The coagulation profile of children admitted with dengue fever and correlation with clinical severity

Background: Dengue is one of the 17 Neglected Tropical diseases (NTD) addressed in the NTD road map. Objective of present study was to find out the correlation between coagulation profile abnormalities and clinical severity of dengue fever.Methods: All cases of dengue fever in children below 12 years of age admitted to a tertiary care medical college of South India for a period of 18 months (January 2013- June 2014) were included in the study. The liver function tests, prothrombin time, International normalises ratio and activated partial thromboplastin level were estimated and correlated with severity.Results: Of the 306 cases of children admitted with dengue fever, 131 (42.8%) were dengue fever without warning signs, 119 (38.8%) were dengue fever with warning signs and 56 (18.4%) were severe dengue according to WHO guidelines 2012. 20.9% cases had significant PT prolongation, 50.3% had INR >1.1 and 33.3% had aPTT prolongation. Of the 56 cases of severe dengue, 83.9% had PT prolongation, 96.4% had INR >1.1 and 91.1% had significant aPTT prolongation. The mean values of PT, INR and aPTT in severe dengue was 19±3.7sec, 1.5±0.3 and 46±7 sec respectively. These were well above the cut off values and showed statistically significant association with severe dengue (p<0.001) compared to non-severe dengue. Similarly, ALT elevation among the total cases also showed majority (67.3%) in the range of 40-400. Of the 56 cases of severe dengue, 30% had values above 1000 IU/l, 51% had AST levels 40-400, and 16% had 400-1000 and 2.5% below 40. Statistical analysis showed significant difference in AST and ALT elevation among dengue fever without warning signs, dengue fever with warning signs and severe dengue (p<0.001).Conclusions: There is statistically significant association between prolongation of coagulation markers and severity of dengue.

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Hematological and coagulation profile of dengue infection in age group 1 to 12 years children in a tertiary care hospital

Panacea Journal of Medical Sciences ◽

10.18231/j.pjms.2021.069 ◽

2021 ◽

Vol 11 (2) ◽

pp. 341-353

Author(s):

Suman Sarkar ◽

Mamta Kumari ◽

Amrita Roy ◽

Anirban Chatterjee ◽

Partha Pratim Pal

Keyword(s):

Dengue Fever ◽

Dengue Infection ◽

Tertiary Care ◽

Warning Signs ◽

World Health ◽

Infected Mosquito ◽

Severe Dengue ◽

Care Hospital ◽

Coagulation Profile ◽

D Dimer

Dengue is an arboviral infection of public health problems in tropical and sub-tropical countries transmitted to humans through the bite of an infected mosquito of the Stegomyia family. It varies in severity, ranging from influenza-like self-limiting illness to life- threatening, which if left untreated, are associated with mortality as high as 20%. Find out hematological and coagulation profile in dengue infected children aged 1 to 12 years and association of hematological and coagulation profile with dengue severity. It is an Observational Cross- sectional study done on 100 dengue patients aged 1 to 12 years during the study period from March 2019 –February 2020. Among 100 dengue fever, 85 (85%) were categorized as dengue fever (DF), 11(11%) DF with warning signs and 4 (4%) were cases of severe dengue (DHF/DSS) according to revised World Health Organisation 2009. The most common age of presentation was above 6 years and females were afflicted more with dengue fever.100% dengue patients presented with fever. Persisting vomiting, pain abdomen, hepatomegaly and hypotension indicate progression towards severe dengue. Raised Hb% and PCV, low to normal values of WBC as well as predominantly decrease in platelet was seen in severe dengue cases however, both ESR and CRP were normal. The Liver function test was deranged SGOT>SGPT in almost all of the dengue patients and it was 3 to 4 times maximally in DFW and SD. PT, APTT prolongation, increased D- dimer and hypofibrinogenemia associated with the severity of dengue fever. Dengue is a common viral infection that may have serious consequences especially in children. There is clear difference in pattern of change of both haematological and biochemical parameters in non-severe dengue fever and severe dengue fever. Rising trend of Hb%, PCV, decreasing value of platelet count, raised transaminases (SGOT>SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase

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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184293 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2265 ◽

Cited By ~ 1

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.

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Serum sodium level in dengue infected children: a retrospective study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183509 ◽

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.

