Hematological Manifestations of Dengue, Malaria and Enteric Fever in Children Presenting To a Tertiary Care Hospital, Pakistan

Background: Dengue fever and enteric fever, two prevalent infectious diseases in tropical and subtropical regions, pose significant public health challenges due to their overlapping clinical manifestations and distinct therapeutic approaches. This study aims to evaluate hospitalization and management protocols for both illnesses, assessing their adherence to clinical guidelines and examining patient outcomes across diverse healthcare settings.Methodology: A retrospective cross-sectional study was conducted by reviewing hospital records over a five-year period (April 2019-April 2024). A total of 218 individuals diagnosed with enteric fever (n=98) and dengue fever (n=120) were included in the study. Data were retrospectively collected using standardized forms from hospital records, laboratory reports, and discharge summaries to capture demographics, clinical presentations, lab findings, treatments, complications, and outcomes for patients with dengue or enteric fever. Statistical analysis was conducted using SPSS, Version 26 (IBM Corp., Armonk, NY), applying descriptive statistics, chi-square test, t-test, logistic regression, and Cox modeling to evaluate associations between treatment protocols and patient outcomes, with significance set at p<0.05.Results: Dengue and enteric fever showed distinct clinical patterns: rash and headache were more common in dengue fever, while abdominal pain and diarrhea predominated in enteric fever. Although demographic differences in age, sex, and residence were observed, they were not statistically significant. Improved outcomes in dengue fever were significantly associated with fluid replacement (n=110, 91.67%, p=0.02), reflecting the collective effect of standard supportive care measures. In contrast, antibiotic therapy (n=98, 100.00%, p=0.01) was central to favorable outcomes in enteric fever. Dengue fever was primarily diagnosed through serological testing (n=115, 95.83%), while enteric fever relied on blood cultures (n=78, 79.59%) (χ²=126.98, p<0.0001, OR=0.02). Hospitalization durations were significantly longer in enteric fever, patients staying ≥5 days compared to dengue fever patients (χ²=8.76, p=0.0031, OR=0.39). Recovery without complications was slightly more frequent in dengue fever (n=112, 93.33%) than in enteric fever (n=88, 89.80%), though this difference was not statistically significant (χ²=0.49, p=0.483, OR=0.60). These findings apply to general dengue fever cases only; patients with dengue hemorrhagic fever were managed separately due to differing clinical protocols.Conclusion: This study highlights the necessity of tailored treatment protocols for enteric and dengue fever, emphasizing the importance of strict adherence to established clinical guidelines to optimize patient outcomes, particularly in resource-limited healthcare settings. While appropriate management, such as antibiotic therapy for enteric fever and supportive care for dengue, is well defined, differentiating between these conditions based solely on clinical presentation remains a significant challenge due to overlapping symptoms with other febrile illnesses. This diagnostic ambiguity underscores the urgent need for more robust, accessible, and rapid diagnostic tools. Furthermore, ongoing education and capacity building for healthcare professionals are essential to enhance clinical judgment, ensure early recognition, and improve compliance with evolving evidence-based practices in the management of febrile illnesses.

Comparison of clinical characteristics and laboratory findings of malaria, dengue, and enteric fever in returning travelers: 8-year experience at a referral center in Tokyo, Japan.

There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses. Adult travelers returning to Australia who presented to the Royal Melbourne Hospital with confirmed diagnosis of dengue, malaria, or enteric fever between January 1, 2000 and March 1, 2013 were included in this retrospective study. Laboratory results for routine initial investigations performed within the first 2 days were extracted and analyzed. There were 304 presentations including 58 with dengue fever, 187 with malaria, and 59 with enteric fever, comprising 56% of all returned travelers with a febrile systemic illness during the study period. Significant findings included 9-fold and 21-fold odds of a normal CRP in dengue compared with malaria and enteric fever, respectively. The odds of an abnormally low white cell count (WCC) were also significantly greater in dengue versus malaria or enteric fever. Approximately one third of dengue presentations and almost half of the malaria presentations had platelet counts <100 × 10(9) /L. A normal CRP with leukopenia and/or thrombocytopenia occurred in 21% to 30% of dengue presentations, but not in malaria or enteric fever presentations. There is a wide differential diagnosis for imported fever, but the non-specific findings of a normal CRP with a low WCC and/or low platelet count may provide useful information in addition to clinical clues to suggest dengue over malaria or enteric fever. Further systematic prospective studies among travelers could help define the potential clinical utility of these results in assisting the clinician when deciding for or against commencement of empiric antimicrobial therapy while awaiting confirmatory tests.

