Dengue Fever : Clinical , Laboratory Profile and Outcome in Pediatric Patient

38 | P a g e Dengue Fever: Clinical, Laboratory Profile and Outcome in Pediatric Patient Dr. Pooja Gandhi1, Dr Pinkal Taral2, Dr Krunal Patel3, Dr Sanketsinh Rathod4, Dr Bhavini Rathwa5 1Assistant Professor, Department of Pediatrics, Smt. Shardaben Hospital, Ahmedabad 2Final year Resident Doctor, Department of Pediatrics, Smt. Shardaben Hospital, Ahmedabad 32nd year Resident Doctor, Department of Pediatrics, Smt. Shardaben Hospital, Ahmedabad 42nd year Resident Doctor, Department of Pediatrics, Smt. Shardaben Hospital, Ahmedabad 52nd year Resident Doctor, Department of Pediatrics, Smt. Shardaben Hospital, Ahmedabad


Dengue virus
The agent of dengue, i.e., dengue viruses, are categorized under the genus Flavivirus. These viruses contain single stranded RNA and are small in size (50 nm). There are four dengue virus serotypes which are designated as DENV-1, DENV-2, DENV-3 and DENV4. These serotypes may be in circulation either singly, or more than one can be in circulation in any area at the same time. Although all four serotypes are antigenically similar, they are different enough to elicit cross protection only for a few months after infection by any one of them. Infection with any one serotype confers lifelong immunity to the virus serotype. [1], [2] Clinical findings of Dengue Fever are: acute onset, high grade and continuous fever, nausea and/ vomiting and abdominal pain. Haemorrhagic manifestations including a positive tourniquet test, petechiae, purpura, ecchymosis, epistaxis, gum bleeding, and haematemesis and/or melena. Hepatomegaly is also observed in children. Shock is manifested by tachycardia, poor tissue perfusion with weak pulse and narrowed pulse pressure (20 mmHg or less) and hypotension as cold, clammy skin and/or restlessness.
Lab features include: WBC count may be normal or with predominant neutrophils in the early febrile phase. Thereafter, there is a drop in the total number of white blood cells and neutrophils, reaching a nadir towards the end of the febrile phase. The change in total white cell count (≤5000 cells/mm3) and ratio of neutrophils to lymphocyte (neutrophils <lymphocytes) is useful to predict theocratical period ``of plasma leakage. This finding precedes thrombocytopenia or rising haematocrit. A relative lymphocytosis with increased atypical lymphocytes is observed by the end of the febrile phase and into convalescence. A sudden drop in platelet count to below 100 000 occurs by the end of the febrile phase before the onset of shock or subsidence of fever. The level of platelet count is correlated with severity of DF. A sudden rise in haematocrit is observed simultaneously or shortly after the drop in platelet count. Haemoconcentration or rising haematocrit by 20% from the baseline is the objective evidence of plasma leakage. Thrombocytopenia, haemo-concentration and mildly elevated serum aspartate aminotransferase (AST/SGOT) levels (≤200U/L) with the ratio of AST: ALT (SGOT/SGPT)>2 are constant findings in DF.
Partial thromboplastin time and prothrombin time are prolonged in about half and one third of DF cases respectively. [3] Study Period: 1st May 2019 to 31st April 2021.

Study Site: Smt. Shardaben General hospital
Type Of Study: Retrospective Observational study Aims and Objective: 1. To study the clinical profile of paediatric patients with dengue fever.

2.
To determine Correlation between the laboratory profile and the severity of dengue fever in Paediatric patients.
3. To study the outcome of dengue fever in paediatric patient.

Materials and Methods:
The present study was conducted in the pediatric department of the tertiary care study institute. -A case with co-existing malaria or enteric fever will be excluded Patient's clinical, demographic profile was noted, investigation and treatment as per protocol were observed. Results tabulated and appropriate statistical analysis done.
Mild dengue fever treatment includes paracetamol for fever and body ache and plenty of fluid.
Moderate dengue with warning sign treatment includes use of normal saline or Ringer's lactate. Severe dengue Fever treatment include use of colloids, inotrope, blood products like PRC, FFP, PCV, and fluid management.       In the present study the most common age group affected was more than 5 year of age 148 patients (45.8%). This age group may be most commonly affected due to outward playing of older children.
In the present study most, common presentation was fever in all patients followed by cough in 195 patients (60.4%) followed by vomiting in 114 patients (35.3%). In study done by Peter P Vazhayil et al also had fever in all patients followed by vomiting in 50 patients (64.1%).
In the present study hepatomegaly was the most common clinical finding in 46 patients (14.2%) followed by rash in 29 patients (8.9%) which was comparable to the study done by Peter P Vazhayil et al which also showed hepatomegaly in 44 patients (56.4%).
In the present study capillary refill time was more than 3 seconds in all DSS patients on admission and equal to 3 second in 2 patients of DHF GRADE 2. In the present study low blood pressure for age was noted in all cases of DSS patients and 2 patients of DHF GRADE 2 also had low blood pressure. In the present study low blood pressure for age was noted in all cases of DSS patients and 2 patients of DHF GRADE 2 also had low blood pressure.