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Study of hepatic involvement in children with dengue infection

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20174650 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2012

Author(s):

Hima Bindu Tirumani ◽

Vinay Kumar Bejugam ◽

Altaf Naseem ◽

Arshad Hussain ◽

. Nizarlalani

Keyword(s):

Dengue Fever ◽

Liver Dysfunction ◽

Dengue Infection ◽

Fold Increase ◽

Liver Function Tests ◽

Hepatic Function ◽

Warning Signs ◽

Severe Dengue ◽

Cross Sectional ◽

Hepatic Involvement

Background: Liver dysfunction in children is variable and depends on disease severity. This study was undertaken to identify the range of hepatic involvement in children with dengue infection.Methods: It is a cross sectional observational study conducted in serologically positive dengue fever in children aged between 1-14 years. Hepatic function was studied in all suspected cases over a period of 1 year from June 2015 to June 2016.Results: Out of 55 cases admitted, liver function tests showed AST levels elevated more than 45U/L in 20 (86.9%) DF, 29 (100%) DHF, 3 (100%) DSS patients. ALT levels were elevated more than 45U/L in 16 (69.5%) DF, 24 (82.75%) DHF, 3 (100%) DSS patients. More than 10 fold increase in levels of both AST and ALT was seen in severe dengue.Conclusions: Dengue infection is associated with variable levels of liver dysfunction. The incidence of hepatic dysfunction is more in patients with dengue fever with warning signs and severe dengue. Significant elevation of transaminase levels helps in predicting the occurrence of severe dengue. It is important to be aware of this entity which needs significant attention and management.

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Correlation between serum ferritin level and severity of dengue fever in a tertiary care center: an observational study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20212244 ◽

2021 ◽

Vol 9 (6) ◽

pp. 1735

Author(s):

Akash R. Murmu ◽

Mubarak R.

Keyword(s):

Dengue Fever ◽

Prognostic Marker ◽

Serum Ferritin ◽

Confidence Limit ◽

Ferritin Level ◽

Care Center ◽

Tertiary Care ◽

Area Under The Curve ◽

Warning Signs ◽

Severe Dengue

Background: Serum ferritin is an acute phase protein and elevated levels of ferritin have been associated with the pathogenesis of many inflammatory infectious viral diseases. Dengue is a mosquito-borne tropical infection that caused by the dengue virus. TNFα and interleukin 1α, another proinflammatory cytokine, transcriptionally induce the H-chain of ferritin. Therefore, serum ferritin can be used as a prognostic marker for dengue severity.Methods: This is a case control study conducted between July 2017 to December 2018.Results: On the 3rd day of fever, the median values of serum ferritin in dengue, fever without warning signs, with warning signs, and severe dengue were 513.5 ng/ml, 1002 ng/ml and 2352.4 ng/ml respectively. On the 7th day of fever, the median values were 474 ng/ml, 900 ng/ml, and 2949 ng/ml respectively. Serum ferritin 1247 ng/ml on day 3 has a sensitivity of 96.4% and specificity of 91% for prediction of severity. Area under the curve for serum ferritin on day 3 was 0.963 (95% confidence limit: 0.934-0.991). Serum ferritin 1050 ng/ml on day 7 has a sensitivity of 98.2 % and specificity of 93% for prediction of severity. Area under the curve for serum ferritin on day 7 was 0.977 (95% confidence limit: 0.957-0.998).Conclusions: Elevation of serum ferritin was significantly seen in those with severe dengue. Serum ferritin can be used as a prognostic marker for dengue severity. Day 3 serum ferritin can be used as a prognostic marker for dengue severity.

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Dengue Outbreak in Children During 2019: Experience at A Tertiary Care teaching Hospital

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i1.53587 ◽

2021 ◽

Vol 20 (1) ◽

pp. 46-50

Author(s):

Mitra Datta ◽

Asma Ferdousi ◽

Salina Haque ◽

Rifat Jahan ◽

Aparup Das ◽

...

Keyword(s):