Background: Among the pediatric age group, acute febrile illness (AFI) is a major cause of hospital admission, causing morbidity and death among children worldwide. Dengue, typhoid, malaria, and chikungunya fever are some of the common causes in Indian clinical settings. Objective: The objective of the study was to analyze the spectrum of AFI in pediatric population along with the evaluation of hematological parameters and to determine the specific causes and also the prognostic implications of these parameters. Materials and Methods: Patients from the pediatric outpatient department presenting with AFI formed the subjects of this study. Hematological profiles and biochemical investigations of atrial fibrillation cases were carried out and correlated. Statistical analysis was done. Results: In case of malaria and typhoid fever, leukopenia was statistically significant. Significant difference (p<0.05) was observed between severity of the thrombocytopenia and dengue fever and malaria. Conclusion: The study focuses the importance of clinical and hematological parameters in AFI and concludes that both parameters give enough clues to diagnose the etiology.

The effects of global warming have long been a focus of scientists’ attention, not only since the USA rejected the Kyoto Protocol, which was drafted to curb the emission of so‐called greenhouse gases. The potential consequences of increasing the Earth's temperature by just a few degrees include a rise in ocean levels due to melting of the polar ice caps, parching of the land and changes of storm, flood and drought patterns. These scenarios are mainly debated among climatologists, but biologists are adding a further dimension with another potentially disastrous effect. ‘In the past five years, there has been increasing discussion about global warming and its potential impact on diseases like malaria and dengue fever in the tropics and even in temperate zones’, Uriel Kitron, Professor of Epidemiology at the University of Illinois in Urbana‐Champaign, said. Indeed, many scientists point to global warming as a factor in the spread of malaria and other vector‐borne infectious diseases. This camp believes that global warming is likely to disturb a delicate equilibrium and contribute to new epidemics of malaria, yellow and dengue fever and encephalitis. Kitron has been studying the invasion of the tiger mosquito in Illinois, LaCrosse encephalitis in the Great Lakes region, and dengue and malaria in Trinidad, Kenya and Mozambique. His research, however, does not clearly link global warming with the spread of these diseases. ‘Vector‐borne diseases have an extremely complex ecology, which renders transmission and what it takes to produce disease not that simple and clear cut’, he said. > Many scientists believe that global warming is likely to disturb a delicate equilibrium and contribute to new epidemics of malaria, yellow and dengue fever and encephalitis Unlike Kitron's middle‐of‐the‐road view, much of the scientific thinking on the topic is polarised, and seems to be tinged with politics. Paul Epstein, Associate …

Introduction: In Indonesia, malaria, dengue fever (DF), and typhoid fever are endemic infectious diseases that remain major public health concerns. Data from the Ministry of Health in 2025 show high incidence rates of these three diseases, especially in Papua, Bali, and urban areas, which increase the risk of coinfection and complicate diagnosis and treatment. Methods: A case is reported of an 18-year-old man presenting with high fever, headache, nausea, and thrombocytopenia. Initial serological and laboratory tests indicated dengue fever and typhoid infection. Routine monitoring and peripheral blood examination were performed and malaria co-infection was detected. Results: The patient's fever and platelets continued to decrease despite being given supportive therapy and antibiotics. Peripheral blood smear confirmed Plasmodium falciparum infection, prompting the addition of antimalarial therapy with dihydroartemisinin-piperaquine and primaquine. Following comprehensive treatment and close monitoring, the patient’s condition improved, with normalization of vital signs and increased platelet count. Conclusion: Coinfection of malaria, dengue fever, and typhoid in Indonesia is rare but requires special attention. Systematic diagnosis and intensive monitoring are essential for effective treatment and prevention of complications. Increased clinical awareness of possible multiple infections in febrile patients in endemic areas can improve prognosis and optimize patient management.

