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

Abstract

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.