DENGUE
SURVEILLANCE OF SUSPECTED CHILDREN ADMITTED IN DHAKA SHISHU(CHILDREN)
HOSPITAL
Alam JM, Hussain M, Mobarak
R
Registrar, Observation Unit, Dhaka Shishu
(Childrebn) Hospital
Professor of Paediatric Medicine and Director,
Dhaka Shishu (Childrebn) Hospital
Epidemiologist, Dhaka Shishu (Children) Hospital
Objective:
I.
To observe the clinical variability of Dengue fever
and Dengue hemorrhagic fever.
II.
To see correlation between clinical, laboratory and
radiological and serological findings of Dengue fever and Dengue
hemorrhagic fever.
III.
To see correlation between clinical, laboratory and
radiological findings with the outcome of Dengue fever and Dengue
hemorrhagic fever.
Methods: The study was conducted
between June 2000 to November 2000. A prospective dengue surveillance of
suspected children admitted in Dhaka Shishu (Children) Hospital -a 345 bed
tertiary care children hospital.Out of 345 children suspected for DF and DHF 198 children between 0-13 years of age who were serologically
confirmed as DF and DHF were
taken as case population and the remaining were taken as controls
(143). A
selection of 198 serologically confirmed cases from 345 provisionally
diagnosed cases of DF and DHF were taken as cases for this study. Each
patient was followed up and investigations were carried out daily and
dengue viral antibody was detected by ELISA, Immuno-chromatographic test
and haemaglutition inhibition (HI) methods.
Results: Primary DF-48
(24.24%), secondary DF-150 (76.76%); among the primary Diseases, classical
DF- 29 (60.41%), DHF without DSS-16 (33.33%), DHF with DSS-2 (.4.16%), DSS
without haemorrhagic manifestations- 1 (2.08%); among the secondary DF
cases; classical DF-25 (16.66%), DHF without DSS-59 (39.33%), DHF with
DSS-41 (27.33%) and DSS without haemorrhagic manifestations-25 (16.66%).
High grade continuous fever or history of similar fever was in 100%
cases. Headache, retro orbital
pain and vomiting were the most common clinical presentations. Petichaeal
bleeding was found in 80.18% cases of DHF and haematemesis-40 (36.03%)
& melaena-56 (50.45%) were the other most common bleeding
manifestations. Haematocrete was high in 90.54% of cases of DHF and DSS,
Platelet count was low in 89.86% of DHF and a significant number of cases
(75%) of classical DF, platelet count was below the lowest limit of
normal. Bilateral pleural
effusion-35 (17.67%) specially right sided pleural effusion-34 (17.17%) and
ascitis-59 (29.79%) was also found, more marked in DSS and DHF. Tourniquet
test was positive in 52 (44.02%) of DHF patients. Clinical recovery was
complete and 90% of cases occurred within 7 days of fever and crucial
period persisted for less than 72 hours only, 3 (1.57%) patients died of
DHF and DSS and they stayed less than 3 hours in hospital. There was only 57%
correlation between clinical suspicion of DF and positive serology. Significant correlation
(p<.05) between laboratory
and radiological diagnosis of DHF and positive serology was found.
Conclusion: Most of the cases in recent
outbreak were secondary cases. DSS and DHF are acute emergencies, prompt
and efficient management can prevent mortality. Bilateral pleural effusion
along with ascitis are omnious signs warranting immediate management of
impending shock.