Facial puffiness a significant risk factor for severe dengue infection in children: Study

Dengue fever-a mosquito borne viral fever, has a varied presentation ranging from subclinical disease to severe life-threatening illness. The World Health Organization (WHO) 2012 guidelines of dengue classify the illness as dengue without warning signs, dengue with warning signs, and severe dengue.

Researches from Government Medical College,Chennai have studied the prevalence of severe dengue in a tertiary care institution, and to identify the risk factors for severe dengue in children.

In this nested case control study children aged 1 month to 12 years who had fever without focus and positive dengue serology were included in the study. Children who were discharged before clinical recovery and those with coinfections were excluded. Subsequently, patients were grouped into three categories – those with dengue without warning signs, dengue with warning signs, and severe dengue as per the WHO dengue guidelines. . The primary outcome was presence or absence of severe dengue, and the secondary outcome was risk factors for severe dengue.

Key findings of the study are:

-Out of 370 patients with dengue, 192 (51.9%) patients had dengue without warning signs, 168 (45.4%) patients had dengue with warning signs, and 10 (2.7%)patients had severe dengue; all the patients with severe dengue presented with shock.

-117(31.7%) children had abdominal pain/tenderness, while 77 (20.8%) had persistent vomiting;a total of 38 (10.3%) children had hepatomegaly, 6 (1.6%) each had facial puffiness and petechiae, and 3 (0.8%) had mucosal bleed in the form of melena.

-Platelet count was normal in 65 (17.6%) children, while 62 (16.8%) had mild thrombocytopenia, and 243 (65.7%) had platelet count less than 1 lakh.

-Leucocyte count which is considered as a marker of severity; was decreased in 208 (56.2%) children, while 12 (3.2%) of them had leukocytosis.

-A total of 60 (16.2%) had raised hematocrit and 40 (10.8%) showed chest X-ray findings, suggestive of pleural effusion.

Authors conclude-"Abdominal pain/tenderness, facial puffiness, hepatomegaly, and pleural effusion are risk factors of severe dengue in children, and children with these findings require close monitoring in a high-dependency unit".

Source: Naaraayan SA, Sundar KC. Risk factors of severe dengue in children: A nested case-control study. J Pediatr Crit Care 2021;8:224-8