scholarly journals Dengue Fever: Clinical, Laboratory Profile and Outcome in Pediatric Patient

Author(s):  
Pooja Gandhi ◽  
Pinkal Taral ◽  
Krunal Patel ◽  
Sanketsinh Rathod ◽  
Bhavini Rathwa

Introduction: Infection with any of the 4 dengue virus serotypes results in a diverse range of symptoms, from mild undifferentiated fever to life-threatening hemorrhagic fever and shock. Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient management. So a study was carried out to know its clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients. Aim: To study the clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients at tertiary care center. Method: Retrospective Observational study from 1st May 2019 to 31st April 2021. Result: Total 323 patients were studied during 1st May 2019 to 31st April 2021. Most common presentation was fever (100%), most common clinical finding is hepatomegaly (14.2%). All severe dengue infection has platelet count < 50000/cumm. In study of 323 patients 194(60%) of dengue fever,85(26.4%) of DHF GRADE 1,9(2.8%) of DHF GRADE 2 were discharged .13(4%) patients of DSS were expired.22 patients (6.8%) went DAMA. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases. Keywords: dengue fever, platelet count, outcome

2021 ◽  
Vol 8 (8) ◽  
pp. 1-7
Author(s):  
Sahana M ◽  
Devakumar VK ◽  
Santhosh Kumar A

Objectives: To study the Clinical and Laboratory profile of children upto 12 years of age with Dengue fever and to study the predictors of Severe Dengue among these children. Methods: Design: Descriptive study over 1 year 9 months. Setting: SAT hospital, Thiruvananthapuram, a tertiary care center. Study Population: 204 children aged 1month to 12 years admitted with serologically confirmed dengue fever without any co-infections; consecutive sampling. Procedure: Relevant history, detailed physical examination and investigations were noted. Patients were classified for their severity based on DENGUE guidelines-WHO 2009. Children were followed up till discharge during hospital stay. Categorical values were expressed as proportions and quantitative variables in mean and standard deviation. Association between various study variables and severe dengue were statistically analysed. Results: Mild dengue was seen in 96 children(47.1%), moderate dengue in 78 children(38.2%) and severe dengue in 30 children(14.7%). Mean age of presentation was 6.4 years. Age distribution- infants were 4.4%, 38.7% were between 1 year and 5 years; 56.9% were between 6 and 12 years.51% of children were males. Common clinical presentation was fever (100%), vomiting(46.6%), abdominal pain(32.4%), lethargy(24.5%), myalgia(22%), headache(16.7%) and reduced appetite(15.7%). Mean fever duration was 5 days. Hypotension was noted in 13.2%, Tender hepatomegaly in 44%, signs of plasma leakage in 6%, hypoalbuminemia in 7.8%. Total number of death was 2(1%). Variables with significant association with severe dengue on univariate analysis were Lethargy (p-<0.001, OR- 11.6), reduced appetite (p- <0.001,OR- 17.14), mucosal bleed (p<0.001, OR- 15.45), Fever spike >39◦C (p- 0.001, OR- 4.3), tender hepatomegaly (p- 0.001, OR- 4.2), decreased urine output (p <0.001, OR- 23.04), hypoalbuminemia (p <0.001, OR-43.5), platelet count below 80,000 (p <0.001, OR-4.43), SGOT above 85 (p <0.001, OR-4.9). According to the maximum area under ROC curve, a cutoff of platelet count 80,000 had 75% sensitivity and 60% specificity for predicting severe dengue. Conclusion: Proportion of children developed severe dengue was 14.7%. Independent predictors of severe dengue after multiple logistic regression were Lethargy, Reduced appetite, Reduced urine output and Hypoalbuminemia. Keywords: severe dengue; urine output; shock; hypoalbuminemia.


2018 ◽  
Vol 5 (6) ◽  
pp. 2265 ◽  
Author(s):  
Senthil Kumar K. ◽  
Rajendran N. K. ◽  
Ajith Brabhukumar C.

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.


Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Shubhankar Mishra ◽  
Ramya Ramanathan ◽  
Sunil Kumar Agarwalla

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.


2017 ◽  
Vol 4 (2) ◽  
pp. 464
Author(s):  
Poornima Shankar ◽  
Prarthana B.

