Dengue haemorrhagic fever in children in the 1996 Delhi epidemic

Abstract

An epidemic of dengue haemorrhagic fever (DHF) occurred in Delhi in 1996. A total of 240 children between the age of 4 months to 13 years of either sex, admitted in one hospital, were evaluated. Two hundred and sixteen (90%) children were from Delhi. A clinical diagnosis of dengue fever (DF) was made in 25 (10%), dengue fever with unusual bleeding (DFB) in 22 (9%), DHF in 80 (33%) and dengue shock syndrome (DSS) in 113 (47%) of the children strictly according to the WHO classification. The age peaked at 8 years. There was no association between various grades of severity of illness and age-groups though girls suffered from more severe illness. No association between severity of malnutrition and severity of illness was observed. Tourniquet test was positive in 40% with DF, 18% with DFB, 62% with DHF and 64% with DSS. In DSS haematemesis was present in 55 (49%), epistaxis in 39 (35%), melaena in 27 (24%) and ecchymosis in 34 (30%) patients. Children diagnosed as DFB had haematemesis and epistaxis in 12 (55%) and 10 (45%) respectively. Intravenous fluid requirement was clearly less in DFB patients than in DHF/DSS patients. Unusual clinical features in the form of jaundice were present in 7 (6%), hepatic encephalopathy in 6 (5%) and dengue encephalopathy in 6 (5%) patients. Dengue 2 virus was isolated from 10 of the 50 patients for whom viral culture was done on C6/36 clone of Aedes albopictus cell line. Eighteen patients suffering from DSS died giving an overall case fatality of 7.5%. The mortality rate in DHF/DSS was 9.3%. It is further suggested that DFB is a distinct entity. Most patients could be classified by the WHO classification if a retrospective packed cell volume was used to assess haemoconcentration. We suggest that development of area-specific criteria for diagnosis and management is desirable.

The pathogenesis of dengue

“…[85][86][87] Girls were also over-represented amongst severe (odd ratio 1.19) and fatal cases (odd ratio 1.57) in the cohort of dengue inpatients at three large hospitals in Ho Chi Minh City between 2001-2009. 85 The basis for an over-representation of females amongst severe and fatal cases has been suggested to be due to differences in health-care seeking behavior on behalf of girls and boys in Asian countries, i.e.…”

Clinical Profile and Outcome of Patients with Dengue Syndrome in Hospital Care

“…Kabra Sk et al found ascites in 87%, pleural effusion in 74% of the patients with dengue shock syndrome and 27% of patients with dengue haemorrhagic fever had ascites and pleural effusion. 6 None of the group-II subjects in this study had pleural effusion or ascites. Hepatomegaly, pleural effusion and ascites were commonly associated with group-III subjects of this study and is similar to the observations made in 1981 Cuban epidemic.…”

“…Hepatomegaly, pleural effusion and ascites were commonly associated with group-III subjects of this study and is similar to the observations made in 1981 Cuban epidemic. 12 Jaundice was found in 2% of patients comparatively less than the study of Kabra Sk et al 6 None had hepatic encephalopathy or dengue encephalopathy.…”

Study of nutritional status, comorbidities and other risk factors associated with dengue fever: data from a tertiary hospital in North India

“…The effects of nutritional status on dengue disease outcome has been controversial in previous studies. [7][8][9][10] Some studies found that patients with excessive body weight were at increased risk for more severe disease, while malnutrition is a protective factor in malnourished children. [11][12][13][14] In our study there was significantly higher number of obese/overweight individuals in cases as compared to that in controls (p < 0.001).…”