Clinical Profile of Dengue Fever and its Utility in Early Prediction of Severe Dengue Among Children Less than 18 Years at a Tertiary Care Hospital in Northern India

Introduction: Dengue is the emerging mosquito-borne infectious disease in India. Dengue is endemic in many countries across the world. Dengue is one of the major causes of paediatric morbidity and mortality and clinical profile of dengue patients change from time to time and region to region. The elucidation of the clinical profile is very important for patient management and saving lives.

Aim: To assess the clinical profile of Dengue Fever (DF) and its utility in early prediction of severe dengue among children 0 to 18 years according to National Guidelines for Clinical Management of DF 2014 at a tertiary care hospital, in Northern India.

Materials and Methods: This was an observational study done at GMC Kathua, Northern India from 1st June 2021 to 30th November 2021. All the clinically suspected patients of dengue in the age group 0 to 18 years were subjected to NS1 antigen and Immunoglobulin M (IgM), Immunoglobulin G (IgG) antibody tests, all patients positive for these were considered as confirmed dengue patients and were included into the study. Parameters studied were the clinical profile of DF and its utility in prediction of severe dengue. Data was analysed by Statistical Package for the Social Sciences (SPSS) software version 28.0.1.0 (142) and different groups were compared by using the Chi-square test and multivariate logistic regression. The p-value<0.05 was considered significant.

Results: Out of the total 640 febrile patients, 71 (11.1%) were positive for dengue and were enrolled in the study. NS1 was positive in 67.6%, IgM in 56.33% and IgG (along with NS1 or IgM or both) in 32.4%. Flushed facies at 81.6% was the most common clinical finding followed by myalgia 74.6%, headache 73.2%, facial puffiness 66.2%, vomiting 54.9%, rash 50.7%, arthralgia 33.8% and retro-orbital pain in 16.9%. The total number of patients with co-morbidities was 7 (9.9%). Patients with warning signs having hepatomegaly ≥2 cm Below Costal Margin (BCM) were 49.3%, followed by recurrent vomiting 38%, pain abdomen 38%, restlessness 33.8%, minor bleeding 28.2% and lethargy 23%. Signs of cardiovascular collapse were cold calamities 26.7% followed by shock 23.9% and narrow pulse pressure <20 mmHg 12.6%. The metabolic disturbance was seen in 12 (16.9%) patients and severe organ involvement in 11 (15.5%). The tourniquet test was positive for 52.1%. A whole blood transfusion was given to eight patients. Only one patient expired with total mortality of 1.4%.

Conclusion: Vomiting and myalgia were found to be statistically significant for early prediction of severe dengue, which may help in early initiation of treatment and decrease both morbidity and mortality. Patients presenting with atypical manifestations of severe organ involvement were also included under the severe dengue category, which was not possible according to previous guidelines.