Clinico-investigative Profile of Dengue Fever in a Rural Tertiary Care Hospital
Abhishek Gupta, DY Shrikhande, PV Nigwekar, Rushikesh S Haridas, Rahul Holkar
Objectives: To study the clinico-investigative profile and outcome of dengue fever (DF) in pediatric age group using latest WHO dengue classification and management guidelines (2012) in a rural tertiary care hospital.
Materials and methods: A prospective observational hospital- based study was carried out from September 01, 2014 to September 30, 2016. This study included lab-confirmed cases of 182 pediatric patients of dengue admitted at Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra. After clinical assessment, they were investigated and classified according to the latest WHO guidelines (2012) as dengue without warning signs, dengue with warning signs, and severe dengue; and were managed subsequently as per the same. Statistical evaluation of the clinical parameters was done using p value estimation.
Results: Out of 182 patients enrolled in the study, 42.85% of the children were admitted as dengue without warning signs followed by 41.75% of the cases were dengue with warning signs and 15.38% were severe dengue. Fever is the most common presenting symptom of DF and was present in 100% of the children, followed by headache, body ache, nausea, malaise/decreased appetite, vomiting, arthralgia, myalgia, abdominal pain, lethargy/ restlessness, and bleeding. Clinical signs: Most patients had rash followed by hepatomegaly, splenomegaly, hypotension, ascites, pleural effusion, generalised edema, pulmonary edema, acute respiratory distress syndrome, pulmonary hemorrhage, and convulsions; all in decreasing order of their occurrence. In laboratory investigations, most patients had a deranged liver function test (most cases with raised aspartate transaminase) followed by thrombocytopenia, hemoconcentration, leukopenia, and neutropenia. Radiological and ultrasonographic findings demonstrated that most of the children had pericholecystic edema (74.17%), detectable as early as 3rd day of illness. Around 11.83% of the patients required blood product transfusion. The mortality rate in our study was found to be 2.74%.
Conclusion: Early diagnosis of dengue is essential with high index of suspicion; detection of NS1 antigen positivity and ultrasonographic evidence of pericholecystic edema can also be useful. Strict adherence to the WHO protocols of severe dengue management aided by their algorithm (flowcharts) results in favorable outcome in the majority of the cases. For judicious fluid management, a good pediatric intensive care unit monitoring is essential. In severe dengue with major hemorrhagic manifestations, fresh whole blood should be used, and platelets are seldom used nowadays.
Dengue, Pediatric dengue, Severe dengue, Warning signs