Clinical and Laboratory Abnormalities due to Dengue in Hospitalized Children in Mumbai in 2004

The clinical and laboratory parameters of dengue in children, along with predictive markers of dengue shock syndrome (DSS), were studied in Mumbai in 2003. In 2004, there was again a resurgence of dengue in Mumbai and a prospective study of children admitted in hospital was undertaken to determine the clinical and laboratory features of dengue, with specific features in order of severity of the disease, viz. dengue fever (DF), dengue haemorrhagic fever (DHF), dengue shock syndrome (DSS) and dengue hepatitis. A total of 69 suspected dengue cases were tested for dengue IgM capture ELISA, of which 34 patients tested positive. The common clinical and laboratory features seen were: fever, thrombocytopenia, elevated serum transaminases, elevated partial thromboplastin time (PTT), hypotension, vomiting, haemoconcentration, leukopenia and hepatomegaly. Patients with DSS had shorter duration of fever, leukopenia, significantly deranged PTT, elevated SGOT and longer recovery period. All patients with DSS required ionotropic support. Only one patient died due to refractory shock, with the case-fatality rate of DSS being 7.1%. Thus, we conclude that appropriate investigations, strict monitoring and prompt supportive management can reduce mortality in dengue. A watch for predictive markers of DSS, if promptly treated, can reduce the mortality.