A Profile of Clinical Presentation, Management and outcome of Dengue Fever in Children admitted at a Tertiary Care Hospital of Rawalpindi During 2019 Outbreak.

Abstract

Introduction: Dengue is an important viral infection in humans. Causing a significant morbidity and mortality. About 390 million infections and 50,000 deaths occur every year world over. About 2.5 billion people in the world live in areas where Dengue transmissions occur.The Dengue patients in Rawalpindi during 2019 out break were more than 12000.The pediatric population in this epidemic is assessed in our study.
Objectives: To assess the clinical, laboratory, radiological profile, management and outcome in children upto 12 years of age presenting with dengue infection to Pediatric department of Benazir Bhutto Hospital during 2019 outbreak.
Methodology: This prospective descriptive study was conducted at Department of Pediatrics, Benazir Bhutto hospital Rawalpindi, for a duration of 6 months from July to December 2019. Every admitted case with confirm Dengue fever according to inclusion criteria was included in this study. Data was recorded on predesigned study questionare, entered and analyzed in SPSS version 24 for descriptive statistics and analysis.
Results: 438 children were enrolled with the clinical diagnosis of dengue fever. Of these 254 (58%) were boys and 184 (42%) were girls. Mean age of children was 8.13 years (SD ± 3.4).Fever at presentation was seen in 95.7%, pain and body aches in 79.4%, vomiting in 54.5% and loss of appetite in 63.4% of cases. Pulse pressure of <30mmHg was seen in 38.5% cases. Thrombocytopenia, leukopenia, HCT > 20% with platelets <50,000, deranged LFTs, hyponatremia, hepato-spleenomegaly and gall bladder wall thickness on ultrasonography were Seen significantly associated with progression of disease and development of complications. 254 children were reported as uncomplicated dengue fever. 119 children developed dengue hemorrhagic fever and were manage accordingly. 65 children went into dengue shock syndrome and treated for the complications. One male child died due to multi organ failure. Average duration of hospital stay remained 2.5 days (±1.2) for uncomplicated dengue fever, 4.9 (±1.9) days for dengue hemorrhagic fever while 7.3(±2.8) days for dengue shock syndrome.
Conclusions: Most commonly affected age group was 8-12 years old with a predominance of male. Signs of plasma leak proved to be reliable indicators of the disease severity and helped in timely institution of fluid therapy according to WHO guidelines. Laboratory parameters like leukopenia, increased haematocrit, thrombocytopenia and increased AST level were significantly associated with development of complications. All levels of health personnel must be aware of clinical signs and symptoms of all dengue types. Careful monitoring of unusual presentations early recognition of severe manifestation and timely intervention can reduce disease specific mortality rate.

Keywords: Clinical presentation,Dengue Fever, Dengue hemorrhagic fever, Dengue shock syndrome