Abdominal Pain ◽

Pleural Effusion ◽

Dengue Fever ◽

Tertiary Care ◽

Clinical Manifestations ◽

Case Fatality ◽

Warning Signs ◽

Severe Dengue ◽

College Hospital ◽

Dengue Outbreak

Background: Dengue outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. This study was aimed to describe the clinico-epidemiological profile and outcome of dengue infected children during 2019 dengue outbreak in Chattogram. Materials and methods: This hospital based prospective observational study was carried out in the Department of Pediatrics in Chattogram Medical College Hospital. Serologically positive dengue cases (Aged £12 years) admitted from July 2019 to December 2019 were enrolled in the study. Hospital outcome of the patient’s was recorded in terms of mortality, Length of Hospital Stay (LOS) need for ICU. Results: Out of total 192 patients as per the National Guideline 66.7% cases were classified as dengue fever without warning signs, 21.9% as dengue fever with warning signs and 11.5% as severe dengue. Overall the mean age was 7.04 (±3.23) years with male preponderance (59%). Along with fever main complaints were abdominal pain (91.7%), vomiting (47.9%) and headache (23.6%). Marked thrombocytopenia (Below 50,000) was present in 37.9%, leucopenia in 27.9% and raised haematocrit in 10.9% of cases. Average LOS was 5.2 (±1.9) days, 18 (9.5%) patients need ICU admission and there was no fatality in this series. Some clinical (Vomiting, flusihing, shock, reduced urinary output) and laboratory (Marked thrombocytopenia, leucopenia, hemoconcentration, pleural effusion and hepatomegaly) variables were associated with severity. Conclusion: Fever with abdominal pain were common presentations of dengue fever. Severe dengue patients presented with vomiting, flashing and shock. Marked thrombocytopenia and pleural effusion and/or ascites were related to shock. Appropriate and timely management is very effective in reducing case fatality. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 46-50

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A study of various hepatic manifestations in dengue fever and their correlation with severity of dengue fever

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200675 ◽

2020 ◽

Vol 7 (3) ◽

pp. 527

Author(s):

Shravya Dhanwada ◽

Samba Siva Reddy R.

Keyword(s):

Dengue Fever ◽

Complete Blood Count ◽

Dengue Infection ◽

Liver Function Tests ◽

Warning Signs ◽

Severe Dengue ◽

Serum Total Bilirubin ◽

Hepatic Involvement ◽

Elevated Liver Enzymes ◽

A Prospective Study

Background: Hepatic involvement in Dengue is known with protean of manifestations ranging from hepatomegaly, elevated liver enzymes to fulminant hepatic failure. Aim of the study was to study the hepatic manifestations in children with dengue illness.Methods: This is a prospective Study with 60 Patients hospitalized with Dengue infection (Seropositive for Dengue). Dengue Seropositive patients are selected and examined for Hepatomegaly and Jaundice and subjected to complete blood count and Liver function tests were analysed.Results: Of 60 serologically confirmed cases hospitalized with dengue, were classified into (i)(DF), (ii) DHF I (iii) DHF II (iv) DHF III and (v) DHF IV. In our study, upon 60 seropositive cases were reported at our hospital during the study period of which 18 were DF, 12 were DHF I, 15 were DHFII, 8 were DHF III and 7 were DHF IV respectively. The Hematocrit levels were raised 20% from the baseline in four classes of Dengue and not raised in DF. Most commonly occurred in age group of 5-7 years. Hepatomegaly was the commonest clinical sign seen. Thrombocytopenia was seen in 88% of all cases. Serum total bilirubin was raised in 10% of subjects with severe dengue infection in DHF III and DHF IV. Serum SGOT and SGPT was raised in 63.3% and 56.7% of patients with dengue of all classes including DF respectively. Thrombocytopenia occurred in 75% of patients with dengue fever, 98% with warning signs and 100% in severe dengue.Conclusions: In developing country like India, incidence of dengue outbreaks is increasing. Hepatic involvement of varying degrees have been reported. As hepatic dysfunction in dengue is transient and reversible, early identification of the same would help to reduce life threatening complications. The role of hepato protective drugs in reducing morbidity and mortality should be analysed by further studies.

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A study on correlation of gall bladder wall thickness with severity of Dengue fever

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194719 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2476

Author(s):

Vijayalakshmi A. ◽

Sreelekha P. ◽

Kalashankar D.

Keyword(s):

Gall Bladder ◽

Dengue Fever ◽

Wall Thickness ◽

Bladder Wall ◽

Tertiary Care ◽

Fatal Outcome ◽

Warning Signs ◽

Severe Dengue ◽

Bladder Wall Thickness ◽

Gall Bladder Wall

Background: Dengue is an acute viral infection with potentially fatal complications. This study was done to describe the correlation of Gall bladder wall thickness with severity of Dengue fever and to predict the fatal outcome of Dengue fever at the earliest to prevent serious consequences by timely interventions.Methods: This was a hospital based prospective observational study conducted at Niloufer Hospital, a tertiary care pediatric hospital attached to Osmania Medical College, Hyderabad, Telangana, India from October 2017 to November 2018. All children between 1 year to 12 years of age that had clinical features of dengue and who were serologically confirmed were included in this study.Results: Age group most commonly affected was 5-8 years with maximum number of dengue cases without warning signs (55.7%). Majority of severe dengue cases (64.3%) had gall bladder wall thickness >5mm. The correlation between severity of dengue and gall bladder wall thickness was found to be highly significant indicating the higher the severity of dengue more the gall bladder thickness.Conclusions: This study concludes gallbladder wall thickness (GBWT) measured by ultrasonography can be used in children for early prediction of the severity of DHF in children and authors can include gall bladder wall thickness as an admission criteria during epidemics.

