Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh

Abstract

Background The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019. Methods We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data. Results Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity. Conclusions Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

“…Two patients had pulmonary bleed who died. Fever was the most common presenting complain seen in 100% cases which is comparable to earlier studies, 9,10,11 whereas Sriram P et al 12 reported fever in 94.6%, Aggarwal A et al 13 reported fever in 93% of patients. Second most common clinical feature vomiting(54.1%), followed by pain abdomen(52.5%) and bleeding manifestations(26.2%) which is similar to other studies.…”

“…Two patients had pulmonary bleed who died. In Khan MAS et al 9 study epistaxis(6.3%) and melena(5.8%) were the most frequent bleeding manifestations. Thrombocytopenia (82%) was the most common association noted followed by deranged liver function (36%) and leukopenia (34.4%), findings were similar to study by Khan MAS et al 9 Significantly more no.…”

“…In Khan MAS et al 9 study epistaxis(6.3%) and melena(5.8%) were the most frequent bleeding manifestations. Thrombocytopenia (82%) was the most common association noted followed by deranged liver function (36%) and leukopenia (34.4%), findings were similar to study by Khan MAS et al 9 Significantly more no. of children who died had liver failure, renal failure , encephalitis, fluid refractory shock which is same as study by Chulananda DAG et al 14 Case fatality rate among severe dengue in this study was 21%, which was comparable to study by Sachdev A et al 15 25.6%.…”

“…Second most common clinical feature vomiting(54.1%), followed by pain abdomen(52.5%) and bleeding manifestations(26.2%) which is similar to other studies. 9,10,13 While in study of Mishra S et al 11 myalgia and abdominal pain were common finding after fever, Sriram P et al 12 reported conjunctival congestion followed by myalgia as second most common findings. 31.1% of the total patients were having bleeding manifestations.…”

“…Commonest age group in our study was 10-15 yrs. In Khan MAS et al9 study majority (46.1%) of cases belonged to the age group of 10-14 yrs. Most common age group in Rathod N P 10 study and Mishra S et al11 study was 6-12 yrs and >11 yrs respectively.…”