Gall Bladder Wall Edema is Not Pathogenic of Dengue Infection

J Trop Pediatr . 2002 Oct;48(5):315-6.

Anupam Sehgal, Sangita Gupta, Vineet Tyagi, Shubhra Bahl, Saroj K Singh, Jacob M Puliyel

Journal of Tropical Pediatrics Vol. 48 October 2002 315
FIG. 1. Distribution of gallbladder wall edema in children with a fever of 101ºF for 5 days or more.
Gall Bladder Wall Edema is Not Pathogenic of
Dengue Infection
We have previously reported gall bladder wall
edema (GBWE) in serology-proven pediatric
dengue hemorrhagic fever (DHF).1 Contemporane-
ously, Setiwan, et al.2 reported GBWE in 94 out of
148 serologically-proven dengue cases. However is
GBWE pathognomic of dengue? This study was
undertaken to answer the question. We looked for
GBWE and dengue serology in all children admitted
with a fever of 100ºF for 5 days or more, during a
dengue epidemic, 2 years after our original study.
The study was conducted in a tertiary care referral
center in North India. All children with a fever of 101ºF
for 5 days or more, admitted from September 2000 to
January 2001, were included in the study. All had
dengue serology and ultrasonography of the abdomen
for GBWE. They also had blood counts, blood smear
examinations, blood culture, Widal test and urine
examination to look for the cause of fever. Dengue
serology was tested at the National Institute of
Communicable Disease, Delhi. IgM hemagglutination
antibody titers greater than 1:160 was interpreted as a
positive result. Gall bladder wall edema was defined as
wall thickening greater than 3 mm on ultrasonography.3
The study population was divided into two groups
according to dengue serology positivity. Each group
was further subdivided according to the presence of
GBWE. The specificity and sensitivity of GBWE in
dengue fever was looked at.
There were 56 children fulfilling the study entry
criteria. Dengue serology was positive in five cases,
four of them had GBWE. In all, GBWE was present
in 25 of 56 children recruited for the study (Fig. 1).
Specificity and sensitivity of GBWE in dengue infec-
tion was 58 and 80 per cent, respectively.
Out of the 56 children recruited, enteric fever was
responsible for fever in 36. GBWE was present in 12
of these 36 cases of enteric fever. GBWE was seen in
conditions as diverse as cerebral malaria, Fanconi
anemia, viral fever with shock, sepsis with dissemi-
nated intravascular hemolysis and shock, sepsis with
meningoencephalitis, urinary tract infection and
pyrexia of unknown origin.
It was felt that GBWE could be an indicator of
dengue1 and this was supported by the study of
Setiwan, et al .2,3 In the light of the results in the
present study, GBWE appears to be too non-specific
to be of help in the primary diagnosis of dengue
infection. GBWE is present in a large number of
conditions as part of polyserositis and it cannot be
used as a diagnostic criteria for dengue fever.