Leana Tran

Clinical Features of and Risk Factors for Rhabdomyolysis Among Adult Patients with

Dengue Virus Infection.

Dengue is a mosquito-borne disease. The Dengue fever does not spread from person to person

directly, but from a mosquito bite. Dengue Haemorrhagic Fever was discovered in the 1950s in Thailand

and the Philippines during the epidemic. The Dengue virus is one of the leading causes of death in the

tropical regions of the world. Dengue disease is most commonly found in the tropical regions such as:

Asia, Mexico, Africa, Taiwan, Pacific Islands, South America, Central America, and more. There are four

known serotypes of the dengue virus: DENV-1,2,3, and 4. These viruses are related to the yellow fever

and West Nile.

Institutional Review Board of Chang Gung Memorial Hospital was able to approve the study that

was conducted. In the study, there were 1,076 patients that participated. The participants ages ranged up

to eighteen years old. All of the participants were tested positive for the DENV infection. Patients in the

study were divided into two groups. One group consisted of patients that have developed rhabdomyolysis

(study) (N=9) and another group consist of patients that did not develop rhabdomyolysis (control)

(N=1,067).

The years between 2009-2013, One hundred and one DHF patients had their blood drawn. Blood

samples were needed to detect cytokine/chemokine levels. The blood samples were immediately

centrifuged to separate the plasma and blood cells running at 2,500 rpm for twenty minutes. The

cytokine/chemokine levels were expressed using median and range. To determine the concentration, a

standard curve was used and a regression line. The Mann-Whitney U test was used to compare the

concentrations of cytokine/chemokine levels between the control and study group. A P value of <0.05 was

noted as significant.
 Out of 1,076 patients, 46.3% were men, 23.7% of the patients had hypertension, 15.3% had

diabetes, and 4.3% received Statin therapy. The most common symptoms include: fevers, bone pain, and

headaches. The serotypes of the Dengue Virus were ranked from most common to least common

diagnosed strain starting with DENV-2 at 91%, DENV-3 (7.3%), DENV-1 (1.6%), and DENV-4 (0.1%).

The study consisted of a mortality rate of 1.1% as 12/1076 patients have passed away. Patients that

consists of rhabdomyolysis tend to be older. (P=0.019).

Of the 1,076 patients, those that received the statin treatment developed rhabdomyolysis (0.04-

2%). Patients that had hypertension that received statin therapy did not increase their chances of

developing rhabdomyolysis, those that had hypertension and did not receive the statin therapy had a high

risk for developing rhabdomyolysis with a DENV-infection. The direct relationship between hypertension

and rhabdomylysis is unknown. The study showed that DHF was not a risk factor for rhabdomyolsis. Out

of all the serotypes for the virus, the most common was DENV-2.