DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181387

Clinical and diagnostic features of dengue haemorrhagic fever in children

Gomathi Chenna Reddy, Nagendra K.

Abstract


Background: Diagnosis of dengue hemorrhagic fever (DHF) in children is based on clinical suspicion and prompting laboratory criteria.

Methods: This prospective study in children (6 months-14 years) presenting with features of DHF aimed to identify symptoms and signs, laboratory parameters for in early detection and assessed the association between clinical, laboratory, immunological parameters and outcome.

Results: Of 50 children, 26 were females, mean±SD age was 8.3±3.02 years; age group 8-12 years were affected the most (38.0%) and infants the least (4.0%). Fever (100%), followed by skin rash (56.0%), myalgia (52.0%) and head ache (48.0%) were the symptoms. Fever of 4-5 days (52.0%), high grade fever (84.0%) and of sudden onset (76.0%) were common. Ascitis was seen in nine. Peteche and malena (48.0%) were predominant manifestation of bleeding tendency (100%). Positive tourniquet test (48.0%) did not correlate with bleeding tendency. Lower levels of Hemoglobin (<12gms%, 100%), hematocrit (<40%, 98.0%), platelet count (<100000/mm3, 100%), serum albumin (76.0%), and abnormal liver enzymes (64.0%) along with prolonged prothrombin time (44.0%) and aPTT (18.05%) were noted. Ultrasound abdomen confirmed Pleural effusion (52.0%), ascitis (22.0%), Hepatomegaly (68.0%). Mean detection time was 4 days. Positive dengue IgM and IgG (60.0%), IgM (16%), and IgG (24%) were observed with increase of IgM in early phase.

Conclusions: lower platelet count, raising haematocrit, increased liver enzymes with low serum albumin levels are early indicators. Prolonged PT and APTT are associated with severe bleeding manifestations. Apart from clinical expertise, chest X-ray, abdominal ultrasonogram are useful diagnostic tools.

 


Keywords


Bleeding tendency, Dengue haemorrhagic fever, Immunological parameters, Low platelet count, Raised liver enzymes

Full Text:

PDF

References


Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016;16:712-23.

Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496:504-7.

Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Rese. 2012;136:373-90

Kalayanarooj S, Rimal HS, Andjaparidze A, Vatcharasaevee V, Nisalak A, Jarman RG, et al. Clinical intervention and molecular characteristics of a dengue hemorrhagic fever outbreak in Timor Leste, 2005. Am J Trop Med Hyg. 2007;77: 534-7.

Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd edition. Geneva : World Health Organization. 1997.

Dengue Guidelines for Diagnosis, treatment, prevention and control. World Health organization. 2009. Available at: http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf. Accessed 10 March 2018.

Handbook on clinical management of Dengue. World Health Organization, Geneva. 2012. Available at: http://www.wpro.who.int/mvp/documents/handbook_for_clinical_management_of_dengue.pdf. Accessed 14 March 2018.

Dengue Control. WHO. Updated 2018. Available at: http://www.who.int/denguecontrol/disease/en/. Accessed 25 February 2018.

Flamand C, Fritzell C, Prince C. Epidemiological assessment of the severity of dengue epidemics in French Guiana. Ooi EE, ed. PLoS ONE. 2017;12:e0172267.

Dias JJ Júnior, Branco MDRFC, Queiroz RCS, Santos AMD, Moreira EPB, Silva MDSD. Analysis of dengue cases according to clinical severity, São Luís, Maranhão, Brazil. Rev Inst Med Trop Sao Paulo. 2017;59:e71.

Mohd-Zaki AH, Brett J, Ismail E, L’Azou M. Epidemiology of Dengue Disease in Malaysia (2000-2012): A Systematic Literature Review. Horstick O, PLoS Neglected Trop Dis. 2014;8(11):e3159.

World Health Organization. Dengue and Dengue haemorrhagic fever. Available at: www.who.int/inf-fs/en/fact117.html. Accessed 14 March 2018.

Gomber S, Ramachandran VG, Kumar S, Agarwal, Gupta P, Gupta P. Haematological observations as diagnostic markers in dengue hemorrhagic fever -a reappraisal. Indian Pediatr. 2001;38:477-81.

Narayanan M, Arvind MA, Thilothammal N, Prema R, Sargunam Rex CS. Dengue Fever Epidemic in Chennai - A Study of Clinical Profile and Outcome. Indian Pediatr. 2002;39:1027-33.

Dhooria GS, Bhat D, Bains SH. Clinical Profile and Outcome in Children of Dengue Hemorrhagic Fever in North India. Iran J Pediatr. 2008;18:222-8.

Anuradha S, Singh NP, Rizvi SN, Agarwal SK, Gur R, Mathur MD. The 1996 outbreak of dengue hemorrhagic fever in Delhi, India. Southeast Asian J Trop Med Public Health. 1998;29:503-6.

