis, lower nadir of platelet count, and higher peak hematocrit level. We
observed no difference in severe dengue or mortality between obese and nonobese
group.
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