Dengue In Children Research Articles

PP144 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: SEVERE DENGUE IN CHILDREN, CASES REPORT

PP144 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: SEVERE DENGUE IN CHILDREN, CASES REPORT

Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study

IntroductionSevere multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management.MethodsMedical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital’s PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses.ResultsSeventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients.ConclusionAge, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.

Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia.

Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.

Dengue virus serotypes and related factors in children with dengue hemorrhagic fever in Southern Vietnam.

After the Coronavirus Disease 2019 pandemic, a high number of cases and severe dengue in children were reported in some provinces in the south of Vietnam. This study aimed to determine the distribution of dengue virus serotypes and their correlation with demographic factors, disease severity, clinical manifestations, and laboratory findings. This study employed a cross-sectional design. Ninety-six dengue-infected children admitted to Can Tho Children's Hospital between October 2022 and March 2023 were included. Confirmation of dengue infection was achieved through the real-time polymerase chain reaction (RT-PCR). Among the identified serotypes, DENV-2 accounted for the highest proportion (71.87%), followed by DENV-1 (23.96%), and DENV-4 (4.17%). DENV-3 was not detected. No significant demographic, disease severity, or laboratory differences were observed among the identified dengue serotypes. However, DENV-2 was associated with a higher occurrence of mucous membrane hemorrhages and gastrointestinal bleeding compared to other serotypes. Although DENV-2 was the most prevalent serotype responsible for dengue in children in southern Vietnam, it did not lead to more severe cases compared to other serotypes. This finding is crucial for evaluating the illness's prognosis.

The Value of Warning Signs From the WHO 2009 Dengue Classification in Detecting Severe Dengue in Children.

World Health Organization proposed 7 warning signs to identify the risk of severe dengue in 2009. This study aimed to evaluate the value of these warning signs in detecting severe dengue in children. A cross-sectional study was conducted utilizing data of children with clinical dengue infection obtained from medical records between January 2009 and December 2018 in Jakarta. Children with confirmed dengue were analyzed and stratified into 3 age groups: infants less than 1 year old, children 1-14 years and adolescents 15-18 years of age. Positive predictive value, negative predictive value (NPV), sensitivity and specificity of each warning sign present or absent on admission in detecting severe dengue were computed. Six hundred ninety-nine children with clinical dengue infection were enrolled, among whom 614 (87.8%) had confirmed dengue infection, either by antigen or antibody serological tests. Severe dengue occurred in 211/614 (34.4%) cases. In infants, important warning signs on admission to detect or exclude severe dengue were liver enlargement (NPV 80.8%) and clinical fluid accumulation (NPV 75%). In children and adolescents, warning sign with highest NPV (in children 76.6% and in adolescents 91.9%) was increase in hematocrit concurrent with a rapid decrease in platelet count. Other warning signs with high NPV values in children were abdominal pain (72%), vomiting (70%), clinical fluid accumulation (69.3%), and in adolescents' abdominal pain (80.7%), vomiting (75.7%), clinical fluid accumulation (82.7%). NPVs increase with more than 1 warning sign in all age groups. In infants, liver enlargement or clinical fluid accumulation are important warning signs for severe dengue, when both are absent, severe dengue is unlikely. In older children and adolescents, an increase in hematocrit with the concurrent rapid decrease in platelet count is most discriminative; followed by the absence of abdominal pain, vomiting or fluid accumulation are unlikely severe dengue.

The study of clinical profile of severe dengue in children

Background: Dengue fever is one of the most important vectors borne viral diseases, causing the significant burden due to high admissions and mortality in southern parts of India. Early detection and early intervention of sickness can reduce this burden for which we should know the clinical features and other parameter in dengue so that mortality rate can be reduced. Methods: It was a retrospective single center study which included patients admitted to department of pediatrics from a period of October 2022 to November 2023. A total of 30 cases of severe dengue admitted in a span of 6 months. A detailed clinical and laboratory data was recorded in a questionnaire format which was analyzed using statistical tool. Results: Among 30 cases of severe dengue the most common clinical feature was shock (53%), hepatitis (36%), clinical fluid accumulation (33%), mucosal bleeding (26%) and ARDS (165). Severe dengue was frequently found in the range of white cell count 1000-4000/ul and platelet count 12000-50000/ul. Conclusions: The key to the management of severe dengue illness lies in the in-depth knowledge of clinical manifestation among children. Thus, it is important to be aware of warning signs and varied presentations of severe dengue so that there will be accurate management of in resource limited setups.