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A clinical study of early manifestations of dengue fever and outcome in children

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0802.06 ◽

2020 ◽

pp. 15-19

Author(s):

Udaya Kumar Neelagiri

Keyword(s):

Platelet Count ◽

Abdominal Pain ◽

Dengue Fever ◽

Mean Value ◽

Warning Signs ◽

Clinical Severity ◽

Severe Dengue ◽

Who Criteria ◽

Elevated Liver Enzymes ◽

Low Platelet Count

Background: In the past few decades the incidence, distribution, and clinical severity of Dengue have increased dramatically. Population growth in the tropics provides many susceptible hosts. Uncontrolled urbanization leads to inadequate management of water and waste, providing a range of large water stores and disposable, non-biodegradable containers that become habitats for the larvae. Children are now being increasingly affected by this disease. We in this present study tried to study clinical, hematological, and hepatic dysfunction in the early course of the disease. Methods: The present prospective observational study was conducted at Prathima Institute of Medical Sciences, Nagnur, Karimnagar. N=75 children between the age group of 6 months to 15 yrs presenting with symptoms and signs suggestive of dengue fever as per WHO criteria were included in the study. Complete history and clinical examination were done. Investigations were performed as per the proforma. Results: From n=75 children n=56 (75%) belongs to dengue with warning signs and severe dengue whereas n=19 cases (25%) belong to mild dengue group. the symptoms recorded out of n=75 (100%) children presented with fever as the predominant complaint followed by vomiting (49%), Retroorbital pain (28%), Abdominal pain (26%), Edema (25%), Bleeding (19%) and rashes (12%), body ache (8%). The range of platelet count at admission was 4,000 – 98,000/cmm, with a mean value of 53,000 (P>0.05). The WHO criteria of a low platelet count of < 100,000/cmm were seen in all cases (100%). Conclusion: in children, importance should be given to symptoms like fever, vomiting, bleeding, musculoskeletal pain, flushing, and abdominal pain. If these are associated with hepatomegaly, positive tourniquet test, low platelet count, and elevated liver enzymes, a strong possibility of dengue to be considered, especially during an epidemic. During the epidemic, dengue should be considered on the differential diagnosis of any child presenting with fever

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Clinical profile and outcome of dengue fever in a paediatric tertiary care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171689 ◽

2017 ◽

Vol 4 (3) ◽

pp. 875

Author(s):

Md Khaja Moinuddin ◽

Sahana Devadas Sahana Devadas

Keyword(s):

Dengue Fever ◽

Tertiary Care ◽

Febrile Illness ◽

Warning Signs ◽

Severe Dengue ◽

Tertiary Care Centre ◽

Laboratory Findings ◽

Cross Sectional ◽

Stable Conditions ◽

Elevated Liver Enzymes

Background: A study of different presentation and outcome of dengue fever in tertiary care centre.Methods: the observational cross sectional study was carried out from June to October 2016 in Bowring and Lady Curzon hospital attached to Bangalore Medical College and Research Institute. Included patients from 1 to 18 years of age who presented with febrile illness. WHO classification and definitions were used to classify disease as dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Clinically, haematological and biochemical findings were recorded till discharge.Results: during study period,142 patients presented with typical features of dengue fever, male being 86 (60%) and female being 56 (40%). Among 142 cases 64 cases were probable dengue, 50 cases were dengue with warning signs and 28 cases were had severe dengue. Fever (100%) was the most common clinical presentation followed by vomiting (70%), body ache (43%), abdominal pain (23%), headache (12%) and rashes (5%). Laboratory findings included thrombocytopenia, leucopenia and elevated liver enzymes. 126 (88%) cases were discharged in clinical stable conditions, (8%) were died during course of treatment and 8 cases left against medical advice.Conclusions: fever with vomiting and thrombocytopenia were most common presentation of dengue fever, appropriate clinical diagnosis and management is relatively simple, inexpensive and very effective in saving lives as long as long correct and timely interventions instituted.

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