Karthikeyan, R (2012) Clinical Profile and Outcome of Dengue Fever among Children Admitted at Tirunelveli Medical College Hospital. Masters thesis, Tirunelveli Medical College , Tirunelveli.
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Abstract
INTRODUCTION: Dengue viral infection is the most common mosquito borne disease in the world with varied presentations, high morbidity and high mortality patterns. 2.5 billion people – two fifths of the world's population in tropical and subtropical countries are at risk 1 . An estimated 50 million dengue infections occur worldwide annually. A very large proportion (approximately 90%) of them are children aged less than five years, and about 2.5% of those affected die. Epidemics of dengue are increasing in frequency. During epidemics, infection rates among those who have not been previously exposed to the virus are often 40% to 50% but can also reach 80% to 90%. Aedes (Stegomyia) aegypti is the primary epidemic vector. Primarily an urban disease, dengue and DHF are now spreading to rural areas worldwide. Dengue viral infections classified on the basis of WHO criteria2 as follows: 1. Dengue fever (DF): Dengue seropositive without bleed. 2. Dengue fever with unusual bleed (DFB): Dengue seropositive with bleeding tendencies, not satisfying WHO criteria for DHF. 3. Dengue hemorrhagic fever (DHF): Dengue seropositive with bleeds with evidence of plasma leakage. 4. Dengue shock syndrome (DSS): DHF with evidence of peripheral circulatory failure. OBJECTIVE OF THE STUDY: To study the clinical profile and outcome of dengue fever in children. DISCUSSION: As discussed in the literature, SouthEastAsian region has a varied clinical profile and outcome compared to the rest of the world. The demographic pattern and the trend of illness are vastly changing every year through the past decade. South India and especially SouthTamilnadu has witnessed several dengue epidemic outbreaks during the past few years. Here I compare the clinical profile and outcome of Dengue in our hospital with other Indian and study done other countries. Totally 53 Sero-positive cases dengue children who presented at Tirunelveli Medical College hospital during the study period were analysed. As per the WHO classification, the frequency of Dengue fever was 20.8%, Dengue hemorrhagic fever 54.7% and Dengue shock syndrome 24.5%, while no cases presented Dengue fever having unusual bleed.(i.e. bleeding without plasma leakage) Narayanan et al (Chennai2001)reported DF (72.78%), DHF (18.6%), DSS (8.4%). Kalyanarooj et al (Indonesia) reported DF (including DFB) (53%), DHF (including DSS)(47%). Ratageri et al(Hubli2003) reported DF(18%),DHF (includingDSS) is 82%. In present study, DHF (including DSS) is 79.2%. Present study is comparable with other studies. This shows that severe forms of dengue-DHF and DSS have increased over the decade. It may be due to increasing endemicity, environmental factors and changing virulence of the viruses. CONCLUSION: 1. Dengue fever is becoming more prevalent in India, especially south India. Incidence of Dengue shock syndrome is increasing. 2. Children between 6 and 12 yrs were most affected by dengue in my study. 3. There was no sex predilection. 4. Abdominal pain is a significant symptom in children with bleed(DHF).it is not a symptom to be ignored .Abdominal Pain in a child with suspected dengue should alert us to the possibility of GI bleed. 5. Cases initially diagnosed as acute watery diarrhoea, eventually turned out to be dengue. And diarrhoea children with suspected dengue were significantly prone for DSS. Hence, high index of suspicion and aggressive management are the need in such cases. 6. Seizure was significant in DSS cases. Any dengue child throwing convulsions should hence be promptly evaluated for unrecognised shock. 7. The bleeding in dengue is not purely due to thrombocytopenia. It is due to multiple etiologies including vascular changes. Refraining from treating the platelet numbers rather than the patient and strict adherence to protocols would go a long way in preventing iatrogenic complications like fluid overload. 8. There is no role for prophylactic platelet transfusion.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Profile ; Outcome ; Dengue Fever ; Children Admitted ; Tirunelveli Medical College Hospital |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 18 Apr 2018 06:42 |
| Last Modified: | 18 Apr 2018 06:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7084 |
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