DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180561

Application of WHO-2009 guidelines in management of dengue in children and its outcome evaluation

Shriharsha Badiger, Mahantesh Matti, Vikram Goudar

Abstract


Background: Dengue is the commonest mosquito born viral infection. The numbers of dengue cases are increasing in recent days. Though the manifestations of dengue are complex, management is made simple by WHO-2009 guidelines. Many of clinicians are unaware or not sensitized about WHO-2009 guidelines in classification and management of dengue cases.

Methods: 143 suspected dengue cases were selected based on presumptive diagnostic criteria and were classified as group A, B and C, and all the patients were treated according to WHO guidelines. 108 cases with positive dengue IgM/IgG were chosen for analysis and rest of the cases were excluded from the study. The ELISA for IgM & IgG was sent on 5th-6th day of fever.

Results: 108 dengue IgM/IgG positive cases were selected for the study. They were grouped as Group A (20), Gr B (60), Gr C (28) according to guidelines. Most common associated symptoms were vomiting (60%), pain abdomen (61%), and puffiness of face (58%). Rashes were present in small number of patients (7.4%) and bleeding in 2.7% children. 5% in group A, 6.6% in group B and 17.8% in group C had platelet counts of <20000/mm3. 70% children of Group -A, 75% of Group -B and 85.7% of Group -C had PCV of >35, with maximum of 53.2 belonging to Group C. None of the patient received platelet transfusion. All children recovered well.

Conclusions: In the present study we managed all the dengue cases as per guidelines of WHO-2009.  The treatment is cost effective and has very good outcome with less complications. The mortality, morbidity and duration of hospital stay were reduced. The need for iv fluids, blood and blood products were brought down significantly. 


Keywords


Dengue fever, Platelets, WHO-2009 guidelines

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References


World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: World Health Organization; 2009. Available at http://whqlibdoc. who.int/publications/2009/9789241547871 _eng. Pdf

WHO. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd ed. Geneva, World Health Organization, 1997. Available at http://apps.who.int/iris/bitstream/10665/41988/1/9241545003_eng.pdf

Halstead SB. Nelson textbook of pediatrics. 20th ed. Elsevier, Inc. International Edition;2015:1329-1632.

Daniel R, Philip AZ. A study of Clinical Profile of Dengue Fever in Kollam, Kerala, India. Dengue Bull. 2005;29:197-202.

Rigau-Pérez JG, Clark GG, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV. Dengue and dengue haemorrhagic fever. Lancet. 1998;352:971-7.

Ministry of Health and family welfare. Government of India. Guidelines for clinical management of dengue fever, dengue hemorrhagic fever and dengue shock syndrome. 2008. Available at http://www.nvbdcp.gov.in/Doc/Clinical%20Guidelines.pdf

Ministry of Health - Sri Lanka National Guidelines. Guidelines on Management of Dengue Fever and Dengue Haemorrhagic Fever in Adults.2012. Available from: http://www.epid.gov.lk/web/images/pdf/Publication/guidelines_for_the_management_of_df_and_dhf_in_adults.pdf

8. National Guidelines for Clinical Management of Dengue Fever. National Vector Borne DiseaseControl Programme, India. World Health Organization 2015. Available at http://www.searo.who.int/india/publications/national_guidelines_clinical_management_dengue1.pdf?ua=1

Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, et al. The WHO dengue classification and case definitions: time for reassessment. Lancet. 2006;368:170-3.

Rigau-Perez J. Severe dengue: the need for new case definitions. Lancet Infect Dis. 2006;6:297-302.

RK Kanth, P Kumar, RN Makroo, V Raina. Role of platelet transfusion in the management of dengue patients in a tertiary care Hospital. Asian J Transfus Sci. 2007;1:4-7.

Lee TH, Wong JGX, Leo YS, Thein TL, Ng EL, Lee LK, et al. Potential harm of prophylactic platelet transfusion in adult dengue patients. PLoS Negl Trop Dis. 2016;10(3):e0004576.