Ratageri VH, Shepur TA, Wari PK, Chavan SC, Mujahid IB, Yergolkar PN. Clinical profile and outcome of Dengue fever cases. Indian J Pediatr. 2005;72:705-6.

Gubler DJ. Aedes aegypti and Aedes aegypti-borne disease control in the 1990s: top down or bottom up? Charles Franklin Craig Lecture. Am J Trop Med Hyg. 1989;40:571-8.

Gibbons RV, Vaughn DW. Dengue: an escalating problem. BMJ. 2002;324:1563-6.

Namvongsa V, Sirivichayakul C, Songsithichok S, Chanthavanich P, Chokejindachai W, Sitcharungsi R. Differences in clinical features between children and adults with dengue hemorrhagic fever/dengue shock syndrome. Southeast Asian J Trop Med Public Health. 2013;44:772-9.

Saraswathy MP, Sankari K, Gnanavel S, Dinesh S, Priya L. Incidence of Dengue Hemorrhagic Fever in children: a report from melmaruvathur tamilnadu, INDIA. JPSI. 2013;2:34-6.

Pone SM, Hökerberg YH, de Oliveira Rde V, Daumas RP, Pone TM, Pone MV, et al. Clinical and laboratory signs associated to serious dengue disease in hospitalized children. J Pediatr (Rio J). 2016;92:464-71.

General Considerations. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd edition. Geneva: World Health Organization. 1997:1-11.

Laoprasopwattana K, Binsaai J, Pruekprasert P, Geater A. Prothrombin Time Prolongation was the Most Important Indicator of Severe Bleeding in Children with Severe Dengue Viral Infection. J Trop Pediatr. 2017;63:314-20.

Rahman M, Rahman K, Siddque AK, Shoma S, Kamal AH, Ali KS, et al. First outbreak of Dengue hemorrhagic fever, Bangladesh. Emerg Infect Dis. 2002;8:738-40.

Kumar R, Tripathi P, Tripathi S, Alok kanodia, Vimala Venkatesh. Prevalence of dengue infection in north Indian children with acute hepatic failure. Ann Hepatol. 2008;7:59-62.

Wali JP, Biswas A, Aggarwal P, Wig N, Handa R. Validity of tourniquet test in dengue haemorrhagic fever. J Assoc Physicians India. 1999;47:2034.

Gupta P, Khare V, Tripathi S, Nag VL, Kumar R, Khan MY, et al. Assessment of World Health Organization definition of dengue hemorrhagic fever in North India. J Infect Dev Ctries. 2010;4:150-5.

Nimmannitya S. Dengue and Dengue Hemorrhagic fever in the South-East Asian Regions. Am J Trop Med Hyg. 1969;18:954-71.

Cao XT, Ngo TN, Wills B, Kneen R, Nguyen TT, Ta TT, et al. Dong Nai Paediatric Hospital Study Group. Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam. Trop Med Int Health. 2002;7:125-32.

Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta AK. An epidemic of Dengue hemorrhagic fever and Dengue shock syndrome in children in Delhi. Indian Pediatr. 1998;35:727-32.

Mohan B, Patwari AK, Anand VK. Hepatic dysfunction in childhood Dengue infection. J Trop Pediatr. 2000;46:40-3.

Poovorawan Y, Hutagalung Y, Chongsrisawat V, Boudville I, Bock HL. Dengue virus infection: a major cause of acute hepatic failure in Thai children. Ann Trop Paediatr. 2006;26:17-23.

Kumar KJ, Jain P, Manjunath VG, Umesh L. Hepatic Involvement in Dengue Fever in Children. Iran J Pediatr. 2012; 22:231-6.

Srivastava VK, Suri S, Bhasin A, Srivastava L, Bharadwaj M. An epidemic of Dengue hemorrhagic fever and Dengue shock syndrome in Delhi: a clinical study. Ann Trop Pediatr. 1990;10:329-34.

Mishra S, Ramanathan R, Agarwalla SK. Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India. Scientifica. 2016;2016:6391594.

Rashmi MV, Hamsaveena. Haematological and biochemical markers as predictors of dengue infection. Malays J Pathol. 2015;37:247-51.

Dietz VJ, Gubler DJ, Rigau-Perez JG, Pinheiro P, Schatzmayr HG, Bailey R et al. Epidemic Dengue 1 in Brazil, 1986: evaluation of a clinically based Dengue surveillance system. Am J Epidemiol. 1990;131:4.

Mia MW, Nurullah AM,Hossain A,Haque MM Clinical and Sonographic Evaluation of Dengue Fever in Bangladesh: A Study of 100 cases Dinajpur Med Col J. 2010;3:29-34.

Majumdar I, Mukherjee D, Kundu R, Niyogi P, Das J. Factors Affecting Outcome in Children with Dengue in Kolkata. Indian Pediatr. 2017;54:778-80.