A predictive model to differentiate dengue from other febrile illness
OBJECTIVE To study the clinicohematological profile and the platelet trends in children presenting with dengue infection during the 2010 dengue epidemic in north India and to compare the it with previous epidemics. METHODS This retrospective study was carried out in a tertiary care hospital of North India. Of the 219 children admitted from August 2010 through November 2010 with suspected dengue infection, 135 were IgM positive and were included in the final analysis. RESULTS These children were further categorized as dengue fever (8%), dengue hemorrhagic fever (51%) and dengue shock syndrome (42%). The mean age (± SD) of children were 8.3 ± 3.5 y with male: female ratio 1.32. Mean duration of fever (±SD) was 6.3 d ± 3.7 d. The clinical features included fever (100%), headache (63%), abdominal pain (71%), petechia (35.5%), rash (26.6%) and bleeding manifestations (48.8%). On examination, Hess test (33.3%), signs of fluid retention (23%), pallor (13.3%),signs of circulatory failure (43%), hepatomegaly (31.1%) and splenomegaly (27%) were positive. Laboratory investigations revealed mean (±SD) hemoglobin 11.5 g/dl (±1.7), hematocrit 36.1(±5.5), leucocyte count 7,551/mm(3) and platelet count 38,800 mm(3) on day of admission. A total of 92.6% of children had thrombocytopenia and 19.2% had abnormal leucocyte count. Deranged liver function tests were observed in 48 children. The mean (±SD) of hospitalization and platelet recovery were 4.2 ± 2.3 d and 3.6 ± 1.3 d respectively and did not vary according to disease category (P > 0.05). Bleeding manifestations were not related to platelet count (P > 0.05). There was no statistical difference in the demographic, clinical or laboratory observations according to disease category (P > 0.05). A total of 24 children had evidence of other co-infections and four had atypical complications. Dengue 2 virus was the strain reported in most of the cases. CONCLUSIONS This study showed shift to higher age of presentation, more number of dengue hemorrhagic fever and associated co-infections in children. The complications and mortality was low and platelet recovery time was not influenced by disease category.