Gallbladder Wall Thickening for Early Detection of Plasma Leakage in Dengue Infected Adult Patients

Leonard Nainggolan, Candra Wiguna, Irsan Hasan, Esthika Dewiasty


Background: plasma leakage is defined as ?20% elevation of hematocrit from baseline or decrease in convalescence or evidence of plasma leakage such as pleural effusion, ascites or hypoproteinaemia/hypoalbuminaemia. These signs of plasma leakage, in the early phase, are usually difficult to ascertain by physical examination and laboratory tests where the patient is only reflecting a mild degree of plasma leakage. This study aimed to investigate whether gallbladder wall thickening (GBWT) in the early phase of the disease can be used to detect the occurrence of plasma leakage in dengue patients. Methods: a diagnostic study was conducted among dengue patients. Patients with fever less than 3 days, positive results of non-structural protein 1 antigen dengue and RT-PCR examination were included consecutively. Laboratory tests and chest and abdominal ultrasonography examination were also performed daily from day-3 to day-7 of fever to confirm the occurrence of plasma leakage using WHO 1997 criteria during treatment. Results: there were 69 patients included in this study. Male patients were found more frequently (52.2%), average age was 24.2 years, and 46 patients (66.7%) presented with secondary dengue infection. On the third day of fever, 37 patients presented with GBWT, 30 of which showed plasma leakage during treatment. Out of 46 patients found to have plasma leakage during treatment, 12 patients had presented with plasma leakage on the third day of fever. Sensitivity and specificity of GBWT on the third day of fever were 65% (95% CI: 0,51-0,79) and 70% (95% CI: 0.51-0.88); PPV and NPV were 81% (95% CI: 0.68-0.94) and 50% (95% CI: 0.33-0.67); LR (+) and LR (-) were 2.14 (95% CI: 1.12-4.12) and 0.5 (95% CI: 0.31-0.81), respectively. Conclusion: gallbladder wall thickening in the early phase of the disease can be used to detect the occurrence of plasma leakage in adult dengue infected patients.


plasma leakage; gallbladder wall thickening; ultrasound; WHO 1997 criteria; dengue


World Health Organization. Dengue haemorrhagic fever. Revised and expanded edition. Diagnosis, treatment, prevention, and control. 2nd ed. Geneva; 1997.

Basu A, Chaturvedi UC. Vascular endothelium: the battlefield of dengue viruses. FEMS Immunol Med Microbiol. 2008;53:287-299.

Halstead SB. Dengue. Lancet. 2007;370:1644-52.

Michels M, Sumardi U, de Mast Q, et al. The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. PLoS Negl Trop Dis. 2013;7(6): e2277.

Oliveira GA, Machado RC, Horyat JV, et al. Transient reticular gallbladder wall thickening in severe dengue fever: a reliable sign of plasma leakage. Pediatr Radiol. 2010;40:720-4.

Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, et al. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. 2007;26:283-90.

Vedaraju KS, Kumar KRV, Vijayaraghavachari TV, et al. Role of ultrasound in the assessment of dengue fever. Int J Sci Stud. 2016;3(10):59-62.

World Health Organization and the Special Programme for Research and Training in Tropical Diseases (TDR). Dengue guidelines for diagnosis, treatment, prevention, and control. New Edition. 2009.

Tatura S, Kalensang P, Mandei JM, et al. Albumin level as a predictor of shock and recurrent shock in children with dengue hemorrhagic fever. Crit Care Shock. 2017;20:24-9.

Khurram M, Qayyum W, Umar M, et al. Ultrasonographic pattern of plasma leak in dengue haemorrhagic fever. J Pak Med Assoc. 2016;66:260-3.

Venkata S, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol. 2005;78:416-8.

Hegde S, Sutay NR, Tinmaswala MA, et al. Ultrasound evaluation of dengue dever. JMSCR. 2016;03(09):7538-45.

Nagolu H, Papireddygari VK, Reddy PRV, et al. Role of ultrasonography in diagnosis and evaluation of dengue fever. Int J Anatomy, Radiol Surg. 2017;6(4):RO52-6.

Zulkarnain I. Gallbladder edema in dengue hemorrhagic fever and its association with hematocrite levels and type of infections. Acta Med Indones-Indones J Intern Med. 2004;36(2);84-6.

Nainggolan L. Primary study of dengue infection profile in Community. Jakarta: Faculty of Medicine Universitas Indonesia; 2009. Unpublished.

Maihuru ATA, Wagenaar J, Brandjs DPM, et al. Dengue: an arthropod-borne disease of global importance. Eur J Clin Microbiol Infect Dis. 2004;23:425-33.

Kim YO, Chun KA, Choi JY, et al. Sonographic evaluation of gallbladder-wall thickening in hemorrhagic fever with renal syndrome: Prediction of disease severity. J Clin Ultrasound. 2001;29:286-9.

Full Text: PDF


  • There are currently no refbacks.