Published: 2021-02-23

A clinical and biochemical laboratory profile to measure the severity of dengue fever in paediatric population and their outcome

Sandhya Rani Talari, Gangadhar Belavadi


Background: Aim of the study was to assess various clinical manifestations of dengue fever, and complications, to establish the diagnosis of dengue fever based on dengue antigen (NS 1) and antibody (IgM, IgG) and to find the association between the clinical findings with laboratory findings.

Methods: 100 cases of suspected children below 18 years of age with clinical features suggestive of dengue infection and children presenting with fever of acute onset (<2 weeks), pain abdomen, vomiting, rash, flushed appearance and bleeding manifestation were studied. The cases were followed up for the clinical and laboratory parameters and were treated according to WHO guidelines.

Results: Out of total 100 cases studied 36 were classified as classical dengue fever, 33 as DHF, 15 as DSS, 16 as DLI. It was observed that the disease was common in age group of 5-11 year (54%). Most of the patients were male (66%) with an M:F ratio of 1.94:1. The common presenting symptoms were fever (96%), vomiting (49%), abdominal pain (42%), headache (12%), myalgia (7%), arthralgia (4%), retro orbital pain (1%). General physical examination revealed presence of hypotension, tachycardia, rashes, facial puffiness (28%), pedal oedema (21%), and conjunctival congestion (18%). The skin bleeding was the most common manifestation noted in 12 cases (12%) followed by GIT bleeding like hematemesis 4 cases (4%) followed by epistaxis 4 cases (4%), haematuria 2 cases (2%) and gum bleeds 2 cases (2%). In systemic examination patients were found to have hepatomegaly (53%), ascites (13%), splenomegaly (8%), and pleural effusion (27%). 36 (36%) patients in the study had leucopoenia and mean total leukocyte count of 6014.5 cells/cu mm. The highest and lowest TLC was 22000 and 1400 cells/cumm respectively. 85% cases had thrombocytopenia in the present study. The mean platelet in the present study was 41870 cells/cu mm. Elevated liver enzymes and elevated serum creatinine count was found in complicated forms of disease.

Conclusions: The treatment of dengue is mainly supportive, but early institution and meticulous monitoring are the corner stone for positive outcome. Much more awareness, vigilance and research in the diagnostic modalities is further needed to avoid unnecessary panic and platelet transfusions.


Dengue fever; Thrombocytopenia; Epistaxis, Liver enzymes, WHO, Haematocrit

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The World Health organization, Dengue: guideline for diagnosis, treatment, prevention and control, new edition. 2009;1.

Bhatt S, Gething P, Brady WOJ. The global distribution and burden of dengue. Nature. 2013;496:504-7.

Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG et al. Refining the Global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6:e1760.

Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S et al. Early clinical and laboratory indicators of acute Dengue illness. J Infect Dis. 1997;176:313-21.

Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgrad Med J. 2004;80:588-601.

Chandrakanta, Kumar R, Garima, Agarwal J, Jain A, Nagar R et al. Changing clinical manifestations of dengue infection in north India. Dengue Bull. 2008;32:118-25.

Cam BV, Fonsmark L, Hue NB, Phoung NT, Poulsen A, Heegaard ED, et al. Prospective case control study of encephalopathy in children with dengue hemorragic fever. Am J Trop Med Hyg. 2001;65:848-51.

Panchareon C, Thisyakorn U. Neurological manifestations in dengue patients. Southeast Asian J Trop Med Public Health. 2001;32(2):341-5.

Gurdeep SD, Deepak B. Clinical profile and outcome in children of dengue hemorrhagic fever in North India. Iran J pediatr. 2008;18(3):222-8.

Sajid A, Ikram A, Ahmed M. Dengue fever outbreak 2011: clinical profile of children presenting at madina teaching hospital faisalabad. JUMDC. 2012;3(1):42-7.

Anuradha S, Singh NP, Rizvi SN, Agarwal SK, Gur R, Mathur MD, et al. The 1996 outbreak of dengue hemorrhagic fever in Delhi, India. Southeast Asian J Trop Med Public Health. 1998;29(3):503-6.

Misra UK, Kalita J, Syam UK, Dhole TN. Neurological Manifestation of dengue viral infection. J Neurol Sci. 2006;244(1-2):117-22.

Kumar ND, Tomar V, Singh B, Kela K. Platelet transfusion practice during Dengue fever epidemic. Indian J Pathol Microbiol. 2000;43:55-60.

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.

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

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

Jagadishkumar K, Jain P, Manjunath VG, Umesh L. Hepatic Involvement in Dengue Fever in Children. Iran J Pediatr. 2012;22(2):231-36.

Butt N, Abbassi A, Munir SM, Ahmad SM, Sheikh QH. Haematological and Biochemical indicators for early diagnosis of Dengue viral infections. J college physicians Surgeons Pak. 2008;18:282-5.

Raghunath D, Durga RC, Basu A. Dengue interaction with platelets; Clinical feature and management; Current status and Research, Tata Mc Graw Hill, New Delhi. 2008;8:147-51.

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.

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

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

Larreal Y, Valero N, Estevez J, Reyes I, Maldonado M, Espina LM et al. Hepatic alterations in patients with Dengue. Invest Clin. 2005;46(2):169-78.

Faridi MMA, Agarwal A, Monish K, Abedin S. Clinical and Biochemical profile of Dengue Hemorrhagic fever in children in Delhi. Tropical doctor. 2008;(38):28-30.

Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S et al. Early clinical and laboratory indicators of acute Dengue illness. J Infect Dis. 1997;176:313-21.

Petdachai W. Hepatic dysfunction in children with Dengue shock syndrome. Dengue bull. 2005;(29):112-8.

Venkata Sai PM, Krishnan R. Role of ultrasound in Dengue fever. Bri J Radiol. 2005;78:416-8.