Classification and study of the clinico-hematological profile of patients with dengue fever in the pediatric age group

Authors

  • Gaurav Mogra Department of Pediatrics, T. N. M. C. and BYL Nair Ch. Hospital, Mumbai, Maharashtra
  • Radha Gulati Ghildiyal Department of Pediatrics, T. N. M. C. and BYL Nair Ch. Hospital, Mumbai, Maharashtra
  • Smilu Mohanlal Department of Pediatrics, T. N. M. C. and BYL Nair Ch. Hospital, Mumbai, Maharashtra

DOI:

https://doi.org/10.18203/2349-3291.ijcp20163687

Keywords:

Dengue fever, WHO classification

Abstract

Background:Dengue fever has become a major public health issue constituting a major burden of monsoon related illnesses. New WHO classification of dengue fever was introduced in 2009. There is a need to study the factors which can predict the severity of dengue fever for timely interventions and management to decrease the mortality and morbidity.

Methods: An observational prospective study was conducted in the pediatric ward and intensive care unit at a tertiary care center in Mumbai to study the correlation between severity and clinical and laboratory parameters, morbidity and mortality in patients with dengue fever. The qualitative data was represented in the form of frequency and percentage tables with the help of SPSS 17.

Results:This study spanning an 18 month period enrolled 100 hospitalized patients.45% of them were classified as probable dengue, 44% as dengue with warning signs and 11% were severe dengue. 64% had a normal nutritional status, 28% moderate malnutrition and 8% severe malnutrition. Most common symptom was fever in 100% children, 57% vomiting, 50% rash, 49% malaise, 44% abdominal pain, 45% headache, 37% petechiae, 26% bleeding manifestation, 3% altered sensorium and 2% convulsion.46% of them had hepatomegaly ,45% with positive tourniquet test, 17 % tachycardia, 10% splenomegaly, 8% signs of circulatory failure and 7% had hypotension. Of the laboratory parameters 72% had abnormal total counts, 58% with thrombocytopenia, 45% deranged liver function tests, 41% had hemoconcentration, 22% deranged renal function test, 13% electrolyte disturbances and 6% metabolic acidosis.48% had pleural effusion and 33% had ascitis. The mortality rate was 2%.

Conclusions:A significant association (p<0.05) was found between abdominal pain, petechiae, bleeding manifestation, altered sensorium, convulsion, tachycardia, hypotension, hepatomegaly, splenomegaly, signs of circulatory failure, positive tourniquet test, hemoconcentration, platelet count, electrolyte disturbances, deranged liver and renal function tests, pleural effusion, ascitis and duration of stay with severity of dengue fever.

References

Chaturvedi UC, Nagar R. Dengue and dengue hemorrhagic fever: Indian perspective. J Biosci. 2008;33(4):429-41.

World Health Organization. Prevention and control of dengue and dengue hemorrhagic fever: comprehensive guidelines. WHO SEARO Regional Publication; 1999:29.

Oishi K, Saito M, Mapua CA, Natividad FF. Dengue illness: clinical features and pathogenesis. J Infect Chemother. 2007;13(3):125-33.

Ranjit S, Kissoon N. Dengue hemorrhagic fever and shock syndromes. Pediatr Crit Care Med. 2011;12(1):96-100.

World Health Organization, Geneva. Dengue: guidelines for diagnosis, treatment, prevention and control. WHO; 2009:1-144.

Guzman MG, Halstaed SB, Artsob H ,Buchy P, Farrar J, Gubler DJ, et al. Dengue: a continuing global threat. Nat Rev Microbiol. 2010;8(12):S7-S16.

Kliegman RM, Stanton BF, Jenson HB, Behrman RE. Nelson textbook of paediatrics. 18th ed. Philadelphia. Saunders Elsevier; 2007:2944-2949.

Kliegman RM, Stanton BF, Schor NF, Behrman RE, Geme JW. Nelson textbook of pediatrics. 19th ed. Philadelphia. Saunders Elsevier. 2011;125:746-52.

Kliegman RM, Stanton BF, Schor NF, Behrman RE, Geme JW. Nelson textbook of paediatrics. 19th ed. Philadelphia. Saunders Elsevier. 2011;478:1714-22.

Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Dewan DK. Hematological observation as diagnostic marker in dengue hemorrhagic fever - a reappraisal. Indian Pediatr. 2001;38(5):477-81.

Kliegman RM, Stanton BF, Schor NF, Behrman RE, Geme JW. Nelsons textbook of paediatrics. 19th ed. Philadelphia. Saun ders Elsevier. 2011;503:1778-1.

Prasad D, Kumar C, Jain A, Kumar R. Accuracy and applicability of the revised WHO classification of dengue in children seen at a tertiary healthcare facility in northern India. Infection. 2013;41(4):775-82.

Sahana KS, Sujata R. Clinical profile of dengue among children according to revised WHO classification: Analysis of a 2012 Outbreak from Southern India. Indian J Pediatr. 2015;82:109-13.

Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Dewan DK, et al. Hematological observation as diagnostic marker in dengue hemorrhagic fever- a reappraisal. Indian Pediatr. 2001;38(5):477-81.

Rasul CH, Ahasan HA, Rasid AK, Khan MR. Epidemiological factors of dengue hemorrhagic fever in Bangladesh. Indian Pediatr. 2002;39(4):369-72.

Shah I, Deshpande GC, Tardeja PN. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J trop pediatr. 2004;50(5):301-5

Vicente CR, Lauar JC, Santos BS, Cobe VM, Junior CC. Factors related to severe dengue during an epidemic in Vitória, State of Espírito Santo, Brazil, 2011. Rev Soc Bras Med Trop. 2013;46(5):629-32.

Anders KL, Nguyet NM, Chau NV, Hung NT, Thuy TT, Lien le B. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg. 2011;84(1):127-34.

Phuong CX, Nhan NT, Kneen R, Thuy PT, van Thien C, Nga NT, et al. Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the world health organization classification system helpful? Am J Trop Med Hyg. 2004;70(2):172-9.

Pongpan S, Wisitwong A, Tawichasri C, Patumanond J. Prognostic Indicators for dengue infection severity. International J Clin Pediatr. 2013;2(1):12-8.

Ahmed FU, Mahmood CB, Sharma JD, Hoque SM, Zaman R, Hasan MS. Dengue and dengue haemorrhagic fever in children during the 2000 outbreak in Chittagong, Bangladesh. Dengue Bull. 2001;25:33-9.

Pichainarong N, Mongkalangoon N, Kalayanarooj S, Chaveepojnkamjorn W. Relationship between body size and severity of dengue hemorrhagic fever among children aged 0-14 years. Southeast Asian J Trop Med Public Health. 2006;37(2):283-8.

Kalayanarooj S, Nimmannitya S. Is dengue severity related to nutritional status? Southeast Asian J Trop Med Public Health. 2005;36(2):378-84.

Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ et al. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the Philippines. Am J Trop Med Hyg. 2005;73(2):435-40.

Gupta V, Yadav TP, Pandey RM, Singh A, Gupta M, Kanaujiya P, et al. Risk factors of dengue shock syndrome in children. J Trop Pediatr. 2011;57(6):451-6.

Hendarto SK, Hadinegoro SR. Dengue encephalopathy. Acta Paediatr Jpn. 1992;34(3):350-7.

Chacko B, Subramanian G. Clinical, laboratory and radiological parameters in children with dengue fever and predictive factors for dengue shock syndrome. J Trop Pediatr. 2008;54(2):137-40.

Shah GS, Islam S, Das BK. Clinical and laboratory profile of dengue infection in children. Kathmandu Univ Med J (KUMJ). 2006;4(1):40-3.

Jayashree K, Manasa GC, Pallavi P, Manjunath GV. Evaluation of platelets as predictive parameters in dengue fever. Indian J Hematol Blood Transfus. 2011;27(3):127-30.

Mourao MP, Lacerda MV, Macedo VO, Santo JB. Thrombocytopenia in patients with dengue virus infection in Brazilian Amazon. Platelets. 2007;18(8):605-12.

Chuansumrit A, Tangnararatchakit K. Pathophysiology and management of dengue hemorrhagic fever. Transfus Altern Transfus Med. 2006;8(1):S3-11.

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Published

2016-12-22

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Original Research Articles