scholarly journals Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ammara Farooq ◽  
Brekhna Aurangzeb ◽  
Taimur Khalil Sheikh ◽  
Huma Bashir ◽  
Maryam Ghuncha ◽  
...  
Keyword(s):  
Disease Progression ◽  
Dengue Fever ◽  
Outpatient Treatment ◽  
Secondary Care ◽  
Inpatient Care ◽  
Tertiary Care ◽  
Warning Signs ◽  
Severe Dengue ◽  
Care Hospital ◽  
Inpatient Group

Background. There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method. This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results. Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender ( p = 0.049 ), lower normal mean platelet ( p = 0.02 ), and high mean hematocrit ( p = 0.001 ) were associated with disease progression. Conclusion. The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.

scholarly journals Clinical profile of dengue fever in children: analysis of 2017 outbreak from Central Kerala, India

2018 ◽  
Vol 5 (6) ◽  
pp. 2265 ◽  
Author(s):  
Senthil Kumar K. ◽  
Rajendran N. K. ◽  
Ajith Brabhukumar C.
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Clinical Profile ◽  
Severe Dengue ◽  
High Morbidity ◽  
Care Hospital ◽  
High Grade Fever

Background: In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. The objective of this study is to assess the clinical profile of the dengue infection in children less than 15 years of age and to evaluate the outcomes of dengue fever from March 2017 to July 2017 at the Pediatric Department of Karuna Medical College, the tertiary care hospital in Palakkad.Methods: In this retrospective study, medical records were reviewed and analyzed. Patients with suspected dengue infection were classified further into 2 groups, Dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (dengue hemorrhagic fever and/or dengue shock syndrome (DHF/DSS) according to WHO.Results: A total of 77 cases were classified into 67 (87%) non-severe and 10 (13%) severe dengue cases. The most common age of presentation was above 10 yrs. The mean age of admission was 8.9 yrs. The most common presenting symptom was fever seen in 93% followed by vomiting in 68%. Elevation in Aspartate transaminase (SGOT) and thrombocytopenia were found in 32.4 %.Conclusions: High grade fever, vomiting, abdominal pain and skin rash with normal or low platelet count were the presenting features. Early diagnosis, monitoring and prompt supportive management can reduce mortality.

scholarly journals Hematological and coagulation profile of dengue infection in age group 1 to 12 years children in a tertiary care hospital

2021 ◽  
Vol 11 (2) ◽  
pp. 341-353
Author(s):  
Suman Sarkar ◽  
Mamta Kumari ◽  
Amrita Roy ◽  
Anirban Chatterjee ◽  
Partha Pratim Pal
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
World Health ◽  
Infected Mosquito ◽  
Severe Dengue ◽  
Care Hospital ◽  
Coagulation Profile ◽  
D Dimer

Dengue is an arboviral infection of public health problems in tropical and sub-tropical countries transmitted to humans through the bite of an infected mosquito of the Stegomyia family. It varies in severity, ranging from influenza-like self-limiting illness to life- threatening, which if left untreated, are associated with mortality as high as 20%. Find out hematological and coagulation profile in dengue infected children aged 1 to 12 years and association of hematological and coagulation profile with dengue severity. It is an Observational Cross- sectional study done on 100 dengue patients aged 1 to 12 years during the study period from March 2019 –February 2020. Among 100 dengue fever, 85 (85%) were categorized as dengue fever (DF), 11(11%) DF with warning signs and 4 (4%) were cases of severe dengue (DHF/DSS) according to revised World Health Organisation 2009. The most common age of presentation was above 6 years and females were afflicted more with dengue fever.100% dengue patients presented with fever. Persisting vomiting, pain abdomen, hepatomegaly and hypotension indicate progression towards severe dengue. Raised Hb% and PCV, low to normal values of WBC as well as predominantly decrease in platelet was seen in severe dengue cases however, both ESR and CRP were normal. The Liver function test was deranged SGOT>SGPT in almost all of the dengue patients and it was 3 to 4 times maximally in DFW and SD. PT, APTT prolongation, increased D- dimer and hypofibrinogenemia associated with the severity of dengue fever. Dengue is a common viral infection that may have serious consequences especially in children. There is clear difference in pattern of change of both haematological and biochemical parameters in non-severe dengue fever and severe dengue fever. Rising trend of Hb%, PCV, decreasing value of platelet count, raised transaminases (SGOT>SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase

