Dengue viral infection in children: a perspective

2012 ◽  
Vol 97 (10) ◽  
pp. 907-912 ◽  
Author(s):  
S Balasubramanian ◽  
Bala Ramachandran ◽  
Sumanth Amperayani
Keyword(s):  
Viral Infection ◽  
Viral Infections ◽  
Early Recognition ◽  
Warning Signs ◽  
Severe Dengue ◽  
High Morbidity ◽  
Ns1 Antigen ◽  
Vector Borne ◽  
Immune Enhancement ◽  
Dengue With Warning Signs

Dengue is a vector-borne viral infection of global importance. Several pathogenetic mechanisms such as immune enhancement and selection pressure have been proposed and febrile, critical and recovery phases have been identified. A new classification proposed by WHO has recently been introduced where definitions have been changed to ‘probable dengue’, ‘dengue with warning signs’ and ‘severe dengue’. The majority of dengue viral infections are self-limiting, but complications have high morbidity and mortality. The diagnosis of dengue viral infection is essentially clinical, although confirmation requires laboratory tests including serology, NS1 antigen detection, PCR and viral cultures. There are no specific anti-dengue drugs and treatment is basically supportive and consists of early recognition of complications and appropriate fluid therapy. A number of candidate vaccines are under development.

“CLINICAL PROFILE AND PREDICTORS OF ILLNESS SEVERITY IN CHILDREN WITH DENGUE FEVER”

2021 ◽  
pp. 41-43
Author(s):  
Manoj Kumar Ram ◽  
Bankey Bihari Singh
Keyword(s):  
Dengue Fever ◽  
Pediatric Population ◽  
Severe Disease ◽  
Dengue Infection ◽  
Warning Signs ◽  
Severe Dengue ◽  
Capillary Leak ◽  
Laboratory Parameters ◽  
Ns1 Antigen ◽  
Dengue With Warning Signs

BACKGROUND & OBJECTIVES: Dengue illness has become exceedingly common over the last few years globally. Due to their unique characteristics, incidence as well as mortality is higher in pediatric population as compared to adults. This study was undertaken to study clinical pattern of dengue fever in children and to identify factors predicting a more severe disease. METHODS: We conducted this hospital based prospective study at A.N.M.M.C.H, Gaya, Bihar over 2 years from January 2016- December 2017. Children >1 month and <15 years age with fever ≥ 3 days and symptoms suggestive of Dengue infection were included and evaluated for dengue infection by testing for NS1 antigen, IgM and IgG against Dengue infection. Children were classied into 3 clinical groups: Dengue without warning signs (DWWS), Dengue with warning signs (DWS) and severe Dengue (SD) as per WHO classication. Clinical and laboratory parameters were compared in the 3 groups. RESULTS: 114 children with Dengue were studied. 62 (54.4%) were males as compared to 52 (45.6%) females. 41 (36%) had DWWS, 53 (46.5%) had DWS and 20 (17.5%) had SD. Mean age was 74.1 months (SD 18.2 months) and mean weight was 21.4 kg (S.D 5.1 kg). Common symptoms were fever (100%), myalgia (76.6%), chills (62.3%), nausea/ vomiting (63.2%) and rash (53.5%). Common signs were ushed appearance (36.8%), positive Hess test (27.2%), bleeding manifestation (13.2%) and hypotension (36.8%). Laboratory investigations revealed anaemia (18.4%), thrombocytopenia (81.6%), Leucopenia (69.3%), elevated transaminase (41.2%), abnormal RFT (5.3%). 27.1% had prolonged aPTT while 21% had prolonged PT. Nausea/vomiting, bleeding, oliguria, capillary leak and liver enlargement (>2 cm) were signicantly more common in severe dengue (p<0.05) whereas rash was commoner in non severe dengue. Lab parameters signicantly more common in SD included rising hematocrit, falling platelets, high urea/creatinine/ALT and hypoalbuminemia & hypocholesterolemia. CONCLUSIONS: DF affects children irrespective of age. Symptoms more common in SD were nausea/vomiting, bleeding and decreased urine. Signs commoner in SD were features of capillary leak and hepatomegaly (>2 cm). Rising hematocrit, falling platelets, high urea, creatinine and ALT but hypoalbuminemia and low cholesterol were found to be statistically signicant laboratory parameters associated with SD.

scholarly journals Clinical profile, laboratory investigations and outcome in dengue positive children in south India

