Abstract

Dengue virus caused an extensive epidemic in Portsudan, Red Sea State, Sudan extending from July to December 2009.  The acute presentation, regarding liver injury, varies from mild or even no hepatitis to sever or even fulminant hepatic failure. Therefore, we measured the levels of liver enzymes, prothrombin time (PT), creatinin in dengue infection and compare them to the clinical presentation of the patients. 633 Patients were seen in the outpatient and inpatient departments of Portsudan teaching hospital, Portsudan, Red Sea State, Sudan in the period from July to December 2009. All of them were serologically confirmed dengue cases and were negative to heptotropic viruses (A, B, C &E), malaria, leptospira, typhoid and brucellosis. The degree of hepatic injury was established according to the alterations in the liver enzymes, prothrombin time and creatinin levels.  Grade 0 - normal levels of liver enzymes; Grade 1 – mild elevation in the liver enzymes, not exceeding the double of reference value; Grade 2 - elevated liver enzymes, with the levels of the enzymes increased to more than three times the reference values; grade 3 - acute hepatitis, with liver enzymes levels increased to at least 10 times their normal values; Grade 4: evidence of hepatic failure (high PT) or hepato-renal involvement (high creatinin).  In this study, there were 280 male and 353 female  serologically confirmed dengue cases (total: 633), 63.8% presented mild alterations in the liver enzymes levels (grade 1), 17.9% presented grade 2 liver involvement, 3.9% of the patients had progressed to acute hepatitis (grade 3) and 1.1% had severe liver damage with fulminant hepatic failure. 50% of the renal impairment occurs in grade 3 liver damage and the other 50% in grade 4 liver damage. All cases of encephalopathy (100%) occur in grade 4 liver damage. Mild elevation of the liver enzymes was a common finding in dengue virus infected patients. There was a high relation between the degree of liver injury and presence of the complications. At least, the aspartate transeferase (AST) should be done regularly in the follow up of dengue patients in Portsudan.

Key words: Dengue virus, hepatitis, liver failure, Portsudan