Severe 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.

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.

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

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

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

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?

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.

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

Mapping Dengue in children in a Colombian Caribbean Region: clinical and epidemiological analysis of more than 3500 cases.

Dengue continues to be a global public health problem due to its impact in terms of morbidity and mortality and economic burden on health systems, with severe effects mainly on children. Among the objectives of sustainable development is the control of infectious diseases; therefore, it is necessary to evaluate the impact of existing programs on the prevention and management of infectious diseases. The aim of this study was to analyze the epidemiological, clinical, and geospatial behavior of dengue in children in a region of the Colombian Caribbean. A retrospective cross-sectional study was carried out. The data provided by the Municipal Health Secretariat were taken and the cases of dengue and severe dengue in children aged 0 to 17 years reported in Sincelejo, Colombia, were extracted. The sociodemographic and clinical characteristics presented were analyzed and descriptive statistics were performed with tables and graphs of frequency and accumulated percentages. To locate the areas with the highest incidence of cases during the year, a geospatial location of the cases was carried out with the QGIS v.3.8 program. In 2019, there were 3611 cases of dengue fever in children aged 0 to 17 years. There were 1394 (38.6%) cases with warning signs, and 41 (1.1%) cases of severe dengue fever. Cases of severe dengue fever occurred more frequently in women. The incidence rate found was 3927 and 45.1 cases per 100,000 population, for dengue and severe dengue in children, respectively. The age ranges with the highest number of cases were children aged 4 to 9 years with 1778 cases. The clinical presentation was varied, with the most frequent symptoms, in all groups, being fever in 100% of cases, myalgias ≥71%, and arthralgias ≥64%. Only 9% (n=315) of the cases, corresponded to cases in the rural area. A very high incidence of cases of dengue and dengue with alarm signs in children was evidenced in the Colombian Caribbean region, mainly in the urban area, despite the existence of public health programs and strategies to control the burden of diseases transmitted by arbovirus vectors.

Efficacy of Dengue Vaccines in the Prevention of Severe Dengue in Children: A Systematic Review.

Dengue is a vector-borne disease caused by the dengue virus (DENV) and is a major health concern worldwide, particularly in regions of endemic disease. Dengue usually presents as a self-limited febrile illness. In some cases, more severe forms with hemorrhage and shock can occur, and children are especially prone to develop it. These forms can be lethal without appropriate management, and no antiviral treatment exists today. In the absence of a curative treatment for dengue, its clinical prevention remains essential. One vaccine - the chimeric yellow fever-dengue-tetravalent dengue vaccine (CYD-TDV) - has been approved for use in some populations, and several others are currently in development, including Takeda's tetravalent dengue vaccine candidate (TAK-003).This study is a systematic review of the current literature realized to evaluate the efficacy of the dengue vaccines in preventing severe dengue in children. This review focuses on the vaccines CYD-TDV and TAK-003. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, and Google Scholar were the databases used to find the relevant data. The articles were selected using specific inclusion and exclusion criteria, and quality appraisal was realized with standardized quality assessment tools. Overall, our study shows that the dengue vaccines CYD-TDV and TAK-003 confer protection against severe dengue in children. Some distinctions exist depending on the vaccine type, the age, and the dengue serostatus of patients. While demonstrating encouraging results, this review also emphasizes the need for more in-depth studies about the safety and efficacy of dengue vaccines.

Gallbladder Wall Thickness to Predict Severe Dengue in Children

Introduction: Significant increase in plasma leakage is characteristic of severe dengue. This results in collection of fluid in serous cavities. Gall bladder wall thickening (GBWT) often precedes the development of pleural effusion and ascites. Early detection of plasma leakage and management is shown to reduce mortality in dengue illness. Ultrasonography is a point of care investigation to identify GBWT. The aim of this study was to determine the cut-off value of GBWT to predict severe dengue in the early phase of the illness. Methods: This was a prospective study done on 310 children with dengue illness. Abdomen and chest ultrasound was done in all these children between third and sixth day of illness. GBWT of more than 3.5 mm was taken as a thickened gall bladder wall. Maximum severity of the illness was considered for categorising the severity of dengue. Results: Out of 310 children, 160 (51.6%) were categorized as dengue fever, 91 (29.4%) as dengue with warning signs and 59 (19%) as severe dengue. The incidence of thickened gall bladder wall was 27.5% in DF (Dengue fever), 68% in DF with warning signs and 96.6% in severe dengue. The odds of finding thickened gall bladder wall in severe dengue are 3.5 times that of dengue fever. GBWT increases as the severity of the illness increases. GBWT of 5 mm has sensitivity of 93.7% and specificity of 70% to predict progress to severe dengue. There was a fair correlation of 46% between thickened gall bladder wall and thrombocytopenia. Gall bladder wall thickness of 2.5 mm had sensitivity of 86.3% and specificity of 80% for ascites. GBWT of 3.5 mm had a sensitivity of 77.6% and specificity of 85% for pleural effusion. Conclusions: GBWT assessment by ultrasonography in early phase of illness can be used as a point of care modality to predict severe dengue. The sensitivity and specificity to predict the progression to severe dengue is 93.7% &amp; 70% respectively for the cut-off value of five mm of GBWT.

