A novel intervention altering disease course in children with dengue: an observational study
Keywords:Dengue fever, Albumin transfusion, Dengue shock syndrome
Background: Dengue fever has emerged as a global public health problem in recent decade, clinical spectrum of disease ranges from mild fever to life threatening dengue shock syndrome. The disease is characterized by thrombocytopenia, hypoalbuminemia and increased capillary permeability leading to third space fluid loss viz ascites, pleural effusion pericardial effusion. This study aims to show that therapeutic intervention (viz albumin transfusion under supervised diuretic cover) during onset of critical phase significantly reduces progression of disease, morbidity and mortality.
Methods: In this observational study enrolled confirmed dengue cases, requiring hospitalization. Basic lab parameters viz complete blood count, liver functions, renal functions, C-reactive proteins, chest X-ray were obtained. Pre requisites prior to albumin infusion were; urine output >0.8 ml/kg/hour, normal renal functions and no shock/hypotension.
Results: We found improved outcomes using this intervention in dengue patients early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality. Out of remaining 78 cases, 24 children developed critical phase, they were managed and transfused albumin infusion under diuretic cover. None of children who received albumin transfusion had mortality.
Conclusions: Early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality as well duration of ICU/hospital stay. We believe albumin transfusion under supervised diuretic cover, also preventing development of major life-threatening complications viz dengue shock syndrome.
Tantawichien T. Dengue fever and dengue hemorrhagic fever in adolescents and adults. Pediatr Int Child Health. 2012;32(1):22-7.
World health organization: a global brief on vector-borne diseases. Available at: https://www.who.int/. Accessed on 20 December 2021.
Special programme for research and training in tropical diseases. Dengue hemorrhagic fever: diagnosis, treatment, prevention and control. Available at: https://www.who.int/. Accessed on 20 December 2021.
Low JG, Ong A, Tolfvenstam T, Lai YL, Ng LC, Leo YS, et al. Decision tree algorithms predict the diagnosis and outcome of dengue fever in the early phase of illness. PLoS Negl Trop Dis. 2008;2(3):e196.
Normile D. Tropical medicine. Surprising new dengue virus throws a spanner in disease control efforts. Science. 2013;342(6157):415.
Dwivedi VD, Tripathi IP, Tripathi RC, Bharadwaj S, Mishra SK. Genomics, proteomics and evolution of dengue virus. Brief Function Genomics. 2017;16(4):217-27.
Manock SR, Jacobsen KH, de Bravo NB, Russell KL, Negrete M, Olson JG, et al. Etiology of acute undifferentiated febrile illness in the Amazon basin of Ecuador. Am J Trop Med Hyg. 2009;81(1):146-51.
Huy R, Buchy P, Conan A, Ngan C, Ong S, Ali R, et al. National dengue surveillance in Cambodia 1980-2008: epidemiological and virological trends and the impact of vector control. Bull World Health Organ. 2010;88(9):650-7.
Sam SS, Omar SF, Teoh BT, Abd-Jamil J, AbuBakar S. Review of dengue hemorrhagic fever fatal cases seen among adults: a retrospective study. PLoS Negl Trop Dis. 2013;7(5):e2194.
Blacksell SD. Commercial dengue rapid diagnostic tests for point-of-care application: recent evaluations and future needs? J Biomed Biotechnol. 2012;2012:151967.
Singla M, Kar M, Sethi T, Kabra SK, Lodha R, Chandele A, et al. Immune response to dengue virus infection in pediatric patients in New Delhi, India-Association of Viremia, inflammatory mediators and monocytes with disease severity. PLoS Negl Trop Dis. 2016;10(3):e0004497.
Thyegaraj A. Dengue. Int J Adv Med. 2020;2(5):814-6.
Jagadish KK, Jain P, Manjunath VG, Umesh L. Hepatic Involvement in dengue fever in children Ironian J Pediatr. 2012;22(2):231-6.