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

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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Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200114 ◽

2020 ◽

Vol 7 (2) ◽

pp. 382 ◽

Cited By ~ 1

Author(s):

V. Shekar ◽

K. Praveen Kumar ◽

C. Soren ◽

K. Venkataramana Reddy ◽

N. Dharani

Keyword(s):

Dengue Fever ◽

Tertiary Care Hospital ◽

Early Recognition ◽

Dengue Infection ◽

Tertiary Care ◽

Warning Signs ◽

Severe Dengue ◽

Severe Thrombocytopenia ◽

Care Hospital ◽

Presenting Symptoms

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

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A study to determine the severity based outcome of pediatric patients with dengue spectrum disorders in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20195745 ◽

2019 ◽

Vol 7 (1) ◽

pp. 154

Author(s):

Vijaysuryakiran K. M. ◽

Mounesh Pattar ◽

Sanjay Paida

Keyword(s):

Dengue Fever ◽

Dengue Infection ◽

Tertiary Care ◽

Warning Signs ◽

Severe Dengue ◽

Warning Sign ◽

High Morbidity ◽

Care Hospital ◽

Increased Risk ◽

Spectrum Disorders

Background: Dengue Fever (DF) has become a major global public health problem. The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. Dengue infection ranges from mild illness to a severe form of haemorrhagic fever and shock syndrome which may prove fatal. Objective of the study was to determine severity-based outcome in children with dengue spectrum disorder in a tertiary care centre in Mumbai.Methods: It was a prospective, non-interventional, observational, surveillance study conducted over 14 months (from September 2016 till October 2017). Children aged <18 years admitted to Nanavati Super Specialty Hospital, Mumbai diagnosed with dengue spectrum disorders according to WHO 2009 classification with clinical features and laboratory investigation confirming dengue were enrolled as study participants.Results: Out of 127 patients, 57(44.9%) were females and 70(55.1%) were males. 81(63.8%) were ward patients, 46(36.2%) required PICU admission. 17(13.4%) patients had dengue with warning signs, 100(78.7%) had dengue without warning signs and 10(7.9%) had severe dengue according to WHO 2009 case classification of dengue. 122(96.1%) were discharged home, 4(3.1%) died of dengue and dengue related complications all four deaths occurred in children with severe dengue.Conclusions: This study showed that commonest inpatient admission category among children with dengue according to WHO 2009 classification was dengue without warning signs Overall mortality in patients with dengue fever without warning sign as well those with warning sign remains very low. Children presenting with severe dengue associated with either organ failure or refractory shock are at increased risk of mortality.

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Importance of Platelet Count and Hematocrit in Dengue Fever in Children

Bangladesh Journal of Child Health ◽

10.3329/bjch.v44i2.51129 ◽

2021 ◽

Vol 44 (2) ◽

pp. 74-77

Author(s):

Farhana Rahat ◽

Morsheda Khanam ◽

Kazi Iman ◽

UK Ghosh ◽

NK Ghosh

Keyword(s):

Platelet Count ◽

Dengue Fever ◽

Dengue Hemorrhagic Fever ◽

Dengue Infection ◽

Tertiary Care ◽

Dengue Shock Syndrome ◽

Hemorrhagic Fever ◽

Warning Signs ◽

Care Hospital ◽

Pediatric Age Group

Background: Dengue fever has become one of the most important public health concerns now a day due to increasing complications and fatal outcomes. Dengue hemorrhagic fever and dengue shock syndrome are life threatening but reversible complications of dengue fever. Objectives: This study was performed to evaluate the relationship between platelet count and hematocrit with the severity of dengue infection in pediatric age group. Materials & Methods: This was a prospective observational study which included 280 dengue seropositive children of 1 month to 15 years, conducted during 1st June to 30th November, 2018 in a tertiary care hospital of Dhaka. Results: Out of 280 dengue cases, 187(66.78%) had thrombocytopenia and 88(47%) had raised hematocrit. Among the thrombocytopenic patients 44% had dengue fever, 47% had dengue hemorrhagic fever and 9% dengue shock syndrome. A significant co-relation was observed between the severities of thrombocytopenia and raised hematocrit with the appearance of dengue warning signs in case of dengue hemorrhagic fever. Conclusion: Thrombocytopenia and raised hematocrit were related to the severity of dengue hemorrhagic fever. Bangladesh J Child Health 2020; VOL 44 (2) :74-77

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Role of early warning signs in children with severe dengue infection

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182540 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1423

Author(s):

Sriram Pothapregada ◽

Vijayalakshmi Sivapurapu ◽

Banupriya Kamalakannan ◽

Mahalakshmy Thulasingham

Keyword(s):