IL1B rs1143634 (+3953) variant associated with severe dengue in Brazilian children

&lt;p class="abstract"&gt;Several variants involved in the expression of proteins related to immunopathological mechanisms have been associated with dengue, but few specifically related to severe dengue. In addition, children are a group with a high incidence and mortality rate due to dengue. Several immunopathological processes developed specifically in children affected with severe dengue partially explain this risk condition. This case-control retrospective study aimed to examine the association of variants in &lt;em&gt;CD209, NFKBIA, IL12B,&lt;/em&gt; and &lt;em&gt;IL1B &lt;/em&gt;genes with severe dengue. These genes encode proteins involved in one of the main pathways of the immune response against dengue virus infection. The study population included affected children and householding controls from Brazil. Genotyping was performed with Real-Time TaqMan assays, and the association analysis was performed with conditional logistic regressions. We found the &lt;em&gt;IL1B&lt;/em&gt; rs1143634 genotypes carrying the T allele to be associated with susceptibility to severe dengue in children. The lower circulating levels of IL-1β associated with carrying the T allele of the &lt;em&gt;IL1B&lt;/em&gt; rs1143634 suggest a role of this cytokine in the impairment of the immune response and plasma leakage, and, consequently, in the development of severe dengue.&lt;/p&gt;

Predictors of severe dengue amongst children as per the revised WHO classification.

World Health Organization (WHO) revised its guidelines for classification and management of dengue in 2009. This revised system was found out to have good sensitivity and negative predictive value but poor specificity as well as positive predictive value. This retrospective study was carried out in a tertiary care hospital of Delhi, India to assess factors predicting the occurrence of severe dengue in children as per the revised classification. A total of 647 suspected dengue cases were admitted in the hospital in the year 2015. Detailed clinical and epidemiological data of 170 patients who were confirmed as dengue either by NS1 antigen test or by serology (Ig M positive) were recorded and statistically analyzed. The number of laboratory-confirmed cases was 170 and included thirty (17.65%) dengue fever (DF), 106 (62.35%) dengue with warning signs (DWS) and 34 (20.0%) severe dengue (SD) patients. Regression analysis revealed that presence of vomiting, altered sensorium, shock, peri-orbital edema, hepatomegaly, splenomegaly, severe anemia, thrombocytopenia, elevated urea and creatinine, decreased total protein and globulin were significantly associated with occurrence of severe disease. The addition of clinical features (peri-orbital edema and splenomegaly); and laboratory findings (elevated urea and creatinine, decreased serum protein and globulin) might help improve the sensitivity and specificity of the revised WHO dengue classification in predicting severe dengue.

Risk factors of severe dengue in children: A nested case-control study

Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferentiated fever to severe fatal form. The objectives of this study were to determine the prevalence and risk factors of severe dengue. Subjects and Methods: This nested case–control study was done in a medical college hospital in South India from October 2019 to January 2020. Children between 1 month and 12 years of age who presented with fever without focus and tested positive for dengue serology were included. Demographic data, anthropometry, clinical features, and laboratory parameters were noted down from all children. Severity of illness was classified according to the World Health Organization dengue guidelines 2009. Prevalence of severe dengue was expressed in proportion with 95% confidence interval (CI). Bivariate analysis was performed using Chi-square test, Fisher's test, and Student's t-test, and a P Results: Out of 370 children, 192 (51.9%) had dengue without warning signs, 168 (45.4%) had dengue with warning signs, and 10 had severe dengue. The prevalence (95% CI) of severe dengue was 2.7% (1.3%–4.9%). Abdominal pain/tenderness (odd's ratio [OR] - 7.429), facial puffiness (OR - 4.333), hepatomegaly (OR - 3.857), and pleural effusion (OR - 13.222) were the significant risk factors for severe dengue. Conclusions: The significant risk factors for severe dengue were abdominal pain/tenderness, facial puffiness, hepatomegaly, and pleural effusion.

Ferritin as a Marker of Severe Dengue in Children

Background: The aim is to evaluate ferritin levels in fever caused by dengue virus and their association with the severity of infection with dengue virus in children. Subjects and Methods: It is a Prospective that was done for 1 year in the department of pediatrics. 56 reported cases with a history of dengue fever for clinical evaluation by positive IgG and IgM antibodies and positive NS1 antigen and were included in the sample. All 16-year-old subjects with clinical dengue suspicion presenting in the department of emergency. Results: Out of total of 56 children with mean age of the children were 11.5 years and SD 3.5 years, and 59% were male who were majority. Mean hospital stay duration was 5 3 days. Most of the patients in study discharged in 5-7 days of admission in hospital. The mean serum ferritin levels among cases with DHF were raised than those with DF with significant p-values of&lt; 0.05 on Day 5 and 6 of illness. During Days 5, 6, and 7 after the onset of fever, the results for sensitivity were 83, 86, and 92 per cent respectively. Conclusion: The incidence of hyperferritinaemia in patients infected with dengue virus is suggestive of highly active use of ferritin level in serum is 1,200 ng/ml as a method for predicting progression to DHF starting on Day 4 of the disease and continuing to recover.