Clinical Profile and Outcome in Children of Dengue Hemorrhagic Fever in North India

Objective: The number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases reported in India has risen in recent years. This study was undertaken to evaluate clinical profile and outcome of children admitted with DHF/dengue shock syndrome (DSS), in the 2006 DHF epidemic in Ludhiana, Punjab. Methods: Eighty one children with dengue hemorrhagic fever were hospitalized in the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, India. All patients were diagnosed, managed and monitored according to a standard protocol. Findings: Children between 10-15 years were most commonly afflicted (59%). Infants were the least affected sub-group (3.7%). Ninety two percent of all children were of DHF and 8% cases presented in DSS. The common symptoms seen were fever (91%), vomiting (41%), poor intake (21%), abdominal pain (16%) and significant bleeding (15%). Hepatomegaly was present in 60% of cases. 85% of cases had petechiae alone, 15% had evidence of significant bleeding manifestation. Gastrointestinal bleeding was the commonest observed bleeding. The complications seen were liver dysfunction (14.8%), coagulopathy (3.7%), renal dysfunction (3.7%), and acute respiratory distress syndrome (2.4%) and disseminated intravascular coagulation (1.2%). Mortality in the study was 3.7%. Refractory shock and coagulopathy were seen in all cases with poor outcome. Conclusion: Increased awareness, better transport facilities and case management according to the WHO guidelines, is needed to further reduce mortality of DHF/DSS cases.