Description and classification of severity of Dengue fever using early clinical and laboratory Parameters in paediatric patients
Jai Pratibha Varshney, Neha Sharma, Atul Seth
Objective: Dengue infection, an arthropod – borne viral haemorrhagic fever, continues to be a major challenge to public health. Infection with dengue virus can cause a spectrum of illnesses. Early identification of patients at risk of developing severe dengue is critical to provide timely supportive care, which can reduce the risk of mortality to 1%. Distinguishing dengue from other febrile illnesses early in illness is challenging, since symptoms are non-specific and common to other febrile illnesses. Although the World Health Organization (WHO) has established new clinical guidelines to classify dengue severity, serological, virological, and molecular biological tests are required to definitively diagnose DENV infection. In many endemic countries, laboratory diagnosis of dengue is often problematic. The idea behind this study is to observe the clinical and biochemical characteristics of the patients with Dengue Fever and see if any of these factors are associated with prediction of poor outcome in terms of morbidity. Methods: This hospital based observational prospective study was conducted in the Paediatric Indoor Unit (Ward and ICU) of a tertiary care hospital over a period of 18 months.378 patients fulfilling the inclusion criteria were included in the study. Results: While abdominal pain, vomiting, anorexia, respiratory distress, abdominal distention and tachypnoea are early clinical signs of severe dengue. Ascites, pleural effusion and abdominal distension were also important early markers indicating increasing severity of disease. Severity of thrombocytopenia and rise in Serum aminotransferase levels were directly proportional to the severity of the disease. Co-positivity for IgM and IgG antibodies was most common lab parameter in patients with severe dengue infection. Conclusion: The revised classification of Dengue illness should shift its focus from detecting severity of the disease by hemorrhagic manifestations and circulatory failure to encompassing a more multi-organ evaluation by simple clinical and lab parameters for early intervention resulting in probably lower mortality as compared to the previous years. The acknowledgement of dengue infection presenting differently in pediatric patients as opposed to their adult counterparts and requirement of separate guidelines for this age group has also been recommended.