Dengue fever causing febrile neutropenia in children with acute lymphoblastic leukemia: An unknown entity

Abstract

Dengue fever is endemic in many parts of the world but it has not been described as a cause of febrile neutropenia. We describe here clinical features, laboratory values and outcome in 10 children with acute lymphoblastic leukemia (ALL) and with dengue fever as a cause of febrile neutropenia. These data are compared to an age-matched control population of 22 children with proven dengue infection without ALL. Except for fever in all patients and plethoric face in one patient, typical symptoms of dengue such as abdominal pain, myalgias, and headaches, were absent. Mean duration of hospital stay was 6.3±2.0 days in ALL patients vs. 5.0±2.0 in controls (p=0.096). Median platelet count was 13,000/cmm (range 1000-28,000) in cases vs. 31,500 (range 13,000-150,000) in controls (p=0.018). Mean time for recovery for platelet was 6.0±1.3days in ALL patients vs. 2.5±0.9days in controls (p<0.001). All 10 patients survived. In endemic areas, high suspicion of dengue fever should be maintained in children with ALL and febrile neutropenia although typical symptoms may be lacking. Platelet recovery may be significantly delayed.

Improving the safety of high‐dose methotrexate for children with hematologic cancers in settings without access to MTX levels using extended hydration and additional leucovorin

“…Dengue fever has been described in patients receiving chemotherapy. [20][21][22] To conclude, in centres lacking access to MTX levels, administration of HD-MTX at full doses, with extended hydration, additional doses of leucovorin and monitoring of serum creatinine is feasible with manageable toxicities. The strategy is simple, inexpensive and universally feasible.…”

Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries

“…In leukemia patients, dengue may delay platelet recovery and result in severe bleeding and anemia [92,93]. Symptoms may be blunted in malnourished and immunocompromised children [94]; and in endemic areas, dengue infection should be a part of the differential diagnosis of FN [93].…”

Initial presentation with dengue infection masking the diagnosis of acute lymphoblastic leukemia

“…Children having ALL complicated by DF showed absence of DF symptoms except for fever on admission. Three out of 11 children later developed DHF and two DSS . In contrast, eight adults that presented with combined diagnosis, showed typical symptoms of fever, myalgia, and/or skin rash.…”

“…A few reports described DF during the course of ALL, resulting in febrile neutropenia after chemotherapy . Children having ALL complicated by DF showed absence of DF symptoms except for fever on admission.…”