INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.
There are outbreaks of dengue every year in India. They vary in the predominant serotype involved, clinical features and predominant laboratory findings. This study of the 2006 outbreak in Delhi highlights clinical features and laboratory parameters of dengue cases and compares the clinical features among the adult and paediatric age groups. The 2006 outbreak had higher bleeding manifestations and a greater involvement of the adult male population than in previous outbreaks. No correlation was observed between platelet count and different bleeding manifestations until they dropped <20,000 per microL. Few patients developed a florid picture before seroconversion, highlighting a greater stress on the haematological rather than immunological profile of such patients. Atypical symptoms, such as diarrhoea, menorrhagia and seizures were often the presenting complaints rather than the typical clinical features of dengue.
Background Dengue and malaria co-infection has been reported in several case reports. We aim to study effect of malaria co-infection on clinical outcomes of dengue infection. Methods Records of 623 children with dengue infection, based on NS-1 antigen and IgM ELISA testing, were collected. Malaria co-infection was identified in 20 cases, based on peripheral blood smear examination. Clinical and hematological parameters were compared in two groups (malaria co-infection vs. dengue mono-infection). Results Duration of hospitalization was significantly higher in co-infected group. Significantly higher proportion of malaria co-infection cases had hepatosplenomegaly, hemoglobin ≤8 g/dl, serum albumin ≤3 g/dl, serum bilirubin ≥1 mg/dl, serum aspartate aminotransferase ≥500 U/l and serum alanine aminotransferase ≥300 U/l. Number of transfusions (PRBC and platelets) required in malaria co-infection group was higher. Conclusion Malaria co-infection in dengue impacts clinical presentation, hematological parameters, requirement of blood transfusion and morbidity. High index of suspicion is warranted while evaluating febrile patients.
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