International Journal of Contemporary Pediatrics
Kishore E et al. Int J Contemp Pediatr. 2019 Nov;6(6):2390-2393
http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291
DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194704
Original Research Article
Clinical profile of Dengue fever in children of Nellore city,
Andhra Pradesh, India
E. Kishore1, Syam Sundar Junapudi2*
1
Department of Pediatrics, Narayana Medical College, Nellore, Andhra Pradesh, India
2
Department of Community Medicine, Government Medical College, Suryapet, Telangana, India
Received: 07 June 2019
Accepted: 11 September 2019
*Correspondence:
Dr. J SyamSundar,
E-mail: doctorshyamj@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: India especially Andhra Pradesh is endemic for dengue, in dengue fever mortality and morbidity is more
in children when compare to adults. Authors objective was to assess the clinical profile of the Dengue fever in children.
Methods: Children below 14 years with serologically positive for dengue included in this study from June 2017 to June
2018, data was collected and analyzed with MS office 2016.
Results: In 100 children 84 were suffering with Non Sever dengue , 16 were suffering with severe dengue. In the study
population 68 were male children and 32 were female children, more children 68 were in the above 11 age group, 52
children stay in hospital for 3-6 days.
Conclusions: Health education and anti-larval measures and anti-adult measures for mosquito control is effective
measures.
Keywords: Children, Clinical profile, Leukocytosis, Non sever dengue fever, Sever dengue fever, Thrombocytopenia
INTRODUCTION urbanization, population growth, increased international
travel, and global warming.3
Dengue fever is a mosquito-borne tropical disease caused
by the dengue virus.1 Symptoms typically begin three to The geographical distribution is around the equator with
fourteen days after infection.2 70% of the total 2.5 billion people living in endemic areas
from Asia and the Pacific. Many people in outbreaks are
This may include a high fever, headache, vomiting, muscle not virally tested, therefore their infections may also be
and joint pains, and a characteristic skin rash. In a small due to chikungunya, a coinfection of both, or even other
proportion of cases, the disease develops into severe similar viruses. Dengue reinfection is observed to be more
dengue, also known as dengue hemorrhagic fever, severe in children due to immunological phenomenon.4 In
resulting in bleeding, low levels of blood platelets and 2010, 25 cases and five deaths were reported from Odisha.5
blood plasma leakage, or into dengue shock syndrome,
where pressure occurs.1,2 Rapid increase in the dengue cases in 2012 became a
public health concern in Eastern India as the majority of
As of 2010 dengue fever is believed to infect 50 to 100 cases were affecting the young adolescents. Andhra
million people worldwide a year with 1/2 million life- Pradesh is endemic for dengue fever, Dengue fever
threatening infections.3 It dramatically increased in mortality and morbidity is more in children when compare
frequency between 1960 and 2010, by 30 fold. This to adults that why the main motive of this study was to
increase is believed to be due to a combination of
International Journal of Contemporary Pediatrics | November-December 2019 | Vol 6 | Issue 6 Page 2390
Kishore E et al. Int J Contemp Pediatr. 2019 Nov;6(6):2390-2393
assess the clinical profile of the dengue infection in the Inclusion criteria
children.6
Children under 14 years who are admitted with provisional
METHODS diagnosis of dengue fever.
This was prospective observational study. Exclusion criteria
Study setting Children who were positive for malaria, meningitis, and
enteric fever and children parents who are not willing to
Children under 14 years who are admitted with provisional give consent were excluded from the study. All children
diagnosis of dengue fever in pediatric ward, Narayana aged up to 14 years with positive dengue tests, either NS1
Medical college, Nellore, Study Population: Children antigen, IgM, IgG antibody rapid serological test kit, or
under 14 years who are admitted with provisional ELISA, were included into this study. Routine blood
diagnosis of dengue. Sample Size: 100 Children less than examinations like hemogram, TLC, TPC, Hb, Hematocrit
14 years of age Study Period: June 2017 to June 2018 (1 were done daily and vitals were monitored with tourniquet
year).Data Collection: By using pre-designed, pretested test. Chest X-ray, ultrasonography of abdomen and liver
questionnaire. Data analysis was done by using MS function tests were done on the third day of admission to
Office 2016. all the participants. The patients were treated with oral
paracetamol, intravenous fluids, blood products, and
Statistical test platelets as per the recent WHO dengue guidelines.7
Rates, Ratios, Proportions and Chi-square tests.