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 175-180
Author(s):  
Radha Kumar ◽  
Ganthimathi Sekhar ◽  
Ananthi N ◽  
Kalyani M
Keyword(s):  
Dengue Fever ◽  
Viral Infections ◽  
Monsoon Season ◽  
Severity Of Illness ◽  
Severe Infection ◽  
Warning Signs ◽  
Severe Dengue ◽  
Presenting Symptoms ◽  
Wide Range ◽  
Dengue With Warning Signs

Dengue fever is one of the most commonly occurring mosquito borne-viral illnesses that has a wide range of presentation in children and is common during the monsoon season. The severity of illness ranges from mild undifferentiated fever, dengue with warning signs, severe dengue fever and dengue fever with organ dysfunction. The symptoms of dengue may be easily mistaken for those of flu or other viral infections. Contrary to other fevers, complications in dengue occur during the phase of defervescence and can be life threatening in children due to shock or profuse hemorrhage. 55 dengue positive children who were diagnosed by dengue antigen detection or dengue antibody positive were included in the study. Most of children were above 10 years and the commonest presenting symptoms were fever, headache, body pain, nausea, anorexia, abdominal pain and vomiting. Most of the children presented with two or more warning signs like persistent vomiting, thrombocytopenia, increasing hematocrit and hepatomegaly. Few children developed features of early shock, which was diagnosed early and treated effectively. All the children responded well to treatment measures and recovered well during hospital stay. Having a high of suspicion and careful monitoring of children is crucial for reducing occurrence of complications and death due to this severe infection.

scholarly journals Clinical profile of dengue fever in children: analysis of 2017 outbreak from Central Kerala, India

2018 ◽  
Vol 5 (6) ◽  
pp. 2265 ◽  
Author(s):  
Senthil Kumar K. ◽  
Rajendran N. K. ◽  
Ajith Brabhukumar C.
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Clinical Profile ◽  
Severe Dengue ◽  
High Morbidity ◽  
Care Hospital ◽  
High Grade Fever

Background: In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. The objective of this study is to assess the clinical profile of the dengue infection in children less than 15 years of age and to evaluate the outcomes of dengue fever from March 2017 to July 2017 at the Pediatric Department of Karuna Medical College, the tertiary care hospital in Palakkad.Methods: In this retrospective study, medical records were reviewed and analyzed. Patients with suspected dengue infection were classified further into 2 groups, Dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (dengue hemorrhagic fever and/or dengue shock syndrome (DHF/DSS) according to WHO.Results: A total of 77 cases were classified into 67 (87%) non-severe and 10 (13%) severe dengue cases. The most common age of presentation was above 10 yrs. The mean age of admission was 8.9 yrs. The most common presenting symptom was fever seen in 93% followed by vomiting in 68%. Elevation in Aspartate transaminase (SGOT) and thrombocytopenia were found in 32.4 %.Conclusions: High grade fever, vomiting, abdominal pain and skin rash with normal or low platelet count were the presenting features. Early diagnosis, monitoring and prompt supportive management can reduce mortality.

scholarly journals Clinicohaematological profile of dengue in children: a hospital based study

2017 ◽  
Vol 4 (4) ◽  
pp. 1340 ◽  
Author(s):  
Irshad Abdul Majeed ◽  
K. Shreedhara Avabratha ◽  
Lokesha R. Gowda ◽  
Sadia Syeda
Keyword(s):  
Dengue Fever ◽  
Early Recognition ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Haematological Parameters ◽  
Severe Dengue ◽  
Clinical Feature ◽  
Igm Elisa ◽  
Ns1 Antigen ◽  
Atypical Presentations

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. The aim of this study is to document varied clinical manifestations and haematological parameters of dengue patients in a tertiary care centre.Methods: A total 130 cases of any of NS1 antigen, IgM card test positive or IgM ELISA positive dengue patients were included in this observational study. Clinical and haematological parameters were noted and analysed statistically.Results: Most common clinical feature was fever (100%) followed by headache (51.5%). Atypical features like seizures due to encephalitis was seen in a child with dengue. Seizure were present in 1.5% of cases, two children died due to severe dengue with shock and multi organ failure. In our study 26.92% of patients had thrombocytopenia. The mean Hb was 12.86 g/dl and platelet count was 104202/mm3.Conclusions: Fever and headache are the main features of dengue. However, one should be aware of different atypical presentations of dengue fever to diagnose and intervene timely. Early recognition of complication and timely intervention are required in the management of dengue cases. 

