Jawad K Ansari, Masood Siddiq, Tassawar Hussain, Inam Baig, Waheeduz Zaman Tariq.
Outbreak of Dengue Hemorrhagic Fever in Karachi.
Pak Armed Forces Med J Jan ;51(2):94-8.

In 1994, there occurred two separate outbreaks of febrile illness in Karachi. These were characterized mainly by thrombocytopenia. Haemorrhages were observed in number of cases. This prospective study included 120 cases who dropped their platelet count below 100,000/cmm. All were adult males with the mean age of 27.1 years. Duration of fever was 3.14 days (mean 7.5). Vomiting and nausea were seen in 77.5% and 59.1 % cases. Myalgias, headache and backache were other common symptoms. Haemorrhages were found in 53.3% cases with epistaxis in 17% and bleeding gums in 14.1%. Platelets were between 90,000 to 100,000 in 23.3%, in 42.6% cases count was between - 50,000 - 90,000 and below 50,000 in 34.1 % with the mean count of 58000/cmm. In 1994, six out of seven sample processed were positive for antibodies against dengue type II. In 1995, 15 out of 34 samples tested were positive for the same dengue type. One patient died of myocariditis. Rest of patients recovered. Occurrence of dengue fever in Karachi has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever. Myocarditis as cause of death in dengue fever has also been documented inviting further research and discussion.

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