A clinico epidemiological analysis of dengue deaths in children during outbreaks in the year 2013 and 2017

Abstract

Background: Majority of published studies have looked at the risk factors for mortality in dengue. There are limited data on critical analysis of the causes of death in children with dengue when they are treated according to the World Health Organization guidelines. This study was conducted to analyze the immediate causes and epidemiology of deaths in children in two different outbreaks of dengue. Subjects and Methods: This was a retrospective observational study conducted at tertiary care teaching hospital during outbreaks in the years 2013 and 2017. All children who died due to Dengue during outbreaks were included in the study. A retrospective chart review was done using predesigned pro forma. Results: A total of 29 children died due to Dengue in two outbreaks. There were Eighteen deaths in the year 2013 and eleven deaths in the year 2017 outbreak. Myocarditis (27%), Encephalitis (24%), Massive hemorrhage (13%), and severe capillary leak (13%) were major immediate causes of death. Myocarditis (45%) was the leading cause of death in 2017 while Dengue encephalitis and massive bleed (23%) each in 2013. Hypoalbuminemia at admission was seen in 26 (89%) patients at admission among all deaths. Aspartate transaminase (AST) >1000 IU/L was seen in 10 (91%) Children and had a sensitivity of 91% and specificity of 50% in diagnosing myocarditis. Conclusions: The primary cause of death in fatal dengue had shown changing epidemiology during two outbreaks. Hypoalbuminemia can predict the beginning of the critical phase better than the defervescence of fever. AST >1000 IU/L may point towards myocarditis.