Clinical Profile of Dengue Among Children According to Revised WHO Classification: Analysis of a 2012 Outbreak from Southern India

Abstract

Children between 5 and 15 y were most affected by dengue fever. Pain abdomen and vomiting were most common presenting symptoms. Ascites, plerural effusion, hepatomegaly, gall bladder wall thickening and abnormal LFT were found significantly high in severe dengue cases.

Changing trends in clinicopathological parameters in dengue with evaluation of predictors of poor outcome in children

“…Only one prior study reported abdominal pain as common presenting complaint, thus there should be a high index of suspicion in children presenting with fever and abdominal pain especially during the outbreak of dengue. 7 Lethargy was present in 72% of children and was the only single parameter associated with poor outcome (p < 0.005).…”

“…This study also had a male preponderence of 62% and mean age was 8 years which is similar to the other Indian studies. 7,8 The most common presenting symptom was lethargy, abdominal pain and mucosal bleeds, fever was present universally in all patients. Only one prior study reported abdominal pain as common presenting complaint, thus there should be a high index of suspicion in children presenting with fever and abdominal pain especially during the outbreak of dengue.…”

“…[7][8][9][10] All patients with mucosal bleed had thrombocytopenia and it was statistically significant, however previous pediatric studies have denied any association between bleeding and thrombocytopenia in dengue (Table 4). 7,11 On examinaton 50% children had hepatomegaly and 17% had third space fluid accumulation, both of these factors independently had significant correlation with shock (p < 0.005 and 0.000 respectively) ( Table 5). …”

“…[12][13][14] However hepatomegaly with liver failure in dengue have been reported only in adult population, some pediatric studies have reported hepatomegaly in dengue but did not have predictive value. 7,[15][16][17] Most of the pediatric studies of dengue have relied upon biochemical parameters like elevated liver enzymes, hyperglycemia, hypoglycemia, deranged PTT for predicting poor outcome in children, but the disadvantage being the time lapse between obtaining these results and assesing the severity of the disease. 7,18 In this study we have evaluated and analysed clinical features associated with shock and prolonged hospital stay, which can be assesed at the time of admission thereby limiting the delay in predicting severity of the disease which may not be apparent at the onset.…”

“…7,19,20 The new classification helps differentiate between severe and nonsevere dengue and also lays out the protocols for the management of the same, eliminating the occurrence of overlap in diagnosis.…”