Clinical and laboratory profile and outcome of dengue cases among children attending a tertiary care hospital of South India

Abstract

INTRODUCTIONDengue is a mosquito borne febrile viral illness. Dengue virus belongs to the family Flaviviridae (single stranded non segmental RNA viruses) and has four distinct serotypes: DEN-1, DEN-2, DEN-3 and DEN-4. Humans are the main reservoir for the dengue virus. Urbanization, substandard living conditions, lack of vector control and climatic changes are some of the important causes for dengue infection. Once considered an urban problem, it ABSTRACT Background: Dengue fever is an arboviral disease which is endemic in tropical countries and is of major concern with its morbidity and mortality. WHO classified dengue into three categories: undifferentiated fever, dengue fever (DF) and dengue haemorrhagic fever (DHF). Severe dengue is also regularly observed during primary infection of infants born to dengue-immune mothers. The objective of present study was to assess the clinical profile, laboratory profile and associated risk factors related to outcome of children less than 15 years of age. The outcome of the children and their management protocols were also assessed in the study. Methods: A prospective cross sectional study with 174 confirmed cases of dengue in children <15 years were enrolled and classified as per WHO guidelines. The demographic data, clinical history, laboratory parameters were noted in a separate questionnaire form. Hematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done and observations noted. Cases were managed as per WHO protocol and risk factors were observed. The outcomes of the cases were noted as discharge or death of the case. Results: A total of 174 children with 149 non-severe dengue and 25 severe dengue cases with 95 males and 79 females were enrolled in the study. 6-10 years was the most common age group. The mean age of children admitted with severe dengue fever was 5.81yrs.and without severe dengue fever was 7yrs.The mean duration of hospitalization was 5.21 days in severe dengue and 3.4 days in non-severe dengue cases. Fever was the most common presenting symptom and hepatomegaly was the common clinical finding in the study. Bleeding manifestations were seen in cases of severe dengue with raised haematocrit levels, raised SGOT levels and severe thrombocytopenia. Pleural effusion and gall bladder wall thickening with ascites was seen in severe dengue cases. Management was by administration of colloids and crystalloids. Conclusions: Dengue is a dreadful fever among pediatric age group which needs to be considered with great caution in management. Understanding the risk factors helps in predicting the mortality which helps in management and better outcome of the fever.

Haematological Profile in Different Clinical Spectrums of Dengue

“…As far as complications like bleeding manifestations were concerned, we found that among different hematological parameters only platelet count had a significant association with bleeding manifestations. These observations are in agreement with the observations of Vanamali et al and Kauser et al [13,14] An association of platelet count with severity of dengue fever was also reported by Nagaram et al [20] , who reported that 46.3% of non-severe and 96% of severe cases in their study had platelet count <50,000/cumm. Even higher discriminant role of platelet count in assessment of severity of dengue fever was reported by Sharma et al [21] who found that 10.7% of non-severe and 82.6% of severe DF cases had platelet count <50,000.…”

“…But Shekhar et al [23] in their study had gender profile similar to that observed in present study with 53% males and 47% females. Nagaram et al [20] also had 54.6% male patients as compared to 45.4% females. There is as such no physiological or epidemiological reason for a gender-bias, in fact, both males and females are equally susceptible to dengue virus fever.…”

“…On the other hand, there are studies specifically performed in pediatric age group. Nagaram et al [20] and Sharma et al [21] performed their studies exclusively amongst children and reported the mean age of patients to be less than 10 years. However, workers like Patel et al (2016), [22] similar to present study did not impose any age restriction and reported the age range of patients from 1 to 76 years.…”

Cost-Effectiveness analisys on the implementation of clinical pathway of pediatric treatment for dengue hemorrhagic fever in PKU Muhammadiyah Hospital Yogyakarta

“…Based on the characteristics presented in Table I, more than one-third of the research samples (68 patients or 34.0%) were at the age of 6-10 years, with an average of 7 years old in each group. This finding is in line with the research carried out in South India from 2015 through 2016 (Nagaram et al, 2017), in which most pediatric DHF patients were in the age range of 6-10 years old. The chi-square test results showed no significant difference in the number of pediatric DHF patients between the age groups (p = 0.689>0.05).…”

Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue

“…Hammond NS y col en Nicaragua, y Armien y col reportan mayor número de casos en el sexo femenino; (12)…”