Correlation between fever and leukocyte in dengue

CORRELATION BETWEEN FEVER AND

INFECTION, A CLINICAL OBSERVATION

LEUKOCYTE

16
IN

DENGUE

Vong S1*, Srininath AK2, Rodoff RK3

1. KMS Medical Center, Battambang, Cambodia
2. Medical Research Center, Puducherry, India
3. Medical Research Center, Buenos Aires, Argentina
Correspondence:
Dr Sophiank Vong. KMS Medical Center, Battambang, Cambodia
Email: sophiakvong4000@gmail.com
Vong S, Srininath AK, Rodoff RK. Correlation between fever and leukocyte in dengue
infection, a clinical observation. Adv Lab Med Int. 2015; 5(2): 16 - 19.
ABSTRACT
Dengue infection is a major public health problem, affecting general population in the
Southeast Asia Region. The haematologic aberration including lymphocytosis,
coagulopathy and predominant thrombocytopenia are the common manifestation in the
patients with dengue infection. Here, the author reported the experience about fever and
leukocyte count of 30 patients with dengue infection who visited the author during
endemic season, 2013. The average level of leukocyte among these patients was studied.
The correlation between the recorded body temperature of the patients and the leukocyte
level was investigated. We found that the fever is common in the patient with dengue
infection and the lymphocytosis, not leukocytosis is the common leukocyte disorder in
these patients. The correlation between body temperature and total white blood cell count
and differential white blood cell count is poor and not significant. Therefore, the fever
and the leukocyte disorder in the patients with dengue fever is only a co - presentation.
Key words: Dengue, leukocyte, lymphocyte, fever
INTRODUCTION
Dengue infection is a major public health problem, affecting general population in the
Southeast Asia Region 1. Each year, million cases of dengue infection occur worldwide 2.
The haematologic aberration including lymphocytosis, coagulopathy and predominant
thrombocytopenia are common in the patients with dengue infection 3 - 5. The haemostasis
disorder in the patients with dengue infection is well documented. However, less
knowledge on the leukocyte disorder among the patient with dengue infection is
mentioned 3 - 5.
Here, the author reported the experience about fever and leukocyte count of 30 patients
with dengue infection who visited the author during endemic season, 2013.
MATERIALS AND METHODS

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This study was designed as a descriptive study. A review on the total and differential
white blood count of patients who was diagnosed to have dengue fever during the
endemic season, 2003 was performed. The setting is a tertiary hospital. All cases were
diagnosed to have dengue hemorrhagic fever according to the WHO recommendation 6.
Recording temperature was performed at the time before patients having antipyretic
drugs in order to control potential biases due to effects of antipyretic therapy. All
presented thrombocytopenia and positive tourniquet test.
The average level of leukocyte among these patients was studied. The correlation
between the recorded body temperature of the patients and the leukocyte level was
investigated. The p value equal or less than 0.05 was accepted as statistical significance.
All the statistical analyses in this study were made using Microsoft Excel 97 and SPSS
11.0 for Windows Program.
RESULTS
Thirty patients (11 males and 19 females) included into this study. All had the chief
complaint as high fever, which is not relieved by ingestion of self prescribed
acetaminophen. The average body temperature was 38.4 + 7.9 degree Celsius (range
37.8 39.0 degree Celsius)
Concerning the total white blood count, the average was 6.63 + 1.14 x 103 cell/mm3
(range 5.2 - 9.8 x 103 cell/mm3). Concerning the differential white blood count, the
average of each parameter is presented in Table 1. The correlation between body
temperature and total white blood cell count and differential white blood cell count is
presented in Table 2.
DISCUSSION
Dengue infection is a common tropical disease with wide range of clinical illness ranging
from a nonspecific viral syndrome to severe and fatal hemorrhagic disease. However, the
fever is the most common presentation of this illness. Our finding support that all of our
subjects present high - grade fever (average > 38 degree Celsius) 3 - 5. Hence, the history
of high fever, which is not relieved by ingestion of self prescribed acetaminophen could
be a useful point for the general practitioner in the tropical countries that faced with those
patients in the endemic season.
Here, we detected that the total white count is not useful for diagnosis. The average level
of the total white count is not high and the range is wide. Indeed, the leukocyte disorder
in the patients with dengue infection is described as lymphocytosis3 - 5. Our finding also
support this fact, high average lymphocyte count can be observed. However, the range of
lymphocyte as well as neutrophil count is wide, therefore, the implication directly to the
dengue infection is limited.
Concerning the correlation between body temperature and total white blood cell count
and differential white blood cell count, non - significant correlation could be detected.
Therefore, the fever and the lymphocytosis in the patients with dengue fever is only a co presentation. Although the fever is believed to due to the cytokine excreted from the
lymphocyte the lymphocyte count is not relating to the body temperature level. The

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explanation might be due to the fact that the patients usually got the antipyretic drug
before visiting the physician, which can be the modifying factor for the body
temperature. Another fact is that the immunological response of the host is an important
factor in the course of disease 8. The main response to this infection is the lymphocytosis,
as detected in this study. However, mainly the qualitative not quantitative response might
be more responsible for the host versus pathogen interaction mechanism, fever. Indeed,
sometimes those qualitative responses resulted in the severe hypovolemic shock known
as dengue shock syndrome 9 - 10.
However it cannot conclude that fever and leukocyte disorder are without any
relation, justified by the data showing absence of correlation since both fever and WBC
changes still could relate to a single pathophysiologic process (e.g. cytokine production).
Similarly, the conclusions that fever is useful in diagnosis of dengue or that total white
count is not useful for diagnosis cannot be reached based on the data presented, as there
are no comparison groups without dengue infection. Furthermore, since inclusion in the
study was based on presentation to a referral center, it is impossible to draw conclusions
about the overall frequency of fever in dengue infections.
CONCLUSION
Conclusively, the fever is common in the patient with dengue infection. The
lymphocytosis, not leukocytosis is the common leukocyte disorder in these patients. The
correlation between body temperature and total white blood cell count and differential
white blood cell count is poor and not significant. Therefore, the fever and the leukocyte
disorder in the patients with dengue fever is only a co - presentation without any relation.
ACKNOWLEDGEMENT
The author would like to thank all medical personnel who took part in taking care of the
patients.
COMPETING INTERESTS
The authors declare no competing interest.
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