Table 1: Demography and distribution of study subjects.
Parameter Variable Total Non sever dengue Sever dengue
Age < 3 Years 8 8 0
4-7 Years 22 20 2
8-11 Years 31 26 5
>11 Years 39 30 9
Sex Male 68 58 10
Female 32 26 6
Duration of hospitalization 0-3 Days 42 40 2
3-6 Days 52 42 10
>6 Days 6 2 4
Classification Un classified fever 28
DF(with and without warning signs) 56
Severe Dengue Fever (DHF) 16
RESULTS Table 2: Lab investigations.
As shown in the Table 1, In 100 children 84 were suffering Non
Sever
with Non Sever dengue, 16 were suffering with severe Investigations Variable sever Total
dengue
dengue. In the study 68 were male children and 32 were dengue
female, more children 68 were in the above 11 age group, TLC
Leucopenia
52 children stay in hospital for 3-6 days. In the present (Total
<4000 23 3 26
study as shown in Table 2, Leucopenia was seen 26 leukocyte
cells/mm3
children, in 58 children leukocyte count was within normal count)
range. As shown in the Table 3, out of 100 children Leucocytosis
thrombocytopenia was seen in 29%, hepatomegaly was in >11000 11 5 16
33%, rise of SGOT was seen in 47% of children. As shown cells/mm3
in the Table 4, all children were suffering with fever Normal TLC
4000-11000 50 8 58
(100%), 34% of children was on Intravenous fluids
cells/mm3
transfusion, 5% on platelets transfusion and 4% on whole
fresh blood transfusion.
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Kishore E et al. Int J Contemp Pediatr. 2019 Nov;6(6):2390-2393
Table 3: Hepatic manifestations of study population. PT/PTT, and vasculopathy.10 In the study Krishnamurti
CH, Kalayanarooj SI, Cutting MA, Peat RA, Rothwell
Hepatic Bleeding Bleeding SW, Reid TJ, Green SH, Nisalak AN, Endy TP, Vaughn
Total
manifestations present absent DW, Nimmannitya SU tourniquet test was positive for
Thrombocytopenia many children, in this study, in the majority of the patient’s
Present 12 17 29 tourniquet test was found to be negative. 11 This may be
Absent 22 49 71 due to low proportion of positive tourniquet test in Indian
Total 34 66 100 studies may be due to the darker skin colour in Indian
Hepatomegaly children.12 As shown in Table 2, leucopenia was more in
non-sever dengue, According to Ratageri VH, Shepur TA,
Present 12 21 33
Wari PK, Chavan SC, Mujahid IB, Yergolkar PN.
Absent 23 44 67
Leukopenia was significantly related with severe dengue
Total 35 65 100 cases which were against our results. 13 In our study
Rise of SGOT thrombocytopenia was seen to be more in those with
Present 19 28 47 severe dengue (Table 3). There was less mortality in the
Absent 16 37 53 present study group, whereas mortality rate was high in the
Total 35 65 100 study Seneviratne SL, Malavige GN, De Silva HJ.14
Table 4: Treatment given in the hospital. CONCLUSION
Non sever Sever In children, symptoms like fever, pain, rashes, and
Management Total
dengue dengue vomiting are associated with hepatomegaly and elevated
Antipyretics 84 16 100 SGOT, a strong possibility of dengue fever is present,
Intravenous fluids 22 12 34 especially in an epidemic setting. Health education and
Platelets transfusion 0 5 5 anti-larval measures and anti-adult measures for mosquito
Whole fresh blood control is effective measures.
0 4 4
transfusion
Funding: No funding sources
Dopamine 0 1 1
Conflict of interest: None declared
Adrenaline 0 1 1 Ethical approval: The study was approved by the
Institutional Ethics Committee
DISCUSSION
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