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INTERNATIONAL JOURNAL OF CURRENT MEDICAL SCIENCES

RESEARCH ARTICLE
ISSN: 2320- 8147
International Journal of Current Medical Sciences- Vol. 5, Issue 10, pp. 78-80, October, 2015

CLINICAL STUDY AND OUTCOME OF DENGUE FEVER IN CHILDREN AND ADOLESCENT AGE
GROUP (UPTO 18 YEARS OF AGE)
Janakiram N*, Ramesh S and Vinoth
Department of Paediatrics, Rajah Muthiah Medical College, Chidambaram

AR TIC L E I NF O
Article History:
th
Received 19 , September, 2015
Received in revised form 27th, September, 2015
Accepted 15th,October, 2015
Published online 28th, October, 2015
Key words:
Distal tibia fractures, medial locking
compression plates, anterolateral locking
compression plates, Karlstrom Olerud score
ABS TR AC T
Background: Dengue is the most important emerging tropical viral disease of
humans in the world today. It is estimated that there are between 50 and 100
million cases of dengue fever (DF) and about 500,000 cases of dengue
haemorrhagic fever (DHF) each year which require hospitalisation. The current
study is undertaken to study the various clinical presentation, laboratory
(haemogram) parameters of Dengue Fever and to evaluate common modes of
clinical presentation and complications of dengue fever cases admitted in Rajah
Muthiah Medical College and Hospital, Chidambaram (November 2013 –
October 2015) and to correlate these features with laboratory (haemogram)
findings which may help us in early diagnosis and better case management.
Aims and objectives: i) To identify early clinical signs and symptoms of
Dengue fever in children/ adolescents (upto 18 years of age). ii) To correlate the
clinical findings of dengue fever with haemogram.
Methods: 43 cases of dengue cases i.e. children/adolescents (upto 18 years of
age group) were admitted in Rajah Muthiah Medical College and Hospital,
Chidambaram between November 2013 to October 2015 were studied.
Results: Out of 43 cases in this study, 39 cases belongs to DF, 3 cases belongs to
DHF and 1 case belongs to dengue shock syndrome (DSS).
Conclusion: The clinical manifestations, examination findings and laboratory
(haemogram) parameters in this study were similar to other Indian studies.
In the present study, dengue fever was the most common presentation followed
by DHF. A focused history, detailed clinical examination and appropriate
relevant investigations can aid for early diagnosis and treatment. Proper
evaluation of the progress of the disease is a key in the management of disease.

Copyright © Janakiram N et al. 2015, This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided
the original work is properly cited.

INTRODUCTION The global prevalence of dengue has grown dramatically

in recent decades.(6,10)
Dengue is a mosquito borne viral illness caused by  2.5 - 3.0 billion people are currently at risk world
Flaviviridae, genus flavivirus. Epidemics of an illness wide.
compatible with dengue fever were first reported in the
 Each year approximately 5, 00,000 cases of dengue
medical literature in 1779 and 1780. With subsequent
haemorrhagic fever require hospitalisation, including
uncontrolled growth of cities, epidemics of Dengue
90% children less than 15 years of age. Mortality of
Fever associated with Dengue Haemorrhagic Fever
Dengue haemorrhagic fever is approximately 5%
emerged as a major public health problem. Dengue virus
with 25,000 deaths reported each year.
infection is increasingly being recognised as one of the
world’s major emerging infectious diseases. Dengue is
The world health organization (WHO) classifies dengue as
endemic in most tropic and subtropical countries
a major international public health concern because of
including India especially in urban areas.
the expanding geographic distribution of both the virus
and the mosquito vector, the increased frequency of

*Corresponding author: Janakiram N

Department of Paediatrics, Rajah Muthiah Medical College, Chidambaram
 International Journal of Current Medical Sciences- Vol 5, Issue, 10, pp. 78-80, October, 2015
epidemics, the co-circulation of multiple virus serotypes, WHO specified criteria for DF, 3 children with DHF, 1
and the emergence of dengue haemorrhagic fever in new child with DSS.
areas.(7,8)
The most common signs were Hepatomegaly (76.7%),
MATERIALS AND METHODS followed by Pallor (48.8%), Splenomegaly (37.2%),
Tachypnoea (34.9%), Petechiae (9.3%), Ascites (7.0%),
Study design: Prospective study. Pleural effusion(2.3%).
Study period: November 2013 – October 2015.
Source of data: All cases of serologically confirmed Dengue NS1 Ag was positive in 35 cases (81.4%), IgM
dengue fever cases in paediatric and adolescent age group (ELISA) was positive in 43 cases (100.0%) in this study.
(upto 18 years) admitted in Rajah Muthiah Medical
College and Hospital (RMMCH), Chidambaram will be DISCUSSION
considered for the study.
Dengue fever is the most important arboviral infection of
RESULTS humans and has become a major global public health
problem. In the present study of 43 cases - 39 cases (91%)
Out of the 43 children/adolescents in the study group, the belongs to DF, 3 cases (7%) belongs to DHF, 1 case (2%)
following characteristics were noted. belongs to DSS In the present study, fever (100%) was the
predominant symptoms followed by myalgia (70%),
DIAGNOSIS – CLINICAL SPECTRUM OF CASES (N=43) lethargy (65%), vomiting (55%), loss of Appetite (48%),
pain Abdomen (37%), headache (30%). In the present
study, bleeding manifestations were found in 4% cases
DHF-7% DSS-2% (9.3%). Apart from petechiae, no other bleeding
manifestations were noted.