Logistic Regression ◽

Dengue Fever ◽

Early Warning ◽

Dengue Infection ◽

Warning Signs ◽

World Health ◽

Severe Dengue ◽

Clinical Variables ◽

Early Warning Signs

Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.Methods: All children (0-12 y of age) diagnosed and confirmed as dengue fever admitted at a tertiary care hospital at Puducherry were retrospectively analysed from hospital case records as per the revised World Health Organization(WHO) guidelines 2009 for dengue fever. The data was analysed by descriptive statistics using SPSS 16.0 statistical software. Early warning signs were analyzed by logistic regression and a P-value of <0.05 was taken as significant.Results: Out of 360 children confirmed with diagnosis of dengue fever, non-severe and severe dengue infection was seen in 214(59.4%) and 146 cases (40.6%) respectively. The most common manifestation of severe dengue infection were shock (40.6%), bleeding (16.7%) and multiorgan failure (2.2%). On logistic regression, the warning signs most commonly associated with severe dengue infection were pain abdomen, hepatomegaly, hypotension at admission and HCT>20% with concomitant platelet<50,000/mm3. Clinical variables which were unlisted in the revised guidelines but significantly associated with severe dengue infection were Age >6 yrs, retro-orbital pain, palmar erythema, joint pain, splenomegaly, positive tourniquet test, right hypochondriac pain and epigastric tenderness.Conclusions: Early identification of the preceding warning signs, timely intervention and vigilant monitoring can reduce the morbidity and mortality in children with severe dengue infection. Since there were other clinical variables not enlisted as warning signs but were significantly associated with severe dengue infection, the list of warning signs in the revised guidelines needs to be expanded.

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Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India

Scientifica ◽

10.1155/2016/6391594 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Shubhankar Mishra ◽

Ramya Ramanathan ◽

Sunil Kumar Agarwalla

Keyword(s):

Dengue Fever ◽

Viral Infections ◽

Dengue Infection ◽

Tertiary Care ◽

Case Fatality ◽

Clinical Profile ◽

Severe Dengue ◽

High Morbidity ◽

Care Hospital ◽

The Mean

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.Objectives. To assess the clinical profile of the dengue infection in children less than 14 years of age and to evaluate the outcomes of dengue fever from September 2013 to August 2015 at the Pediatric Department of Maharaja Krishna Chandra Gajapati Medical College, the largest tertiary care hospital of southern Odisha.Results. A total of 97 cases were classified into 84 (86.59%) nonsevere and 13 (13.40%) severe dengue cases. The most common age of presentation was above 11 yrs. The mean age of admission was 8.7 yrs. The most common presenting symptom was fever seen in 100% and hepatomegaly (43.8%), the most common physical finding. Gastrointestinal bleeding was markedly seen in severe dengue (76.9%). Elevation in aspartate transaminase (SGOT) was found in 47.42% and thrombocytopenia in 27.5%. The correlation between hepatomegaly and elevated SGOT was significant (Pvalue 0.0346). Case fatality rate (CFR) was 1.03%. The mean duration of hospitalisation was 3.8 days.Conclusion. In children, if symptoms like fever, pain, rashes, and vomiting are associated with hepatomegaly and elevated SGOT in context of low TPC, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

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Dengue Fever: Clinical Characteristics of A Tertiary Care Hospital Study

Bangladesh Journal of Child Health ◽

10.3329/bjch.v44i1.49684 ◽

2020 ◽

Vol 44 (1) ◽

pp. 30-33

Author(s):

Mohammed Rizwanul Ahsan ◽

Manzoor Hussain ◽

SK Azimul Hoque ◽

Al Amin Mridha ◽

Sabrina Makbul

Keyword(s):

Renal Impairment ◽

Dengue Fever ◽

Urban Areas ◽

Clinical Characteristics ◽

Hepatic Dysfunction ◽

Dengue Infection ◽

Tertiary Care ◽

World Health ◽

Health Concern ◽

Care Hospital

Background: Incidence of dengue infection has increased worldwide and has become a significant public health concern. Clinical suspicion based on the frequency of symptoms is very important for early diagnosis. Objectives: To observe the clinical characteristics of serologically confirmed hospitalized cases of dengue fever. Material and Methods: This cross-sectional study was done among admitted children with dengue infection in Dhaka Shishu (Children) Hospital from July 2018 to October 2018. The diagnosis of dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) were established according to the World Health Organization (WHO) classification criteria. Cases who were NS1 antigen and IgM dengue antibody positive included in this study. Results: Among 51 serologically confirmed dengue fever patients, mean age was 6.66 ± 3.69 years. Majority of the cases (74.5%) were less than 10 years of age, 60.8% were male, 39.2% were female, and 88.23% of patients came from urban areas. Classic DF was found in 74.5% of patients, while 25.49% of patients DHF, and 11.7% DSS. Fever was the most common (72.55%) symptom followed by headache, vomiting and myalgia. Hemorrhagic manifestations found in 21.57% of cases. The most common complications were hepatic dysfunction (47.09%) followed by renal impairment, encephalopathy, multi-organ failure, and ARDS. Conclusion: The majorities of dengue cases were from urban areas, below ten years of age and classical DF. Besides fever other common symptoms were headache, vomiting and myalgia. The most common complications were hepatic dysfunction, renal impairment and encephalopathy. Bangladesh J Child Health 2020; VOL 44 (1) :30-33