Background: Dengue fever (DF) is the arboviral infection with the largest incidence worldwide. Clinical expression of dengue virus infection varies from no symptoms to severe dengue with shock. It is the most rapidly spreading vector borne disease in the world. Nearly 100 million cases of Dengue fever and between 250,000 and 500,000 cases of severe dengue are annually reported to the WHO. The objective of this study was to study aims at determining the LDH and serum albumin levels as early parameter to predict the severity of Dengue illness.Methods: A observational clinical study conducted at K.I.M.S hospital, Bangalore, Karnataka, a tertiary care hospital. Children admitted in KIMS Hospital, Bangalore, Karnataka, a tertiary care hospital, Serum LDH and serum albumin levels are measured using the blood sample taken on the 3rd day of fever after confirmation of dengue fever (NS1 Ag- positive).Results: Study enrolled 150 patients with confirmed infection of Dengue virus who were admitted to paediatric unit between July 2014 and December 2016. Serum samples taken 72-96 hours within onset of fever were used for biochemical tests. Of 150 patients, 40 developed Severe Dengue (SD). Cases of SD had higher levels of lactate dehydrogenase (LDH) and low levels of serum albumin. Multivariate analysis showed that early alterations of LDH levels i.e.  Out of 40 patients who developed severe dengue, 37 patients i.e. 92.7% had raised levels of LDH with levels more than >600 IU and<3 levels of serum albumin 13 patients i.e 32.5% of severe dengue cases with P value of < 0.001, which showed significant association.Conclusions: Early alterations of biochemical parameter like LDH and serum albumin can predict Severe Dengue in patients with acute dengue illness.


2017 ◽  
Vol 4 (3) ◽  
pp. 1074 ◽  
Author(s):  
Punith Patak Nagaram ◽  
Prathima Piduru ◽  
Venkata Krishna Munagala ◽  
Vishnu Vandana Matli

Background: Dengue fever is an arboviral disease which is endemic in tropical countries and is of major concern with its morbidity and mortality. WHO classified dengue into three categories: undifferentiated fever, dengue fever (DF) and dengue haemorrhagic fever (DHF). Severe dengue is also regularly observed during primary infection of infants born to dengue-immune mothers. The objective of present study was to assess the clinical profile, laboratory profile and associated risk factors related to outcome of children less than 15 years of age. The outcome of the children and their management protocols were also assessed in the study.Methods: A prospective cross sectional study with 174 confirmed cases of dengue in children <15 years were enrolled and classified as per WHO guidelines. The demographic data, clinical history, laboratory parameters were noted in a separate questionnaire form. Hematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done and observations noted. Cases were managed as per WHO protocol and risk factors were observed. The outcomes of the cases were noted as discharge or death of the case.Results: A total of 174 children with 149 non-severe dengue and 25 severe dengue cases with 95 males and 79 females were enrolled in the study. 6-10 years was the most common age group. The mean age of children admitted with severe dengue fever was 5.81yrs.and without severe dengue fever was 7yrs.The mean duration of hospitalization was 5.21 days in severe dengue and 3.4 days in non-severe dengue cases. Fever was the most common presenting symptom and hepatomegaly was the common clinical finding in the study.  Bleeding manifestations were seen in cases of severe dengue with raised haematocrit levels, raised SGOT levels and severe thrombocytopenia. Pleural effusion and gall bladder wall thickening with ascites was seen in severe dengue cases. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a dreadful fever among pediatric age group which needs to be considered with great caution in management.  Understanding the risk factors helps in predicting the mortality which helps in management and better outcome of the fever. 


2021 ◽  
Vol 71 (5) ◽  
pp. 1524-28
Author(s):  
Taimoor Ashraf Khan ◽  
Shazia Nisar ◽  
Muhammad Mahad Qureshi ◽  
Muhammad Samiullah ◽  
Muhammad Israr

Objective: To characterize the clinical presentations and laboratory markers (as disease predictors and markers) and severity of disease in patients admitted with dengue fever. Study Design: Prospective observational study. Place and Duration of Study: Department of Infectious Diseases, Pak Emirates Military Hospital Rawalpindi, from May to Oct 2018 Methodology: In our study, we included the patients treated for dengue fever. Data were recorded on predesigned proforma and analyzed using Microsoft excel 365 and Social Package for Statistical Sciences version 23. Results: A total of 160 patients were included in this study, all were males. All cases were positive for Nonstructural Protein 1 Antigen. Symptoms seen in abundance were fever with rigors, chills, backache, retro-orbital pain, nausea and vomiting. Manual platelet count at admission ranged from 15-396 x 103 (mean 107.5 ± 6.8 x 103). Platelet count on discharge ranged from 102-577 x 103 (mean 207.9 ± 95.4 x 103). A total of 34 (21.25%) patients out of 160 confirmed and admitted dengue fever cases had Dengue Hemorrhagic Fever (Nonstructural Protein 1 Antigen positive, thrombocytopenia and leukopenia) and 2 patient went into dengue shock syndrome. The derangement in alanine aminotransferase and alkaline phosphatase levels were shown in 98 (61.2%) and 62 (31.2%) of patients. All these patients were immunoglobulin M and Nonstructural Protein 1Antigen positive. Conclusion: Raised serum alanine aminotransferase and alkaline phosphatase levels along with early positive Nonstructural Protein 1 Antigen is a marker of disease severity.