scholarly journals Complement protein levels and MBL2 polymorphisms are associated with dengue and disease severity

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ngo Truong Giang ◽  
Hoang van Tong ◽  
Do Quyet ◽  
Nghiem Xuan Hoan ◽  
Trinh Huu Nghia ◽  
...  
Keyword(s):  
Warning Signs ◽  
Severe Dengue ◽  
Healthy Controls ◽  
Complement Protein ◽  
Complement Proteins ◽  
Protein Levels ◽  
Study Population ◽  
Dengue With Warning Signs ◽  
The Complement System

Abstract The complement system may be crucial during dengue virus infection and progression to severe dengue. This study investigates the role of MBL2 genetic variants and levels of MBL in serum and complement proteins in Vietnamese dengue patients. MBL2 genotypes (− 550L/H, MBL2 codon 54), MBL2 diplotypes (XA/XO, YA/XO) and MBL2 haplotypes (LXPB, HXPA, XO) were associated with dengue in the study population. The levels of complement factors C2, C5, and C5a were higher in dengue and dengue with warning signs (DWS) patients compared to those in healthy controls, while factor D levels were decreased in dengue and DWS patients compared to the levels determined in healthy controls. C2 and C5a levels were associated with the levels of AST and ALT and with WBC counts. C9 levels were negatively correlated with ALT levels and WBC counts, and factor D levels were associated with AST and ALT levels and with platelet counts. In conclusions, MBL2 polymorphisms are associated with dengue in the Vietnamese study population. The levels of the complement proteins C2, C4b, C5, C5a, C9, factor D and factor I are modulated in dengue patients during the clinical course of dengue.

Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986–2012)

2019 ◽  
Vol 113 (11) ◽  
pp. 670-677 ◽  
Author(s):  
Bianca De Santis Gonçalves ◽  
Rita Maria Ribeiro Nogueira ◽  
Ana Maria Bispo de Filippis ◽  
Marco Aurélio Pereira Horta
Keyword(s):  
Rio De Janeiro ◽  
Dengue Infection ◽  
Warning Signs ◽  
Severe Dengue ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Status ◽  
Viral Loads ◽  
Dengue Virus Type 3 ◽  
Dengue With Warning Signs ◽  
Type 3

AbstractBackgroundSince 1981, >12 million cases of dengue have been reported in Brazil. Early prediction of severe dengue with no warning signs is crucial to avoid progression to severe dengue. Here we aimed to identify early markers of dengue severity and characterize dengue infection in patients in Rio de Janeiro.MethodsWe evaluated early severity markers, serotypes, infection status, number of days of illness and viral loads associated with dengue fever in patients from Rio de Janeiro, Brazil through an observational retrospective study (1986–2012). We compared dengue without warning signs and dengue with warning signs/severe dengue (DWWS/SD). Infection status was classified by enzyme-linked immunosorbent assay and viraemia was quantified by quantitative real-time reverse transcription polymerase chain reaction.ResultsThe presence of DWWS/ SD was significantly associated with younger age; patients 13–19 y of age had a significantly greater chance of presenting warning signs. Dengue virus type 3 (DENV3) was more likely to induce DWWS/SD, which was more frequent on days 4–5 of illness.ConclusionsDENV3, 4–5 d of illness and 13–19 y of age were early biomarkers of dengue severity. To our knowledge, this was the first study to analyse the characteristics of dengue severity in the state of Rio de Janeiro over 27 y of epidemics since the introduction of DENV.

scholarly journals Serum sodium level in dengue infected children: a retrospective study

2018 ◽  
Vol 5 (5) ◽  
pp. 1801
Author(s):  
Reshma Raj ◽  
Rashmi Alva
Keyword(s):  
Dengue Fever ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Warning Signs ◽  
Severe Dengue ◽  
Dengue With Warning Signs ◽  
Group B

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. Aim of this study is to document the serum Sodium level in dengue infected children in a tertiary care centre.Methods: A total 128 cases of NS1 antigen, IgM positive or ELISA positive dengue patients were included in this observational study and analyzed.Results: The serum Sodium level in dengue varies according to the different groups. In group A (dengue with no warning signs) the serum Sodium level was normal, whereas in case of group B (dengue with warning signs), there was significant hyponatremia. In group C, severe dengue the serum Sodium was normalConclusions: Mild hyponatremia is a common electrolyte disturbance in patients with dengue with warning signs. Hence, the lower the serum Sodium levels the higher is the incidence of complications associated with dengue fever.

scholarly journals Immunophenotyping and transcriptional profiling of human plasmablasts in dengue.

