Clinical Profile of Children with Dengue and Factors Associated with Severe Dengue and Dengue with Warning Signs

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the World. The spectrum of manifestations includes mild fever to severe and life-threatening disease, though uncommon complications such as myocarditis have also been reported in many cases. We conducted this study to analyze association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever. Aims and objectives of the study was the association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever.Methods: This was a prospective observational study in which 80 paediatric patients who were hospitalized anddiagnosed to be having Dengue fever were included. All patients were stratified into either of the 3 groups- Dengue without warning signs, Dengue with warning signs and severe Dengue. A detailed history and thorough clinical examination were done for all patients. A complete blood count, electrolytes, hepatic and renal function tests were done in all children. Cardiac function was assessed by 2D Echo, CPK-MB and Troponin-I, p value less than 0.05 was taken as statistically significant.Results: Of the 80 studied cases there were 53 (66.25%) males and 27 (33.75%) females with a M:F ratio of 1.9:1. Dengue with and without warning signs was seen in 27.5% and 60% cases respectively whereas severe dengue was seen in 12.5% cases. The ejection fraction was comparable across the 3 groups. On 2D echo ejection fraction was 62.95%, 63.21% and 65.1% in cases with warning signs, without warning signs and severe dengue respectively. Additionally, ECG abnormalities were seen in 8.75% patients. All 80 patients had a normal CPK-MB and Troponin-I levels.Conclusions: Cardiac markers (CPK-MB and Troponin-I) remain unaffected during Dengue illness and do not have significant correlation between Dengue without warning signs, Dengue with warning signs and severe Dengue.

Download Full-text

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.

Download Full-text

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

Scientific Reports ◽

10.1038/s41598-020-71947-2 ◽

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.

Download Full-text

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

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz066 ◽

2019 ◽

Vol 113 (11) ◽

pp. 670-677 ◽

Cited By ~ 1

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.

Download Full-text

Dengue viral infection in children: a perspective

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-301710 ◽

2012 ◽

Vol 97 (10) ◽

pp. 907-912 ◽

Cited By ~ 10

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.

Download Full-text

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.

Download Full-text

Immunophenotyping and transcriptional profiling of human plasmablasts in dengue.

10.1101/2021.04.09.439257 ◽

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.

Download Full-text

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

The Journal of Infection in Developing Countries ◽

10.3855/jidc.12468 ◽

2020 ◽

Vol 14 (07) ◽

pp. 781-787 ◽

Cited By ~ 3

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.

Download Full-text

Serum ionic calcium levels and hypocalcemia in dengue fever in children and its correlation with its severity: case control study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192030 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1289

Author(s):

V. G. Manjunath ◽

Sruthi Balla ◽

Jagadish Kumar

Keyword(s):

Dengue Fever ◽

Case Control Study ◽

Case Control ◽

Warning Signs ◽

Severe Dengue ◽

Case Group ◽

Major Health Problem ◽

Ionic Calcium ◽

Dengue With Warning Signs ◽

Control Study

Background: Dengue fever (DF) is a major health problem, 90% of dengue hemorrhagic fever (DHF) occurring in children <5 years and mortality of 2.5%. Abnormalities like metabolic acidosis, hyponatremia and hypocalcemia can occur in severe dengue especially in dengue shock patients. Alterations in calcium homeostasis, may play a role in the pathogenesis of dengue shock. Objectives is to evaluate serum ionic calcium (Ca2+) levels in children aged 1-18yrs with dengue fever and correlate it with severity and outcomeMethods: The study was prospective hospital based case-control study. Case group had 75 children with dengue fever with equal number of controls. Cases were classified according to WHO classification. Serum Ca2+ levels were estimated within 24 hours of admission.Results: Majority of children with dengue were in the age-group of 6-15 years (71.4%). Out of 75 cases,16% were dengue without warning signs, 54.7% dengue with warning signs and 29.3% were severe dengue cases. Mean Ca2+ level (in mmol/l) was 1.2009 (±0.09) among controls and 1.0911 (±0.10) in dengue cases (p=0.0001). Mean Ca2+ level in dengue without warning signs was 1.0950 mmol/l, dengue with warning signs was 1.1088 mmol/l and severe dengue was 1.0559 mmol/l. Mean Ca2+ level in severe dengue was significantly lower compared to dengue with warning signs (p=0.04). Hypocalcemia was seen in 56% of dengue cases but only 14% among controls. Seven children with severe dengue who died had hypocalemia.Conclusions: Hypocalcemia is common in dengue fever. Lower levels of ionic calcium correlate with severity of dengue illness and may be considered as a prognostic indicator of poor outcome.

Download Full-text

CARDIAC MANIFESTATIONS OF DENGUE FEVER IN CHILDREN

10.36106/ijsr/3000608 ◽

2021 ◽

pp. 15-18

Author(s):

Gaurav Choudhary ◽

Yograj Khinchi ◽

Chaman R Verma ◽

Bhagwan Sahai Natani ◽

Rakesh Bilwal ◽

...

Keyword(s):

Public Health ◽

Dengue Fever ◽

Public Health Problem ◽

Warning Signs ◽

Severe Dengue ◽

Inclusion Criteria ◽

Medical Sciences ◽

Dengue Virus Serotypes ◽

Dengue With Warning Signs ◽

Cardiac Manifestations

Introduction: Dengue fever represents a signicant public health problem in tropical and subtropical regions. 70% of total cases are from Asia, especially India. Caused by 4 dengue virus serotypes( DENV-1, DENV-2 DENV-3 and DENV-4), DENV-2 being the most prevalent in India. Incidence and range of cardiac manifestations in dengue fever vary widely. Aims & objectives: To study the incidence and range of cardiac manifestations of dengue fever in children. Material & methods:This is an observational study, conducted in department of pediatrics at National Institute of Medical Sciences & Research, Jaipur in study period of 18 months. A total of 94 patients were included in the study fullling the inclusion criteria. Results: The overall incidence of cardiac manifestations was found to be 31.9%. The incidence of cardiac manifestations in dengue without warning signs was 4.4%, in dengue with warning signs was 52.5% and in severe dengue was 77.7%. Conclusion: Incidence of cardiac manifestations increases with increase in disease severity

Download Full-text