Author(s):  
Mohd Syis Zulkipli ◽  
Sanjay Rampal ◽  
Awang Bulgiba ◽  
Devi Peramalah ◽  
Nor'Ashikin Jamil ◽  
...  

Abstract Background Dengue, an acute infectious disease caused by a flavivirus, is a threat to global health. There is sparse evidence exploring obesity and the development of more severe dengue cases in adults. With increasing prevalence of obesity in areas with a high risk of dengue infection, obesity may increase the burden and mortality related to dengue infection. Our study aimed to determine the association between obesity and the development of more severe dengue infection in primary healthcare settings and whether these associations were modified by dengue fever phase. Methods A cohort study was conducted among laboratory-confirmed dengue patients aged &gt;18 y in the central region of Peninsular Malaysia from May 2016 to November 2017. We collected demographic, clinical history, physical examination and laboratory examination information using a standardized form. Dengue severity (DS) was defined as either dengue with warning signs or severe dengue. Participants underwent daily follow-up, during which we recorded their vital signs, warning signs and full blood count results. Incidence of DS was modeled using mixed-effects logistic regression. Changes in platelet count and hematocrit were modeled using mixed-effects linear regression. The final multivariable models were adjusted for age, gender, ethnicity and previous dengue infection. Results A total of 173 patients were enrolled and followed up. The mean body mass index (BMI) was 37.4±13.75 kg/m2. The majority of patients were Malay (65.9%), followed by Chinese (17.3%), Indian (12.7%) and other ethnic groups (4.1%). A total of 90 patients (52.0%) were male while 36 patients (20.8%) had a previous history of dengue infection. BMI was significantly associated with DS (adjusted OR=1.17; 95% CI 1.04 to 1.34) and hematocrit (%) (aβ=0.09; 95% CI 0.01 to 0.16), but not with platelet count (x103/µL) (aβ=−0.01; 95% CI −0.84 to 0.81). In the dose response analysis, we found that as BMI increases, the odds of DS, hematocrit levels and platelet levels increase during the first phase of dengue fever. Conclusion Higher BMI and higher hematocrit levels were associated with higher odds of DS. Among those with high BMI, the development of DS was observed during phase one of dengue fever instead of during phase two. These novel results could be used by clinicians to help them risk-stratify dengue patients for closer monitoring and subsequent prevention of severe dengue complications.


Author(s):  
Vidyasagar Ram ◽  
Khwaja Saifullah Zafar ◽  
Manoj Kumar ◽  
Ganga Prasad Vaishya ◽  
Ejaz Ahmad ◽  
...  

Background: In India, dengue epidemics are becoming more frequent. Dengue viral infections are among the most important mosquito-borne disease of the Indian subcontinent. The study aimed to compare the clinical and haematological profile of all patients diagnosed with dengue viral infection. Patient with confirmed infection with dengue virus were prospectively evaluated for disease progression and to determine their final clinical outcome. The objective of the study was to study the clinico-haematological profile of dengue infection at rural tertiary care centre.Methods: This prospective study included 456 clinically suspected cases of dengue infection of ages more than 14 years of age. Dengue was confirmed by serological methods. Confirmed cases of dengue infection were analyzed according to age, sex and education. Clinical and hematological data were compared between dengue fever and dengue hemorrhagic fever.Results: Serologic dengue infection was positive in 220 (48%) out of 456 clinically suspected cases of the dengue infection. 127 (57.73%) patients were males and 93 (42.27%) were females. 149 (67.72%) patient had dengue fever while 71 (32.27%) had dengue hemorrhagic fever. The proportion of dengue cases was highest among male aged 15 to 24 years-old. A gradual decrease occurred in the percentage of dengue cases in the population aged 44 years-old or more. Common clinical symptoms were fever, headache, abdominal pain, myalgia, joint pain and retro-orbital pain. Common haematological abnormalities were thrombocytopenia, leukopenia and elevated alanine aminotransferase (SGOT).Conclusions: Differences in the clinical, biochemical and haematological profile of dengue virus infection, indicative of a variation in disease severity from DF to DHF. In this study, we present recent data on readily obtained clinical and laboratory data that can be used for early diagnosis and earlier appropriate treatment of dengue virus infection.


2021 ◽  
Vol 44 (2) ◽  
pp. 74-77
Author(s):  
Farhana Rahat ◽  
Morsheda Khanam ◽  
Kazi Iman ◽  
UK Ghosh ◽  
NK Ghosh

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


2021 ◽  
Vol 11 (2) ◽  
pp. 341-353
Author(s):  
Suman Sarkar ◽  
Mamta Kumari ◽  
Amrita Roy ◽  
Anirban Chatterjee ◽  
Partha Pratim Pal

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&#62;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&#62;SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase


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