Study of Clinical, Laboratory Profile and Outcome of Dengue Fever Admitted in Paediatric Ward of a Tertiary Care Hospital of Western Uttar Pradesh, India

Abstract

BACKGROUNDDengue Fever epidemic resurfaced this year after 2005 with more number of cases and with varying presentations and complications. The presentation can vary from a mild febrile illness to severe refractory shock or severe bleeding. Dengue is an important cause of mortality and morbidity in India. Many recent studies have shown varied clinical manifestations from different geographical locations. The present prospective observational study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from dengue in a tertiary care centre of Western Uttar Pradesh, India. Objective-To study the clinical, pathological, laboratory profile and outcome of the confirmed cases of Dengue fever in Paediatric age group admitted in the hospital. MATERIALS AND METHODSThe Prospective observational study was performed at Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh which is a tertiary care hospital of Western Uttar Pradesh. The study period was from June 2013 to November 2013. Patients up to 18 years of age who were admitted in Paediatric ward and were positive for serological test (NS1 Ag, IgM /IgG) for dengue fever were included. The patients were subjected to detailed history and examination and relevant investigations were sent. RESULTSTotal 126 patients were included. Out of these, 66 were male (52.38%) and 20 were female (47.61%). Majority of them presented in critical phase on day 4-6 of illness (57.14%). Most of the cases were admitted in post monsoon period in the month of October and November. The most common presentation was fever 126 (100%) followed by petechial rash 75 (59.52%). Pruritus was present in 60 (47.61%) patients. NS1 antigen was positive in majority of patients (78, 61.9%). Thrombocytopenia was the commonest haematological abnormality. Deranged hepatic, renal and cerebral functions were noted. Total leucocyte counts were less than 4000 in most of the patients (54, 42.8%). Bleeding manifestations in the form of gum bleeding, haematuria, epistaxis, melaena were present mainly in patients having severe thrombocytopenia (<50,000/cu mm). On ECG 39(23.8%) patients were having myocarditis whereas 24 (19%) patients had pleural effusion on chest x-ray. The average duration of stay in the hospital was 6-7 days and majority of the patients were discharged on day 9-10 of illness. Comorbid conditions in the form of malaria 9 (7.1%) and enteric fever 7 (5.5%) were also noted. Blood cultures were positive in only 8 (6.3%). 8 patients expired and mortality rate was 6.3%. Shock, bleeding, encephalitis, ARDS, late presentation and diagnosis were associated with poor outcome and mortality. CONCLUSIONDengue is an important cause of mortality and morbidity in western Uttar Pradesh and adjoining areas. Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases. High index of...