DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20211673

Relative bradycardia- indicator of severe dengue fever: a comparative study between PICU and ward patients

Priyasha Tripathi, Priya Gogia, Surendra Singh Raghuwanshi

Abstract


Background: Mortality due to dengue fever during epidemics is very high with all the four serotypes actively found in India. It is very difficult to distinguish and manage illness of viral aetiologies based on initial clinical features. Bradycardia can be seen as notable clinical finding in severe dengue fever. Clinical features that can be used in the initial assessment of febrile patients are essential tools for physicians in limited resource settings. Awareness of bradycardia as an early indicator of severe dengue fever could help in the early recognition and potentially reduce morbidity and mortality.

Methods: This is an observational comparative study of 40 dengue fever positive paediatric patients admitted in PICU and general ward. The study was conducted at Atal Bihar Vajpayee Govt Medical College, Vidisha from 20 August to 20 November 2020 (3 months).

Results: Bradycardia, as a significant clinical feature was present in almost all PICU patients as compared to ward patients. It can be taken as a clinical marker of severity to prevent life threatening complications of dengue like shock and haemorrhage.

Conclusions: With specific WHO guidelines to classify and treat dengue fever, we try to prevent its deadly consequences but in resource limited settings like ours, initial clinical judgement can prevent much causality and prepare us to foresee and timely manage the complications.


Keywords


Relative bradycardia, Dengue fever, PICU

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References


Dash PK, Saxena P, Abhyankar A, Bhargava R, Jana AM. Emergence of dengue virus type-3 in northern India. Southeast Asian J Trop Med Public Health. 2005;36(2):370-7.

Gibbons RV, Vaughn DW. Dengue: an escalating problem. British M J. 2002;324(7353):1563-6.

Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgrad Med J. 2004;80(948):588-601.

Khongphatthanayothin A, Suesaowalak M, Muangmingsook S, Bhattarakosol P, Pancharoen C. Hemodynamic profiles of patients with dengue hemorrhagic fever during toxic stage: an echocardiographic study. Intensive Care Med. 2003;29(4):570-4.

Wali JP, Biswas A, Chandra S, Malhotra A, Aggarwal P, Handa R, et al. Cardiac involvement in Dengue Haemorrhagic Fever. Int J Cardiol. 1998;64(1):31-6.

Fink J, Gu F, Vasudevan SG. Role of T cells, cytokines and antibody in dengue fever and dengue haemorrhagic fever. Rev Med Virol. 2006;16(4):263-75.

Lateef A, Fisher DA, Tambyah PA. Dengue and relative bradycardia. Emerg Infect Dis. 2007;13(4):650-1.

Pérez JG, Clark GG, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV. Dengue and dengue haemorrhagic fever. Lancet. 1998;352(9132):971-7.

Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998 Jul;11(3):480-96.

Cunha BA. Diagnostic significance of relative bradycardia. Infect Dis Prac. 1997;21:38-40.

Arif SMH, Khokon KZ, Azad AK, Faizi MA. Dengue Haemorrhagic Fever with Bradycardia. J Medicine 2009;10:36-7.

Girdhar R, Kothari Y, Raj RA, Shastry P, Kannadka C, Kenchappa K, et al. Successful or Unsuccessful Thrombolysis with Streptokinase in Acute Myocardial Infarction: A Descriptive Study. JMSCR. 2017;5(11):30413.

Méndez A, González G. Abnormal clinical manifestations of dengue hemorrhagic fever in children. Biomedica. 2006;26(1):61-70.

Naresh G, Kulkarni AV, Sinha N, Jhamb N, Gulati S. Dengue hemorrhagic fever complicated with encephalopathy and myocarditis: a case report. J Commun Dis. 2008;40(3):223-4.

WHO. Dengue and dengue haemorrhagic fever, 2008. Available at: https://www.who.int/csr/resources/publications/dengue/Denguepublication/en/. Accessed on 17 February 2021.