Effect of single-dose, live, attenuated dengue vaccine in children with or without previous dengue on risk of subsequent, virologically confirmed dengue in Cebu, the Philippines: a longitudinal, prospective, population-based cohort study

A three-dose dengue vaccine (CYD-TDV) was licensed for use in children aged 9 years and older starting in 2015 in several dengue-endemic countries. In 2016, the Philippine Department of Health implemented a dengue vaccination programme, which was discontinued because of safety concerns. We assessed the relative risk of developing virologically confirmed dengue among children who did or did not receive a single dose of CYD-TDV by previous dengue virus (DENV) infections at baseline classified as none, one, and two or more infections. In this longitudinal, prospective, population-based cohort study, we enrolled healthy children (aged 9-14 years) residing in Bogo or Balamban, Cebu, Philippines, between May 2, and June 2, 2017, before a mass dengue vaccination campaign, via the Rural Health Unit in Bogo and three Rural Health Units in Balamban. We collected demographic information and sera for baseline DENV serostatus and conducted active surveillance for acute febrile illness. Children who developed acute febrile illness were identified, clinical data were collected, and blood was drawn for confirmation of dengue by RT-PCR. The primary outcome was the relative risk of developing virologically confirmed dengue among children who received or did not receive a single dose of CYD-TDV by DENV serostatus at baseline. A single dose of CYD-TDV did not confer protection against virologically confirmed dengue in children who had none or one previous DENV infection at baseline. One dose conferred significant protection against hospital admission for virologically confirmed dengue among participants who had two or more previous DENV infections at baseline during the first 3 years (70%, 95% CI 20-88; p=0·017) and the entire follow-up period (67%, 19-87; p=0·016). The risk of developing virologically confirmed dengue after a single dose of CYD-TDV varied by baseline DENV serostatus. Since the study assessed the effect of only a single dose, the findings cannot inform decisions on vaccination by public health officers. However, the findings have implications for children who receive an incomplete vaccination regimen and these results should prompt more detailed analyses in future trials on dengue vaccines. The Philippine Department of Health, Hanako Foundation, WHO, Swedish International Development Cooperation Agency, International Vaccine Institute, University of North Carolina, and US National Institute of Allergy and Infectious Diseases.

Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas

BackgroundFever is a common symptom among travellers returning from tropical/subtropical areas to Europe, and promptly distinguishing severe illnesses from self-limiting febrile syndromes is important but can be challenging due to...

Clinical Profile of Paediatric Patients Admitted with Dengue Fever in a Tertiary Care Hospital of North India

Background: Dengue, a viral disease transmitted by mosquitoes, is the fastest spreading mosquito-borne illnessin human history, with its global incidence increasing 30-times over the past fifty years. This is a prospectivestudy with the aim to study clinical manifestation of dengue in children diagnosed admitted in a medical collegeHospital in Jammu, India.Methods: The study was conducted on 300 children admitted as dengue fever in a tertiary care hospital from October2022 to December 2022. Paediatric patients who were admitted with symptoms like fever, headache, myalgia,vomiting etc. were evaluated with other clinical features (warning signs of dengue fever, signs of haemorrhage,signs of plasma leakage and signs of shock) and the other causes of fever other than Dengue were rule out.Results: Sixty three percent (63.3%) of patients were adolescents (age &gt;10 Years) and most common symptom wasfever (83%) while as bleeding manifestations was seen in 9.3% and Dengue Shock Syndrome 7.7% patients.Conclusion: Study emphasizes that being the disease with panic, can be well managed to go beyond just a feverinto haemorrhage and shock by timely identification clinically and laboratory methods and followed by appropriateintervention.