The platelet count and tourniquet test did not consistently

correlate with each other. The tourniquet test was positive
in 9% of cases. On systemic examination, Hepatomegaly
DF-91% was seen in 33 cases (76.7%) in the present study. The
mean haemoglobin and haematocrit in the present study
SIGNS IN PATIENTS (N=43) were 9.97 gm% and 35.12 % respectively. In a study done
by Gurdeep S.D et al; the mean haematocrit value was
120
97.7%

35.5 % .3
90.7%

93%
76.7%

100
65.1%
PERCENTAGE

62.8%

80 There was no significant statistical correlation between

51.2%
48.8%

haematocrit and severity of disease among the clinical

34.9%

37.2%

60
subgroups of dengue.1Narayanan et al reported the same
23.3%

40
to be 10.8 gm% and 33.2% respectively.
9.3%

2.3%
7%

20 Thrombocytopenia and dysfunctional platelets remains a

0 central hallmark of dengue fever, surprisingly little is
Splenomegaly
Tachypnoea

Hepatomegaly
Pallor

effusion
Petechiae

Ascites

Pleural

known about the interaction of dengue virus with

platelets.4 The mean platelet in the present study was
83883 cells/cu.mm. The platelet counts at the admission
was neither an indicator of prognosis nor of bleeding
SIGNS tendencies or progression of the disease. This suggest that
Present Absent
other factors like platelet dysfunction or disseminated
intravascular coagulation may have role in bleeding in
DENGUE SEROLOGY dengue fever cases. However studies which include only
DHF cases shows correlation between low platelet count
120
and bleeding manifestations.5
100%
100

81.4%
The studies by Gomber et al1 and Narayanan et al2 have
80 documented the same opinion. The dengue NS1Ag was
PERCENTAGE

positive in 35 cases, IgM (ELISA) was tested positive in

60
43 cases, IgG was negative in 43 cases in this study.
40
CONCLUSION
20

0
0% In the present study, dengue fever was the most common
NS1 Ag IgM (ELISA) IgG (ELISA) presentation followed by other complicated forms such as
TEST COMPONENT dengue haemorrhagic fever and dengue shock syndrome.
Out of total 43 cases studied, 39 children/ adolescents met Most of the patients presented with clinical features such

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 International Journal of Current Medical Sciences- Vol 5, Issue, 10, pp. 78-80, October, 2015
as fever, vomiting, lethargy, abdominal pain, headache,
myalgia, distension of abdomen, cough/cold, rashes and
retro orbital pain . Tachypnoea, pallor, petechiae , positive
tourniquet test, hepato - splenomegaly, ascites, pleural
effusion were the clinical findings seen in this study. A
focused history, detailed clinical examination and
appropriate relevant investigations will aid for early
diagnosis. The treatment of dengue is mainly supportive,
but early institution and meticulous monitoring are the
corner stone for positive outcome.
BIBLIOGRAPHY
1. Narayanan M, Arvind MA, Thilothammal N, Prema
R, Sargunam Rex CS et al. Dengue Fever Epidemic
in Chennai – A Study of Clinical Profile and
Outcome. Indian Pediatr 2006; 39: 1027-1033.
2. Gomber S, Ramachandran VG, Kumar S, Agarwal,
Gupta P, Gupta P et al. Hematological observations
as diagnostic markers in dengue haemorrhagic fever
– a reappraisal. Indian Pediatr. 2006; 38: 477-481.
3. Gurdeep S.D, Deepak B; Clinical profile and
outcome in children of dengue haemorrhagic fever in
North India. Iran Journal of pediatrics 2008; 18(No:
3) :222-228.
*******
4. Raghunath D, Rao Durga C (Ed); Atana Basu
;Dengue interaction with platelets; Clinical feature
and management ;Current status and Research , Vol
8, Tata Mc Graw Hill, New Delhi, 2008: 147-151.
5. Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta
AK. An epidemic of Dengue hemorrhagic fever and
Dengue shock syndrome in children in Delhi. Indian
Pediatr 2008; 35: 727-732.
6. Agarwal A, Chandra J, Aneja S, Parwari AK, Dutta
AK. An epidemic of dengue hemorrhagic fever and
dengue shock syndrome in children in Delhi. Indian
paediatrics 2008; 35:727-732.
7. Gubler DJ, epidemic dengue/dengue haemorrhagic
fever as a public health, social and economic problem
in the 21st century. Trends microbiologic 2008;
10:100-103.
8. Gubler DJ. The global emergence/resurgence of
arboviral diseases as public health problems. Arch
Med Res 2008; 33:330-342.
9. IAP textbook of Paediatrics, 4th edition.
10. World Health Organization. Prevention and control
of dengue fever and dengue haemorrhagic fever:
comprehensive guidelines. WHO regional
publication SEARO, No. 29 WHO 2011.
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