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The changing clinico-demographic profile of dengue infection in children: a hospital-based study from eastern India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20202003 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1901

Author(s):

Radheshyam Purkait ◽

Rajarshi Basu

Keyword(s):

Dengue Fever ◽

Dengue Infection ◽

Tertiary Care ◽

Clinical Manifestations ◽

Warning Signs ◽

Severe Dengue ◽

Eastern India ◽

Female Ratio ◽

Male Female Ratio ◽

Study Population

Background: Many parts of India, including the eastern regions, are now endemic for the dengue infection with increased recognition of atypical neurological manifestations apart from the classical clinical features.Methods: This prospective study was conducted in the department of paediatrics in a tertiary care teaching hospital in eastern India from July 2019 to November 2019 to determine the changing trends of the clinical features in the dengue patients of this region in the recent years among paediatric populations. All the serologically confirmed dengue patients admitted during this period satisfying the inclusion criteria were enrolled in the study population and classified as per new WHO-2009 classification into: dengue fever without warning signs (DF), dengue fever with warning signs (DFWS) and severe dengue (SD). Detailed history, clinical and laboratory parameters were recorded and analysed for all children.Results: Out of the total of 110 cases, 16 cases (14.55%) were DF, 80 cases (72.73%) were DFWS and 14 cases (12.73%) were SD. The commonest age group affected (63.64 %) was between 4-<10 years. The male: female ratio of cases was 1.68:1. Besides classical clinical manifestations, we observed CNS involvement in nine cases (8.18%). Among them, five patients had dengue encephalitis, two patients had dengue encephalopathy, one patient had hypokalemic paralysis and one patient had Guillain-Barré syndrome. All the patients were treated as per standard guidelines.Conclusions: Clinician must be aware of such association during dengue outbreak because early diagnosis and appropriate supportive care can reverse this potentially fatal disease.

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Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes

Journal of Tropical Medicine ◽

10.1155/2021/3296448 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Ammara Farooq ◽

Brekhna Aurangzeb ◽

Taimur Khalil Sheikh ◽

Huma Bashir ◽

Maryam Ghuncha ◽

...

Keyword(s):

Disease Progression ◽

Dengue Fever ◽

Outpatient Treatment ◽

Secondary Care ◽

Inpatient Care ◽

Tertiary Care ◽

Warning Signs ◽

Severe Dengue ◽

Care Hospital ◽

Inpatient Group

Background. There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method. This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results. Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender ( p = 0.049 ), lower normal mean platelet ( p = 0.02 ), and high mean hematocrit ( p = 0.001 ) were associated with disease progression. Conclusion. The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.

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Study of incidence, manifestations and complications of dengue fever

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam201180072 ◽

2018 ◽

Vol 5 (1) ◽

pp. 137

Author(s):

Jahnavi K. ◽

Srinivasulu T.

Keyword(s):

Platelet Count ◽

Dengue Fever ◽

Dengue Infection ◽

Tertiary Care ◽

Dengue Shock Syndrome ◽

Hemorrhagic Fever ◽

Simple Random Sampling ◽

Study Data ◽

World Health ◽

Care Hospital

Background: Dengue is endemic in India and epidemics are common. Due to poor availability of resources, there is increased morbidity and mortality related to dengue. The objective of the research to study the incidence, manifestations and complications of dengue fever.Methods: Patients admitted in medicine wards of a tertiary care hospital during the study period of two years with the history of fever with other nonspecific symptoms were included in the present study. Data was collected in a pre-tested proforma by meeting objectives of the present study. 100 patients who fulfilled World Health Organization criteria for dengue fever were selected by simple random sampling method.Results: In 75 patients the platelet count was above 150000cell/cumm. Most of them had dengue fever. 12 patients showed platelet count between 20000-100000cells/cumm. and among them 10 were DHF and 2 were simple dengue infection. Five patients showed platelet count less than 20000cells/cumm. and among them 2 were DHF and 3 were DSS. Most of the bleeding skin manifestations were seen when platelet count was below 50000cells/cumm. Mucosal bleeding was observed when the platelet count was below 30000cells/cumm. Abnormal coagulation profile was noted in 18% of the patients and 6% patients were in acute renal failure. Mortality was 0% in dengue fever, 44% in DHF and 100% in DSS.Conclusions: Platelet count was directly related to the number of complications. Dengue shock syndrome and dengue hemorrhagic fever was associated with increased mortality.

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