scholarly journals Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

2020 ◽  
Vol 7 (2) ◽  
pp. 382 ◽  
Author(s):  
V. Shekar ◽  
K. Praveen Kumar ◽  
C. Soren ◽  
K. Venkataramana Reddy ◽  
N. Dharani
Keyword(s):  
Dengue Fever ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
Severe Dengue ◽  
Severe Thrombocytopenia ◽  
Care Hospital ◽  
Presenting Symptoms

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

scholarly journals A study to determine the severity based outcome of pediatric patients with dengue spectrum disorders in a tertiary care hospital

2019 ◽  
Vol 7 (1) ◽  
pp. 154
Author(s):  
Vijaysuryakiran K. M. ◽  
Mounesh Pattar ◽  
Sanjay Paida
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
Severe Dengue ◽  
Warning Sign ◽  
High Morbidity ◽  
Care Hospital ◽  
Increased Risk ◽  
Spectrum Disorders

Background: Dengue Fever (DF) has become a major global public health problem. The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. Dengue infection ranges from mild illness to a severe form of haemorrhagic fever and shock syndrome which may prove fatal. Objective of the study was to determine severity-based outcome in children with dengue spectrum disorder in a tertiary care centre in Mumbai.Methods: It was a prospective, non-interventional, observational, surveillance study conducted over 14 months (from September 2016 till October 2017). Children aged <18 years admitted to Nanavati Super Specialty Hospital, Mumbai diagnosed with dengue spectrum disorders according to WHO 2009 classification with clinical features and laboratory investigation confirming dengue were enrolled as study participants.Results: Out of 127 patients, 57(44.9%) were females and 70(55.1%) were males. 81(63.8%) were ward patients, 46(36.2%) required PICU admission. 17(13.4%) patients had dengue with warning signs, 100(78.7%) had dengue without warning signs and 10(7.9%) had severe dengue according to WHO 2009 case classification of dengue. 122(96.1%) were discharged home, 4(3.1%) died of dengue and dengue related complications all four deaths occurred in children with severe dengue.Conclusions: This study showed that commonest inpatient admission category among children with dengue according to WHO 2009 classification was dengue without warning signs Overall mortality in patients with dengue fever without warning sign as well those with warning sign remains very low. Children presenting with severe dengue associated with either organ failure or refractory shock are at increased risk of mortality.

scholarly journals A study on the outbreak of dengue fever in a tertiary care children’s hospital in southern Tamil Nadu, India

2019 ◽  
Vol 6 (3) ◽  
pp. 1194
Author(s):  
Belgin Premkumar ◽  
Baburaj S. ◽  
Margaret Hepzibah N. ◽  
Misha K. P. ◽  
Binu Abraham
Keyword(s):  
Dengue Fever ◽  
Tamil Nadu ◽  
Tertiary Care ◽  
Case Fatality ◽  
Dengue Shock Syndrome ◽  
Viral Disease ◽  
Severe Dengue ◽  
Care Hospital ◽  
Clinical Criteria ◽  
Public Health Challenge

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study’s objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.

scholarly journals Biochemical parameters (lactate dehydrogenase, serum albumin) as early predictor of severe dengue

2017 ◽  
Vol 4 (2) ◽  
pp. 464
Author(s):  
Poornima Shankar ◽  
Prarthana B.
Keyword(s):  
Lactate Dehydrogenase ◽  
Dengue Virus ◽  
Serum Albumin ◽  
Dengue Fever ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Severe Dengue ◽  
P Value ◽  
Care Hospital ◽  
Biochemical Tests