Introduction: Thrombocytopenia is a common symptom of malaria, and typically occurs more frequently in Falciparam malaria. It appears that P. vivax does trigger thrombocytopenia, contrary to popular belief. Therefore, patients with low platelets and fever ought to be considered for malaria, though B12 deficiency does not always accompany malaria cases. Methods: This study was conducted at indoor patients at the NIMS hospital to investigate the relationship between vitamin B12 with thrombocytopenia associated with dengue fever and malaria. Patients were investigated for routine investigations such as CBC, ESR, RFT, RBS, LFT, PBF, VIT B12 LEVEL, Dengue profile and MP card test. In out of 125 patients,75 patients have dengue fever, and 50 patients have malaria fever. Result: In dengue fever out of 75 patients, 61 patients (81%) had thrombocytopenia with vitamin B12 deficiency (B12 level &lt;100 pg/l). In malaria out of 50 patients, 28 patients (56%) have thrombocytopenia with vitamin B12 level (B12 level &gt;300 pg/l), 22 patients (44%) have thrombocytopenia with vitamin B12 level normal (B12 level 201-300). Vitamin B12 level &lt; 190 pg/ml was found in 47(94%) patients with severe thrombocytopenia while 32 number (74%) patients with mild thrombocytopenia. In group with B12&lt;190 pg/ l need of SDP transfusion was significantly high i.e; (115.13±42.08) in comparison to other groups, as well as the recovery time of platelets to 20000/µl threshold, was found to be high in B12 &lt;190 pg/l group (42.60±8.89 days) as compared to other groups. Conclusion: Using platelet analysis by PBF, the results of this study were obtained. There is no clumping of platelets, and the platelets show the normal size, color, and shape.

Background: Dengue and typhoid fever are endemic diseases with similar symptoms and characteristics, necessitating rapid and accurate diagnosis. Aim: The purpose of this article is to describe cases of dengue or typhoid fever in children, and children who infected both diseases. This case reports from three children suffering from infectious diseases in one of DKI Jakarta Regional Jakarta and focuses on the patient's body temperature. Result: The findings revealed that children with typhoid fever experienced an increase temperature from the evening until early morning on average, with the temperature gradually rising. Child with dengue fever is immediately high, usually above 390C, and the body temperature fluctuates during the patient's hospitalization. Children who infected both diseases showed the body temperature rises sharply towards the night, above 390C. Conclusion: Early detection of characteristics body temperature this infectious disease in children can reduce the risk of complications and hasten the patient's recovery.

Fever in a traveler returning from the Amazon. Do not forget hepatitis A

To optimize antimicrobial treatment of patients with fever upon admission to the department of internal medicine of Dr Soetomo Hospital in Surabaya, Indonesia. Prospective intervention study. The intervention comprised development of a consensus guideline, an official declaration of the guideline by the head of department, distributing a guideline pocketbook, carrying out blood cultures free of charge, teaching sessions and refresher courses. The outcome was measured with reference to (i) percentage of patients with fever started on antibiotic therapy, (ii) amount of antibiotics used expressed as defined daily doses (DDD)/100 patient-days, (iii) percentage of appropriate prescriptions and of prescriptions without indication as assessed by independent reviewers, (iv) percentage of treatments in accordance with guidelines, (v) percentage of patients in whom blood cultures were taken before starting antimicrobial therapy, (vi) percentage of treatments appropriately stopped on re-evaluation of the patients at 72 h and (vii) mortality. The study involved 501 patients, 95 residents and 60 specialists. After the intervention 17% patients less were treated with antibiotics upon admission and antibiotic use fell from 99.8 to 73 DDD/100 patient-days. The percentage of patients with sepsis and dengue treated in accordance with the guideline increased by 23% and 30%. The percentage of appropriate therapies, therapies without indication and mortality did not change significantly. The percentage of patients for whom a blood culture was taken upon admission increased from 3% to 81%; however, almost all were taken after they commenced antibiotic therapy. Therapy was not adjusted after 72 h in any case. Interrupted time series analysis showed that the start of development of the guideline and the declaration of the guideline were the interventions with the greatest impact. The multifaceted intervention had limited success. A very important drawback to the prudent use of antibiotics was the absence of adequate microbiological diagnostics.

Objective: The study aimed to evaluate the hematological parameters of patients with dengue fever in order to increase the sensitivity of screening for early diagnosis and as an aid to the early institution of appropriate treatment. &#x0D; Materials and Methods: This study was conducted in Peadiatrics Department Benazir Bhutto Hospital, Rawalpindi for a period of 6 months from July 2019 to December 2019. &#x0D; Results: During the study period of 6 months, 438 dengue serology-positive children were admitted, amongst which 254 were male (58%), and 184 were female (42%). The children's age ranged from 1 month to 12 years, with a mean age of 8.03 years (SD + 3.13 years). Out of 438 children, 254 (58%) were uncomplicated dengue fever (DF), 119 children (27%) developed dengue hemorrhagic fever (DHF). 65 children (15%) went into dengue shock syndrome (DSS). The predominant findings in the complete blood picture (CBC) were Thrombocytopenia (80.1%) and leucopenia (65.1%). Normal leucocyte count was seen in 59 cases (13.68%). Thrombocytopenia (platelets less than 100,000) was seen in 351 patients (80.1%) out of which 30 cases (6.9%) had a platelet count less than 50,000. Leukopenia was found in 285 (65.1%) patients. Most of the patients were positive for NS1 (70.3%). IgM was positive in 62.1% and IgG was positive in 14.8%. Enteric Fever as co-infection was found in 30(6.8%) children.&#x0D; Conclusion: Careful assessment and interpretation of hematological changes in dengue patients allow early diagnosis and institution of appropriate treatment.

