Vertical transmission of dengue-a case report.

Abstract

A 28-year-old primigravida, resident of Amritsar married for 3 years, was admitted to Sri Guru Ram Das Institute of Medical Sciences and Research Institute, Sri Amritsar, at 34 weeks of gestation with history of high grade fever (103 F) with rigors and chills for 7 days which was associated with severe body aches and weakness. On admission, her temperature was 102 F, pulse 110/min, respiratory 16/min, and BP was 110/70 mm of Hg. On examination, petechiae were present over both feet, and fundal height was 30 weeks. The complete blood count (CBC) revealed hemoglobin— 11.8 g/dl, hematocrit—33 %, platelet count—20,000/ml, and WBC—3,900/ml. Coagulation analysis revealed normal results. Widal test and malaria card test were negative. The diagnosis of dengue was confirmed when IgM and IgG antibodies specific to dengue virus were detected. Renal function, liver function test, and serum electrolytes showed normal values. On the second day of admission, biophysical profile score was recorded, and Color Doppler for fetal well being was done which showed mild oligohydramnios with BPP score 8/10 with normal Doppler studies. Two units of SDPC were transfused daily for 3 consecutive days, and platelet counts were 18,000, 23,000, and 30,000/ml on these days, respectively. On the third day of admission, the patient went into preterm labor and delivered vaginally with right mediolateral episiotomy a female baby weighing 2.5 kg with Apgar scores of 6 and 8 at 1 and 5 min, respectively. Inj vitamin K 1 mg was given as routine. Labor and postpartum period were uneventful in spite of thrombocytopenia. Mother was discharged on the 5th day with platelet count 1.5 lakh/ml. Baby was grunting and so she was admitted to NICU. Her initial CBC count showed hemoglobin—15.4 g/ml, hematocrit—43 %, WBC—24,600/ml, and platelet count— 54,000/ml. On the same day, baby developed petechiae, subconjunctival hemorrhage, and brownish aspirate from ryles tube. Serology for dengue was sent, and IgM for dengue was positive. Baby was treated with appropriate fluid management, antibiotics, and platelet-rich plasma. Petechiae gradually spread to trunk and extremities. After 4 days, baby developed boggy swelling over head. On day 10, baby developed generalized anasarca and hepatomegaly with blood urea—175 mg/dl, serum creatinine—2.0 mg/dl, serum Na—111 meq/l, serum K—2 meq/l, serum proteins—4.6 g/dl, and serum bilirubin—14.5 mg/dl. CBC Kaur G., Associate Professor Guljit Hospital, 24 C Rani Ka Bagh, Amritsar, Punjab, India