Pattern of management and outcome of dengue fever in pediatric in-patients in a tertiary care hospital: a prospective observational study

Zainab Ghazala, H. V. Anuradha, M. C. Shivamurthy

Abstract


Background: Dengue is one of the most important mosquito borne viral diseases presenting with varied symptomatology. A broad-angled evaluation with integration of clinical and laboratory parameters would direct the physicians through the stages of the disease process and the line of management. The objectives were to identify the pattern of management of dengue fever in pediatric in-patients and to assess the outcome.

Methods: A prospective observational study was carried out in pediatric inpatients. Data were collected by intensive case record review. Patients of age group 1-18 years of both genders diagnosed of dengue fever were included. The prescribing pattern in children presenting at various stages of dengue fever was analyzed. The outcome was assessed in terms of course in hospital and duration of hospital stay.

Results: A total of 110 patients diagnosed with dengue fever with one or more warning signs were admitted during the study period. Thirty percent cases had liver enzymes more than 3 times the normal and 68% patients had platelet count <1,00,000/cumm. Two cases of dengue encephalitis were reported. Most common intravenous fluid given was ringer lactate followed by isolyte P and others. Most common antibiotic prescribed was ceftriaxone followed by ampicillin and others. The symptomatic treatment given consisted of paracetamol, anti-acidity drugs and anti-emetic drugs. Vitamin K was prescribed to 41% and zinc and folic acid supplements were prescribed to 30% children. There was no correlation found between vitamin K and outcome of the disease.

Conclusion: Antibiotics and vitamin K though not a part of standard World Health Organization guidelines was seen to be an important part of management. Supportive care with judicious fluid management during the critical and recovery period with continuous monitoring is required for all patients. Further comparative studies are needed to establish the role of antibiotics and other supportive measures like zinc and folic acid on the outcome of the disease.


Keywords


Dengue fever, Management, Outcome, Observational study, Pediatric

Full Text:

PDF

References


Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva: World Health Organization; 2009.

Guidelines for Clinical Management of Dengue Fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome. Government of India; 2008.

Guzmán MG, Kouri G, Bravo J, Valdes L, Vazquez S, Halstead SB. Effect of age on outcome of secondary dengue 2 infections. Int J Infect Dis. 2002;6(2):118-24.

Kamath SR, Ranjit S. Clinical features, complications and atypical manifestations of children with severe forms of dengue hemorrhagic fever in South India. Indian J Pediatr. 2006;73(10):889-95.

Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai: a study of clinical profile and outcome. Indian Pediatr. 2002;39(11):1027-33.

Centers for Disease Control and Prevention (CDC). Dengue hemorrhagic fever – US-Mexico border, 2005. MMWR Morb Mortal Wkly Rep. 2007;56(31):785-9.

Souza LJ, Alves JG, Nogueira RM, Gicovate Neto C, Bastos DA, Siqueira EW, et al. Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases. Braz J Infect Dis. 2004;8(2):156-63.

Parkash O, Almas A, Jafri SM, Hamid S, Akhtar J, Alishah H. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia). BMC Gastroenterol. 2010;10:43.

Kanade T, Shah I. Dengue encephalopathy. J Vector Borne Dis. 2011;48(3):180-1.

Thangaratham PS, Jeevan MK, Rajendran R, Samuel PP, Tyagi BK. Dual infection by dengue virus and Plasmodium vivax in Alappuzha District, Kerala, India. Jpn J Infect Dis. 2006;59(3):211-2.

Bhalla A, Sharma N, Sharma A, Suri V. Concurrent infection with dengue and malaria. Indian J Med Sci. 2006;60(8):330-1.

Lee IK, Liu JW, Yang KD. Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue hemorrhagic fever. Am J Trop Med Hyg. 2005;72(2):221-6.

Malavige GN, Velathanthiri VG, Wijewickrama ES, Fernando S, Jayaratne SD, Aaskov J, et al. Patterns of disease among adults hospitalized with dengue infections. QJM. 2006;99(5):299-305.

Bhaskar ME, Moorthy S, Kumar NS, Arthur P. Dengue haemorrhagic fever among adults – An observational study in Chennai, South India. Indian J Med Res. 2010;132:738-40.

De Burghgraeve T, Kaptein SJ, Ayala-Nunez NV, Mondotte JA, Pastorino B, Printsevskaya SS, et al. An analogue of the antibiotic teicoplanin prevents flavivirus entry in vitro. PLoS One. 2012;7(5):e37244.

Dung NM, Day NP, Tam DT, Loan HT, Chau HT, Minh LN, et al. Fluid replacement in dengue shock syndrome: a randomized, double-blind comparison of four intravenous-fluid regimens. Clin Infect Dis. 1999;29(4):787-94.

Ngo NT, Cao XT, Kneen R, Wills B, Nguyen VM, Nguyen TQ, et al. Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis. 2001;32(2):204-13.

Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. 2005;353(9):877-89.