Study of clinical and laboratory predictive markers of dengue fever and severe dengue in children

Abstract

Introduction: Dengue fever is the most rapidly spreading arboviral infection with major public health consequences. Leucopenia, thrombocytopenia, hematocrit, elevated aminotransferases, low CRP and prolonged APTT, are useful predictive markers for early diagnosis of dengue infection. Objectives of the study: To study the clinical presentation and laboratory predictive markers of dengue fever, dengue with warning signs and severe dengue. Materials and Methods: Prospective hospital based study of 100 patients who were classified as dengue (DF), dengue fever with warning signs (DWS) and severe dengue (SD). Lab investigations included WBC count, Platelet count, Hematocrit, SGOT, SGPT, PT, APTT, INR, CRP. Clinical and laboratory parameters in the 3 groups of dengue fever were compared in the study. Results: Study group included 100 cases of which DF was 36%, DWS 52% and SD 12%. Commonest presenting symptom was fever, nausea and vomiting. Pain abdomen, hepatomegaly, splenomegaly, bleeding, jaundice were seen in DWS and SD group. Lab parameters: Mean WBC count was low to normal in all 3 groups. Platelet count was low in all groups. Hematocrit, SGOT/SGPT, PT /APTT/INR was progressively found to be increased in the 3 groups. Low CRP was found in all 3 groups. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Ascites, pleural effusion, shock, liver dysfunction and hemorrhage are the markers for severe dengue. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases.

A Study of Prognostic Markers for Dengue Infection

“…2,13 However, the lowest platelet count alone cannot strongly predict the incidence of bleeding and is dependent on liver function status and coagulation parameters. 2,13,18 In the present study, white blood cell or white blood cell (WBC) count was observably low on the final diagnosis, concurrent with the literature. 18,19 Of note, WBC count is often consistently low throughout illness.…”

“…2,13,18 In the present study, white blood cell or white blood cell (WBC) count was observably low on the final diagnosis, concurrent with the literature. 18,19 Of note, WBC count is often consistently low throughout illness. 19 This could be the reason that in the present study, the final diagnosis was independent of the WBC count.…”

“…Reportedly, WBC count can be within the normal range in severe dengue owing to physiological stress. 18 Elevated levels of liver enzymes are often present in severe dengue. Concurrent with the literature, in the present study, SGOT and SGPT levels were remarkably high in DHF and DSS cases.…”

“…Concurrent with the literature, in the present study, SGOT and SGPT levels were remarkably high in DHF and DSS cases. 18 Such high levels exhibit the severity of the hepatocellular injury. 20 However, levels of liver enzymes peak typically around the second week of infection and thus should be carefully evaluated for prognosis.…”