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations.

Presence of coinfection may make the otherwise straightforward presentation, diagnosis and management of the either disease complicated. Dengue and enteric fever coinfection is uncommon, though as a single disease both are common in tropical countries. Here, coinfection by dengue and enteric fever has been described in a 14-year-old boy residing in the tropic. Diagnosis of dengue was suggested by positive serological tests, and Salmonella paratyphi A was isolated by blood culture. Presence of enteric fever presumably protracted the course of illness by dengue fever. The patient was managed successfully by intravenous ceftriaxone, along with supportive care. So, the physicians practicing in the endemic region should have high degree of suspicion while dealing with the febrile patients in clinical practice.Bangladesh J Medicine Jul 2017; 28(2) : 100-103

Background and objectivesSalmonella typhi is involved in one of the most prevalent infectious diseases of South East Asia, typhoid fever, but diagnostic tests cannot be performed regularly in developing countries. The objective of the study is to determine the association of eosinopenia with culture or serology-proven typhoid fever in patients, to determine the association of leukopenia with culture or serology-proven typhoid fever in patients and to determine independent predictors of eosinopenia.MethodsThis case-control study, done at Fauji Foundation Hospital, Pakistan, included patients with symptoms suggestive of typhoid fever, culture, or serology positive for typhoid fever and excluded patients who had been previously diagnosed with malaria and dengue hemorrhagic fever. After flagging cultures and serology, the records were viewed for leukocyte counts. Data, including age, gender, and clinical symptoms, were also recorded for analysis.ResultsOut of 200 participants, 59 participants with diagnosed typhoid fever had eosinopenia. There were 29 participants who had been diagnosed with typhoid fever via culture or serology and had leukopenia. Eosinopenia and leukopenia were more likely to be present in patients with a diagnosis of typhoid (OR: 9.60, 20.00). The independent predictors for eosinopenia were DOT enzyme immunoassay (DOT EIA) positive for Salmonella typhi, culture positive for Salmonella typhi and leukopenia (p<0.05).ConclusionThe presence of eosinopenia and features or serology suggestive of typhoid would most likely be associated with cultures being positive and, therefore, might provide an efficient means to begin treatment.

Background: The global incidence of dengue has grown dramatically in recent decade. Half of world’s population is now at risk. India represents significantly a larger burden, accounting for nearly 34% of the global burden of dengue infection. Dengue infection needs to be addressed as a single disease with different clinical presentations ranging from asymptomatic conditions to severe clinical courses that may lead to high morbidity and mortality.Method: This was retrospective observational study carried out during period of July 2017 to April 2018, to study clinical profile and laboratory parameters in dengue fever patients. Confirmed dengue cases having NS1 positive or IgM positive or having both NS1 and IgM positive or dengue ELISA reactive, having minimum one CBC reports done and not having other confounding factor such as co-infection, bone marrow diseases etc. that may altered clinical and laboratory results are included in study. Statistical analysis was done by SPSS software version 18.0.Results: Out of 48 confirmed dengue cases maximum patients 58.33% was from young age group (21 to 40 years) with M:F ratio was 2.43:1. Fever was found in 100% patients, in order of frequency followed by headache, bodyache, abdominal pain, weakness, retro-orbital pain, anorexia, dry cough, back pain, nausea, diarrhoea, vomiting, rash, joint pain, itching and malena.NS1was positive in 41.67% cases, dengue ELISA in 31.25%, IgM was positive in 20.83% cases, and both NS1 and IgM positive were in 4.17% cases. TLC count was low 35.42%, high in 12.50% of cases and remaining had normal TLC count. Platelet count was ranged between normal platelet counts to thrombocytopenia. One case had platelet count less than 20000. Out of 48 patients, 2 (4.17%) had malena.Conclusion: In this study, fever was found in all patients, and headache, body ache and weakness were common symptoms, but significant number of patients also had gastroentstinal and respiratory symptoms like abdominal pain, nausea, diarrhea, vomiting and dry cough. TLC count ranging from normal TLC, leukopenia to leucocytosis. Large number of patients had low platelet count that shows dengue fever had varied clinical presentation.