DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192016

Clinical and laboratory predictors to differentiate severe dengue from scrub typhus in children

Bharathi Elangovan, Rajesh N. T.

Abstract


Background: Objective of study was to compare the clinical features and laboratory parameters at admission and differentiate severe dengue from scrub typhus in children.

Methods: Retrospective analysis of case records and comparison of clinical and laboratory parameters at admission of all children with a diagnosis of severe dengue and scrub typhus was done.

Results: A total of 72 children were included (severe dengue =40; scrub typhus =32) during the study period. The mean (SD) age of children with severe dengue and scrub typhus was 7.9(3.8) and 11.8(5.8) years, respectively. Majority of children with severe dengue presented with hypotension, 21(52.5%) vs 3(9.4%) in scrub typhus. Children with severe dengue had a relatively low ANC (2.6±1.97x103/mm3 vs 3.9±2.06x103/mm3), low platelet count (50.23±35.55x103/mm3 vs 140±95.0x103/mm3) and low mean ESR at 1hour (8.1±6.82mm vs 33.88±13.79mm) than scrub typhus.

Conclusions: Compared to scrub typhus, severe dengue was significantly associated with hypotension, lower ANC, ESR and platelets.


Keywords


Eschar, Fever, Low ESR, Rash, Thrombocytopenia, Scrub typhus, Severe dengue

Full Text:

PDF

References


World Health Organization. Dengue and dengue haemorrhagic fever. Factsheet no. 117, 2008. Available at: https://www.who.int/en/news-room/fact-sheets/detail/dengue-and-severe-dengue.

Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Res. 2012;136(3):373-90.

KendreVarsharani V, Shekde SD, Chinte LT. The Study of Clinico-epidemiological Features of Dengue Cases Admitted in Tertiary Care Hospital, Latur, Maharashtra. Int J Recent Trends Sci Technol. 2014;10(2):369-72.

Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: The disease spectrum and diagnostic predictors-an experience from a tertiary care hospital in South India. Trop Doct. 2010;40:230-4.

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

Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health. 2012 Mar;5(1):82-8.

Bhat NK, Dhar M, Mittal G, Shirazi N, Rawat A, Kalra BP, et al. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iranian J Pediatrics. 2014 Aug;24(4):387.

Pothapregada S, Kamalakannan B, Thulasingham M, Sampath S. Clinically profiling pediatric patients with dengue. J Glob Infect Dis. 2016;8(3):115-20.

Rose W, Rajan RJ, Punnen A, Ghosh U. Distribution of eschar in pediatric scrub typhus. J Trop Pediatr. 2016;62(5):415-20.

ArunBabu T, Vijayadevagaran V, Ananthakrishnan S. Characteristics of pediatric scrub typhus eschar in south Indian children. Pediatr Dermatol. 2017;34(2):124-7.

Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr. 2012 Nov;79(11):1459-62.

Chanta C, Triratanapa K, Ratanasirichup P, Mahaprom W. Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity. J Med Assoc Thai. 2007 Nov;90(11):2366-9.

Jagadishkumar K, Jain P, Manjunath VG, Umesh L. Hepatic involvement in dengue fever in children. Iran J Pediatr. 2012 Jun;22(2):231-6.