Background: Dengue fever (DF) is the arboviral infection with the largest incidence worldwide. Clinical expression of dengue virus infection varies from no symptoms to severe dengue with shock. It is the most rapidly spreading vector borne disease in the world. Nearly 100 million cases of Dengue fever and between 250,000 and 500,000 cases of severe dengue are annually reported to the WHO. The objective of this study was to study aims at determining the LDH and serum albumin levels as early parameter to predict the severity of Dengue illness.Methods: A observational clinical study conducted at K.I.M.S hospital, Bangalore, Karnataka, a tertiary care hospital. Children admitted in KIMS Hospital, Bangalore, Karnataka, a tertiary care hospital, Serum LDH and serum albumin levels are measured using the blood sample taken on the 3rd day of fever after confirmation of dengue fever (NS1 Ag- positive).Results: Study enrolled 150 patients with confirmed infection of Dengue virus who were admitted to paediatric unit between July 2014 and December 2016. Serum samples taken 72-96 hours within onset of fever were used for biochemical tests. Of 150 patients, 40 developed Severe Dengue (SD). Cases of SD had higher levels of lactate dehydrogenase (LDH) and low levels of serum albumin. Multivariate analysis showed that early alterations of LDH levels i.e.  Out of 40 patients who developed severe dengue, 37 patients i.e. 92.7% had raised levels of LDH with levels more than >600 IU and<3 levels of serum albumin 13 patients i.e 32.5% of severe dengue cases with P value of < 0.001, which showed significant association.Conclusions: Early alterations of biochemical parameter like LDH and serum albumin can predict Severe Dengue in patients with acute dengue illness.

scholarly journals Clinical and laboratory profile and outcome of dengue cases among children attending a tertiary care hospital of South India

2017 ◽  
Vol 4 (3) ◽  
pp. 1074 ◽  
Author(s):  
Punith Patak Nagaram ◽  
Prathima Piduru ◽  
Venkata Krishna Munagala ◽  
Vishnu Vandana Matli
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Bladder Wall ◽  
Tertiary Care ◽  
Severe Dengue ◽  
Wall Thickening ◽  
Severe Thrombocytopenia ◽  
Care Hospital ◽  
Age Group ◽  
Laboratory Profile

Background: Dengue fever is an arboviral disease which is endemic in tropical countries and is of major concern with its morbidity and mortality. WHO classified dengue into three categories: undifferentiated fever, dengue fever (DF) and dengue haemorrhagic fever (DHF). Severe dengue is also regularly observed during primary infection of infants born to dengue-immune mothers. The objective of present study was to assess the clinical profile, laboratory profile and associated risk factors related to outcome of children less than 15 years of age. The outcome of the children and their management protocols were also assessed in the study.Methods: A prospective cross sectional study with 174 confirmed cases of dengue in children <15 years were enrolled and classified as per WHO guidelines. The demographic data, clinical history, laboratory parameters were noted in a separate questionnaire form. Hematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done and observations noted. Cases were managed as per WHO protocol and risk factors were observed. The outcomes of the cases were noted as discharge or death of the case.Results: A total of 174 children with 149 non-severe dengue and 25 severe dengue cases with 95 males and 79 females were enrolled in the study. 6-10 years was the most common age group. The mean age of children admitted with severe dengue fever was 5.81yrs.and without severe dengue fever was 7yrs.The mean duration of hospitalization was 5.21 days in severe dengue and 3.4 days in non-severe dengue cases. Fever was the most common presenting symptom and hepatomegaly was the common clinical finding in the study.  Bleeding manifestations were seen in cases of severe dengue with raised haematocrit levels, raised SGOT levels and severe thrombocytopenia. Pleural effusion and gall bladder wall thickening with ascites was seen in severe dengue cases. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a dreadful fever among pediatric age group which needs to be considered with great caution in management.  Understanding the risk factors helps in predicting the mortality which helps in management and better outcome of the fever. 

scholarly journals Serum sodium level in dengue infected children: a retrospective study

2018 ◽  
Vol 5 (5) ◽  
pp. 1801
Author(s):  
Reshma Raj ◽  
Rashmi Alva
Keyword(s):  
Dengue Fever ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Warning Signs ◽  
Severe Dengue ◽  
Dengue With Warning Signs ◽  
Group B

