Dengue epidemic management in a developing country

Abstract

Context: Dengue epidemic causes a wide spectrum of illness ranging from mild asymptomatic illness to severe fatal dengue. The cumulative dengue diseases burden has attained an unprecedented proportion in recent times with a sharp increase in the size of the human population at risk. Aims: Use of the WHO criteria (2012) for triage of dengue patients in an epidemic in a developing country with resource crunch of trained manpower and infrastructure. Settings and Design: The study was a retrospective and descriptive study carried out in a tertiary center in New Delhi, India during the dengue epidemic of 2013. Materials and Methods: Triage of dengue cases were done in an outpatient department setting as per latest WHO guidelines 2012 and only those cases with danger signs or severe dengue were admitted. A combination of serological studies involving nonstructural protein 1 antigen, IgM and IgG antibodies were used for diagnosis. Statistical Analysis Used: Statistical analysis was done by SPSS version 19 and P < 0.05 was considered signifi cant. Results: We studied the clinical, biochemical and serological profi le of the inpatients retrospectively. Active participation of parents has to be utilized to augment the monitoring of patients in a developing country with manpower and infrastructure resources crunch. Conclusion: In a developing country like India, with an ever exploding population, an epidemic of dengue causes a severe manpower and resources' crunch. Use of the WHO criteria for triage of dengue patients in an epidemic can help in effective management of dengue cases in an epidemic situation.

The clinical profile of dengue infection cases presenting in a tertiary care institute: an observational study

“…22,26 Nair B et al reported 25% frank bleeding with epistaxis being most common. Melena and epistaxis were commonest bleeding manifestations noted which is similar to observation made in the study by Ahmed et al 23,27 In this study, children with bleeding tendencies were not necessarily those having low platelet count, indicating a combination of causes such as thrombocytopenia, coagulopathy, and vasculopathy leading to bleeding manifestations.…”

“…6.7% of cases had seizures which was similar to 6.8% seizures presentation noted by Nair B et al 23 As observed in the study done by Wang C et al arthralgia and myalgia were relatively less common complaints in children compared to adults whereas pain abdomen (32.5%) and vomiting (60.5%) constituted the more common presenting symptoms and were seen more commonly in severe dengue patients. 28 Various studies have reported that Indian children with DHF have a lower than expected rise in hematocrit during the plasma leakage period due to the high prevalence of iron deficiency anemia.…”

“…Nair B et al reported 38.9% cases of shock in their study. 23 45.3% patients had January February a positive tourniquet test which was more than the 24% reported by Sahana K and Sujatha R. 8 Kulkarni M et al found that abdominal pain and tender hepatomegaly may predict DHF in children and that these patients should be closely monitored for DSS. 24 Although hepatomegaly is among the WHO clinical criteria for dengue fever, splenomegaly is not generally held to be a feature of dengue infection.…”

“…Nausea/vomiting, abdominal pain, rash, diarrhea and petechiae have been reported more commonly in DHF by Sirivichayakul C et al, while Nair B et al found fever with rash and abdominal pain most commonly. 22,23 Sirivichayakul C et al found rhinorrhoea to be commonly associated in the clinical profile of dengue and Halstead SB et al suggested including dengue in the differential diagnosis of all acute respiratory tract infection in children. 22,26 Nair B et al reported 25% frank bleeding with epistaxis being most common.…”