2021 ◽  
Author(s):  
Charu Aggarwal ◽  
Keshav Saini ◽  
Elluri Seetharami Reddy ◽  
Mohit Singla ◽  
Kaustuv Nayak ◽  
...  
Keyword(s):  
Chemokine Receptors ◽  
Influenza Infection ◽  
Transcriptional Profiling ◽  
Dengue Infection ◽  
Warning Signs ◽  
Severe Dengue ◽  
Dengue Disease ◽  
Mucosal Tissues ◽  
Dengue With Warning Signs

Previous studies have shown that plasmablasts expand massively in dengue patients as compared to many other situations such as influenza infection or vaccination. However, a detailed understanding of the phenotypes and transcriptional features of these cells is lacking. Moreover, despite India having nearly a third of global dengue disease burden, there is virtually no information on plasmablasts responses in dengue patients from India. Here, we provide a detailed characterization of plasmablast responses from dengue confirmed febrile children in India. Immunophenotyping and RNA seq analysis showed that in addition to secreting dengue specific antibodies, these massively expanding cells expressed several adhesion molecules, chemokines and chemokine receptors that are involved in endothelial interactions, homing to skin or mucosal tissues including intestine. Surprisingly, we found that these cells also upregulated expression of several cytokine genes that are involved in angiogenesis, leukocyte extravasation and vascular permeability. These transcriptional features were qualitatively similar to plasmablasts from influenza vaccinees. Interestingly, the expansion of the plasmablasts in dengue patients was significantly lower in patients with primary dengue infection compared to those with secondary dengue. Moreover, within the primary dengue patients, their expansion was significantly lower in patients with mild dengue infection (DI) compared to patients with dengue with warning signs (DW) or severe dengue (SD). These results significantly improve our understanding of human plasmablast responses in dengue.

scholarly journals Comparing the 2009 and 1997 World Health Organization dengue case classifications in a large cohort of South Asian patients

2020 ◽  
Vol 14 (07) ◽  
pp. 781-787 ◽  
Author(s):  
Umesh Jayarajah ◽  
Upul Dissanayake ◽  
Visula Abeysuriya ◽  
Pradeep K De Silva ◽  
Priyankara Jayawardena ◽  
...  
Keyword(s):  
World Health Organisation ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
Dengue Case ◽  
Dengue Disease ◽  
Asian Patients ◽  
Resource Limited ◽  
Dengue With Warning Signs ◽  
Health Organization

Introduction: Due to the shortcomings in the 1997-World Health Organisation (WHO) dengue case classification (DCC), a revised classification was proposed in 2009. This study was aimed to assess the clinical usefulness of the two classifications during a large dengue epidemic. Methodology: Clinical data of dengue patients admitted to selected units at National Hospital of Sri Lanka, Panadura Base Hospital and Nawaloka Hospital Colombo between June and August 2017 were collected prospectively. Cases were classified using the 1997 and 2009 WHO DCCs. Results: 1,878 patients [adult = 1,573 (83.8%)] were studied. Based on 1997-WHO-DCC-DF (Dengue Fever): 1,316 (70.1%), DHF (Dengue Haemorrhagic Fever) -1: 468 (24.9%), DHF-2: 86 (4.6%) and DHF-3: 8 (0.4%). Based on 2009-WHO-DCC–Dengue with warning signs (WS): 1647 (87.7%), Dengue without WS: 231 (12.3%) and severe dengue (SD): 41 (2.18%). A total of 1,088 (82.7%) DF and 559 (99.5%) DHF patients developed WS. Of those without WS, 228 (17.3%) were DF patients and 3 (0.5%) were DHF patients. Three (0.23%) DF and 38 (6.76%) DHF patients had SD. All SD patients had WS. The level of agreement between the two systems of classification was poor (Kappa = - 0.035, p < 0.001). Conclusions: The 2009-WHO-DCC was more useful than 1997-WHO-DCC in predicting dengue disease severity as few DF patients also had SD. Furthermore, the presence of WS identified patients with SD. However, the 2009-WHO-DCC may not suit the resource limited countries as WS are non-specific, and lack of diagnostic tests can result in case overload.

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