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. Aim of this study is to document the serum Sodium level in dengue infected children in a tertiary care centre.Methods: A total 128 cases of NS1 antigen, IgM positive or ELISA positive dengue patients were included in this observational study and analyzed.Results: The serum Sodium level in dengue varies according to the different groups. In group A (dengue with no warning signs) the serum Sodium level was normal, whereas in case of group B (dengue with warning signs), there was significant hyponatremia. In group C, severe dengue the serum Sodium was normalConclusions: Mild hyponatremia is a common electrolyte disturbance in patients with dengue with warning signs. Hence, the lower the serum Sodium levels the higher is the incidence of complications associated with dengue fever.

scholarly journals Importance of Platelet Count and Hematocrit in Dengue Fever in Children

2021 ◽  
Vol 44 (2) ◽  
pp. 74-77
Author(s):  
Farhana Rahat ◽  
Morsheda Khanam ◽  
Kazi Iman ◽  
UK Ghosh ◽  
NK Ghosh
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Dengue Hemorrhagic Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Care Hospital ◽  
Pediatric Age Group

Background: Dengue fever has become one of the most important public health concerns now a day due to increasing complications and fatal outcomes. Dengue hemorrhagic fever and dengue shock syndrome are life threatening but reversible complications of dengue fever. Objectives: This study was performed to evaluate the relationship between platelet count and hematocrit with the severity of dengue infection in pediatric age group. Materials & Methods: This was a prospective observational study which included 280 dengue seropositive children of 1 month to 15 years, conducted during 1st June to 30th November, 2018 in a tertiary care hospital of Dhaka. Results: Out of 280 dengue cases, 187(66.78%) had thrombocytopenia and 88(47%) had raised hematocrit. Among the thrombocytopenic patients 44% had dengue fever, 47% had dengue hemorrhagic fever and 9% dengue shock syndrome. A significant co-relation was observed between the severities of thrombocytopenia and raised hematocrit with the appearance of dengue warning signs in case of dengue hemorrhagic fever. Conclusion: Thrombocytopenia and raised hematocrit were related to the severity of dengue hemorrhagic fever. Bangladesh J Child Health 2020; VOL 44 (2) :74-77

scholarly journals Correlation between serum ferritin level and severity of dengue fever in a tertiary care center: an observational study

2021 ◽  
Vol 9 (6) ◽  
pp. 1735
Author(s):  
Akash R. Murmu ◽  
Mubarak R.
Keyword(s):  
Dengue Fever ◽  
Prognostic Marker ◽  
Serum Ferritin ◽  
Confidence Limit ◽  
Ferritin Level ◽  
Care Center ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Warning Signs ◽  
Severe Dengue

Background: Serum ferritin is an acute phase protein and elevated levels of ferritin have been associated with the pathogenesis of many inflammatory infectious viral diseases. Dengue is a mosquito-borne tropical infection that caused by the dengue virus. TNFα and interleukin 1α, another proinflammatory cytokine, transcriptionally induce the H-chain of ferritin. Therefore, serum ferritin can be used as a prognostic marker for dengue severity.Methods: This is a case control study conducted between July 2017 to December 2018.Results: On the 3rd day of fever, the median values of serum ferritin in dengue, fever without warning signs, with warning signs, and severe dengue were 513.5 ng/ml, 1002 ng/ml and 2352.4 ng/ml respectively. On the 7th day of fever, the median values were 474 ng/ml, 900 ng/ml, and 2949 ng/ml respectively. Serum ferritin 1247 ng/ml on day 3 has a sensitivity of 96.4% and specificity of 91% for prediction of severity. Area under the curve for serum ferritin on day 3 was 0.963 (95% confidence limit: 0.934-0.991). Serum ferritin 1050 ng/ml on day 7 has a sensitivity of 98.2 % and specificity of 93% for prediction of severity. Area under the curve for serum ferritin on day 7 was 0.977 (95% confidence limit: 0.957-0.998).Conclusions: Elevation of serum ferritin was significantly seen in those with severe dengue. Serum ferritin can be used as a prognostic marker for dengue severity. Day 3 serum ferritin can be used as a prognostic marker for dengue severity.

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