Development and validation of a bedside dengue severity score for predicting severe dengue in children

Development and validation of a bedside dengue severity score for predicting severe dengue in children

The burden of dengue in children and risk factors of transmission in nine districts in Sri Lanka

AbstractWe sought to understand the differences in age‐stratified seroprevalence rates in different regions in Sri Lanka to plan dengue vaccination programs, especially as the WHO has given guidance to vaccinate in high transmission settings. Age stratified seroprevalence rates were assessed in children, aged 10−20 years, in nine districts representing the nine provinces in Sri Lanka, from September 2022 to March 2023. A stratified multistage cluster was used to select 146 schools representing each district. Of the 5207 children recruited, the overall dengue seroprevalence rates in children was 24.8%, with the highest rates reported from Trincomalee (54.3%) and the lowest rates from Badulla (14.2%), which is a high‐altitude estate area. While the age‐stratified seroprevalence rates increased in some districts such as Trincomalee, Jaffna, Gampaha, and Ratnapura, which reported the highest seropositivity rates, there was no such increase with age in the other districts. There was a weak correlation between the dengue antibody positivity rates and age in most districts which had seroprevalence rates of &gt;25%, while there was no increase in antibody titers with age in the other districts. The seroprevalence rates was significantly higher in urban areas (35.8%) compared to rural (23.2%) and estate areas (9.4%), although there was no association with seropositivity rates with population density (Spearman's r = −0.01, p = 0.98), in each district. The seroprevalence rates in many districts were very different to those reported from Colombo, with many districts reporting low transmission rates. These data would be important to consider when rolling out dengue vaccines in Sri Lanka.

Clinical Profile, Laboratory Findings and Outcome of Severe Dengue Infection among Children Admitted at a Tertiary Care Hospital in Bangladesh

Background: Dengue infection is endemic in Bangladesh and presents with varying degrees of severity of illness in children. Objective: The purpose of the present study was to assess the common clinical profile, biochemical findings and outcome of severe dengue fever in children. Methodology: This prospective cohot study was conducted on dengue NS1 or IgM or RT-PCR positive admitted children up to 14 years of age from April 2019 to October 2019 for a period of 6 months at the Pediatrics Department of Evercare Hospital, Dhaka. Data were analyzed after collection of demographic variables, presenting complaints and examination findings of 75 enrolled children. Results: A total of 75 cases were classified as severe dengue fever. The most common age of presentation was 4 to 7 years. The most common presenting symptom of severe dengue cases were fever (97.3%), abdominal pain and vomiting (77.3%) and shock (62.7%). Pleural effusion was the most common physical findings seen in 35 cases (46.6%) followed by ascites in 26 cases (34.7%). Elevation in aspartate amino transaminase AST (IU/L) was found in 82.6%, low albumin was found in 78.7% of the cases. Hypernatremia was the most common electrolyte abnormality found in 35 cases (46.7%). Regarding coagulation profile, raised D-dimer &amp; low fibrinogen were found in 53 (70.7%) &amp; 42 cases (56.0%) respectively. Activated partial thromboplastin time (aPTT) was prolonged in 37.3%. Case fatality rate (CFR) was 5.3%. Conclusion: In conclusion, raised AST and D-dimer, low fibrinogen &amp; albumin level as well as hyponatremia are significant laboratory findings indicating severity of the disease. Shock is a common presentation of severe dengue in children. Bangladesh Journal of Infectious Diseases, December 2022;9(2):40-46

Codetection of Plasmodium falciparum in Children Hospitalized With Dengue Fever in the Dominican Republic.

Cases of malaria and dengue in the Dominican Republic both spiked in 2019, but their rates of codetection are poorly characterized, especially in children. We performed a prospective, observational study in January to December 2019 at the Hospital Infantil Robert Reid Cabral, in the Dominican Republic, enrolling hospitalized children with a clinical suspicion of dengue fever. Participants with a positive plasma dengue IgM antibodies were included in this study. Clinical and hospital data were abstracted, and dried blood spot samples were collected from participants and tested with quantitative polymerase chain reaction to detect the presence of Plasmodium falciparum DNA. A total of 429 children with serological evidence of acute dengue were included in this study, of whom 1.4% (n = 6/429) had codetection of dengue and malaria. There were no significant differences in fever duration or presence of vomiting, abdominal pain and rash between both groups. Children with dengue and malaria codetection were numerically more often admitted to the pediatric intensive care unit, despite no differences found in overall clinical severity. The codetection of malaria and dengue in children was overall uncommon in our Dominican Republic cohort despite the rise in cases in 2019 but may be associated with a more severe hospital course. Further epidemiological and cohort studies to characterize the risk of both pathogens as case numbers fluctuate will be important to better understand the dynamics of coinfections.

