Abstract
BackgroundThe mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019.MethodsWe conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data.ResultsAmong the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity.ConclusionsDengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.
Highlights
The mosquito-borne arboviral disease dengue has become a global public health concern
Dengue has become a global public health concern, especially in most tropical and subtropical countries. It is a mosquito-borne (Aedes aegypti and Aedes albopictus) arboviral disease caused by the dengue virus (DENV) [1]
In Bangladesh, the first recognized dengue outbreak was reported in the capital city, Dhaka in 1964 [5]
Summary
The mosquito-borne arboviral disease dengue has become a global public health concern. Dengue has become a global public health concern, especially in most tropical and subtropical countries. It is a mosquito-borne (Aedes aegypti and Aedes albopictus) arboviral disease caused by the dengue virus (DENV) [1]. More than 50% of the global population are at risk of dengue transmission, with the vast majority in Asia, followed by Africa and America [4]. It is one of the leading causes of death among children in Southeast Asia [2]. The high mortality was suspected to be associated with a high incidence of dengue shock syndrome (DSS) and secondary dengue infections [9]
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