Dengue Severity Score for Predicting Severe Dengue in Children: Need to Validate in Different Settings

Dengue Severity Score for Predicting Severe Dengue in Children: Need to Validate in Different Settings

Liver immunopathogenesis in fatal cases of dengue in children: detection of viral antigen, cytokine profile and inflammatory mediators.

Dengue virus (DENV), the etiologic agent of dengue fever illness, represents a global public health concern, mainly in tropical and subtropical areas across the globe. It is well known that this acute viral disease can progress to severe hemorrhagic stages in some individuals, however, the immunopathogenic basis of the development of more severe forms by these patients is yet to be fully understood. In this context, we investigated and characterized the histopathological features as well as the cytokine profile and cell subpopulations present in liver tissues from three fatal cases of DENV in children. Hematoxylin and Eosin, Periodic Acid Schiff and Picro Sirius Red staining were utilized for the histopathological analysis. Immunohistochemistry assay was performed to characterize the inflammatory response and cell expression patterns. Vascular dysfunctions such as hemorrhage, vascular congestion and edema associated with a mononuclear infiltrate were observedin all three cases. Liver tissues exhibited increased presence of CD68+ and TCD8+ cells as well as high expression of MMP-9, TNF-a, RANTES, VEGFR-2 mediators. Viral replication was confirmed by the detection of NS3 protein. Taken together, these results evidenced key factors that may be involved in the development of severe alterations in liver tissues of children in response to DENV infection.

Bedside Severity Prediction Score for Predicting Severe Dengue in Children: A Shot in the Arm for Triaging Dengue Positive Children?

Bedside Severity Prediction Score for Predicting Severe Dengue in Children: A Shot in the Arm for Triaging Dengue Positive Children?

Indirect IgG ELISA and serotype-specific neutralizing antibody titers are associated with protection against dengue in children in Cebu, Philippines

Abstract Standard measures of dengue virus (DENV) antibodies have not been established as protective against dengue. We assess whether an indirect dengue IgG ELISA (PanBio; Brisbane, QLD, Australia) and serotype-specific neutralizing antibody titers measured by a two-dilution focus reduction neutralization test (FRNT) are associated with protection against dengue. Healthy children (n = 1,214) aged 9–14 years in Cebu, Philippines were enrolled in a prospective population-based cohort study in May – June 2017 and were tested for dengue when they reported a febrile illness through March 2020. Serum samples were collected at enrollment, and all were tested by ELISA. FRNTs were performed using the WHO DENV1–4 reference strains on a random subset to quantify serotype-specific neutralizing antibodies (nAbs). Inverse probability weighting was used to adjust for subset size. The odds of dengue as predicted by antibody measures were assessed by logistic regressions and adjusted for age, gender, and residential site. Dengue naïve children were used as the reference group in all models. The probability of dengue was 9.2% (95% CI: 4.5 – 17.9) for the naïve group, 9.5% (4.8 – 17.8) for those with ELISA &amp;lt; 2, but 4.5% (2.8 – 7.2) for those with ELISA &amp;gt;= 2 (p=0.04). The probability was even lower at 1.4% (0.6 – 3.1) for those with the highest DENV1–4 geometric mean titers (GMT, p = 0.0001). Pre-vaccine nAbs to DENV2 and DENV3 were protective against a homotypic dengue case (DENV2: OR 0.28, 95% CI 0.12 to 0.65; DENV3: OR 0.27, 95% CI 0.13 to 0.57), but not heterotypic dengue. We show a commercial ELISA and serotype-specific nAbs are associated with the probability of dengue, providing useful assays for use in population and vaccine trials. This work was supported by the Philippine Department of Health, the Intramural Research Program of the National Institute of Allergy and Infectious Diseases (NIAID), and NIH Extramural Grant: P01AI106695.

CLINICAL CHARACTERISTICS OF SEVERE DENGUE IN CHILDREN DURING 2017 OUTBREAK

Objective: To study the clinical features of severe dengue in children during the 2017 outbreak, at the National Hospital for Tropical Diseases. &#x0D; Subjects and Methods: Retrospective study on all children diagnosed with severe dengue. &#x0D; Results: The proportion of children classified with severe dengue was 6.6% (49/742). Among the categories of severe dengue, severe plasma leakage (shock or fluid accumulation with respiratory distress) was 42.9% (21/49), severe organ impairment 30.6% (15/49) and severe bleeding 26.5% (13/49). Ratio of men/women = 1.04/1, with background disease 4.1%. The age group &gt; 12 ÷ ≤18 years accounts for the highest proportion (63.3%), followed by &gt; 5 ÷ ≤ 12 years (32.7%) and the age from 13 to 60 months (4.1%). The most common clinical manifestations were hemorrhage (79.5%), fever &gt; 39oC (51%), nausea or vomiting (48.9%) and abdominal pain (44.9%). Hematocrit &gt; 0.42 l/l (71.4%); platelet &lt; 50G/l (77.5%), the rate of AST ≥ 1000U/l was 12.2%, ALT ≥ 1000U/l was 8.2%, acute renal failure 18.3%. Two deaths were associated with shock and severe organ impairment. &#x0D; Conclusion: In the 2017 outbreak, in children with severe dengue, there were 3 clinical manifestations (severe plasma leakage, severe organ impairment, severe bleeding). The rate of severe organ impairment is more common than in previous outbreaks. Shock patients present with severe organ failure and vice versa. Further studies are needed to evaluate severe organ impairment in children.

Evaluating the importance of clinical manifestations and laboratory parameters associated with progression to severe dengue in children

Background The ability to predict the progression to severe dengue is crucial in managing patients with dengue fever. Severe dengue is defined by one or more of the following signs: severe plasma leakage, severe bleeding, or severe organ involvement as it can be a life-threatening condition if left untreated.&#x0D; Objective To identify clinical manifestations and laboratory parameters associated with dengue hemorrhagic fever disease progression in children by systematic review and meta-analysis.&#x0D; Methods We searched six medical databases for studies published from Jan 1, 2000, to Dec 31, 2020. The meta-analysis used random-effects or fixed-effects models to estimate pooled effect sizes. We assessed heterogeneity using Cochrane Q and I2 statistics, publication bias by Egger’s test and LFK index (Doi plot), and categorized subgroup analysis by country. This study was registered with PROSPERO, CRD42021224439.&#x0D; Results We included 49 papers in the systematic review, and we encased the final selected 39 papers comprising 23 potential predictors in the meta-analyses. The other 10 papers were not included because the raw data could not be calculated for the effect measure in the meta-analysis. Among 23 factors studied, seven clinical manifestations demonstrated association with disease progression in children, including neurological signs, gastrointestinal bleeding, clinical fluid accumulation, hepatomegaly, vomiting, abdominal pain, and petechiae. Six laboratory parameters were associated during the early days of illness, including elevated hematocrit, aspartate aminotransferase [AST], and alanine aminotransferase [ALT], low platelet count, low albumin levels, and elevated activated partial thromboplastin time. Dengue virus serotype 2 (DENV-2) and secondary infections were also associated with severe disease progression.&#x0D; Conclusion This review supports the use of the warning signs described in the 2009 WHO guidelines. In addition, monitoring serum albumin, AST/ALT levels, identifying infecting dengue serotypes, and immunological status can improve the prediction of further risk of disease progression.

INVESTIGATING THE HEMATOLOGICAL PARAMETERS IN CHILDREN WITH DENGUE HEMORRHAGIC FEVER NEWLY HOSPITALIZED AT TRA VINH OBSTETRICS AND PEDIATRICS HOSPITAL, VIETNAM

The study described several hematological parameters in children with Dengue hemorrhagic fever newly hospitalized at Tra Vinh Obstetrics and Pediatrics Hospital in 2022. The retrospective study investigated 400 selected children. The results showed that children with severe Dengue hemorrhagic fever accounted for 5.5\%. For epidemiological characteristics, within the population of children with the disease, 43.75\% were aged 10 to 16 years old, the male/female ratio was 1.18/1, the majority were Kinh ethnic group (77.5\%) and lived in rural areas (71.8\%). For characteristics of hematological indicators, platelets and white blood cells decreased, PT \% decreased, and APTT prolonged. The factors, including age group, the decrease in platelet counts, the increase in hematocrit, and the increase in APTT time, are associated with the incidence of severe dengue in children. The study results contribute to identifying a group of patients at risk of severe dengue in the first test after being hospitalized, which helps doctors closely monitor and detect early serious complications for timely treatment.