Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2021

Open Access 01-12-2021 | Research

Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh

Authors: Md. Abdullah Saeed Khan, Abdullah Al Mosabbir, Enayetur Raheem, Ahsan Ahmed, Rashawan Raziur Rouf, Mahmudul Hasan, Fawzia Bente Alam, Nahida Hannan, Sabrina Yesmin, Robed Amin, Nazmul Ahsan, Sayeeda Anwar, Syeda Afroza, Mohammad Sorowar Hossain

Published in: BMC Pediatrics | Issue 1/2021

Login to get access

Abstract

Background

The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019.

Methods

We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data.

Results

Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity.

Conclusions

Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.
Appendix
Available only for authorised users
Literature
1.
2.
Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, et al. The global burden of dengue: an analysis from the global burden of disease study 2013. Lancet Infect Dis. 2016;16(6):712–23.PubMedPubMedCentralCrossRef
3.
4.
Messina JP, Brady OJ, Golding N, Kraemer MUG, Wint GRW, Ray SE, et al. The current and future global distribution and population at risk of dengue. Nat Microbiol. 2019;4(9):1508–15.PubMedPubMedCentralCrossRef
5.
Ordoñez J, Russell PK, McCown JM, Buescher EL. Recovery of dengue viruses from patients during epidemics in Puerto Rico and East Pakistan. Am J Trop Med Hyg. 1966;15(4):573–9.PubMedCrossRef
6.
Karim MN, Munshi SU, Anwar N, Alam MS. Climatic factors influencing dengue cases in Dhaka city: a model for dengue prediction. Indian J Med Res. 2012;136(1):32–9.PubMedPubMedCentral
7.
Bin YE, Bangali AM, Mahmood MAH, Rahman MM, Chowdhury AR, Talukder KR. Dengue outbreak 2000 in Bangladesh: from speculation to reality and exercises. Dengue Bull. 2001;25:15–20.
8.
9.
Akram A. Alarming turn of dengue fever in Dhaka City in 2019. Bangladesh J Infect Dis. 2019;6(1):1–2.CrossRef
10.
11.
Pervin M, Tabassum S, Sil BK, Islam MN. Isolation and serotyping of dengue viruses by mosquito inoculation and cell culture technique: an experience in Bangladesh. Dengue Bull. 2003;27:81–90.
12.
Islam MA, Ahmed MU, Begum N, Chowdhury NA, Khan AH, Parquet C, et al. Molecular characterization and Clinical evaluation of dengue outbreak in 2002 in Bangladesh. Japanese J Infect Dis. 2006;59:85–91.
13.
Muraduzzaman AKM, Alam AN, Sultana S, Siddiqua M, Khan MH, Akram A, et al. Circulating dengue virus serotypes in Bangladesh from 2013 to 2016. Virus Dis. 2018;29(3):303–7.CrossRef
14.
15.
Titir SR, Paul SK, Ahmed S, Haque N, Nasreen SA, Hossain KS, et al. Nationwide distribution of dengue virus type 3 (Denv-3) genotype I and emergence of denv-3 genotype III during the 2019 outbreak in Bangladesh. Trop Med Infect Dis. 2021;6(2):58.PubMedPubMedCentralCrossRef
16.
Bhattacharya MK, Maitra S, Ganguly A, Bhattacharya A, Sinha A. Dengue: a growing menace -- a snapshot of recent facts, figures and remedies. Int J Biomed Sci. 2013;9(2):61–7.PubMedPubMedCentral
17.
Elling R, Henneke P, Hatz C, Hufnagel M. Dengue fever in children: where are we now? Pediatr Infect Dis J. 2013;32(9):1020–2.PubMedCrossRef
18.
19.
de Souza LJ, Bastos Pessanha L, Carvalho Mansur L. Assed de Souza L, Barbosa Tâmega Ribeiro M, do Vale da Silveira M, et al. comparison of clinical and laboratory characteristics between children and adults with dengue. Brazilian J Infect Dis. 2013;17(1):27–31.CrossRef
20.
Kittigul L, Pitakarnjanakul P, Sujirarat D, Siripanichgon K. The differences of clinical manifestations and laboratory findings in children and adults with dengue virus infection. J Clin Virol. 2007;39(2):76–81.PubMedCrossRef
21.
Wang CC, Lee IK, Su MC, Lin HI, Huang YC, Liu SF, et al. Differences in clinical and laboratory characteristics and disease severity between children and adults with dengue virus infection in Taiwan, 2002. Trans R Soc Trop Med Hyg. 2009;103(9):871–7.PubMedCrossRef
22.
23.
Wakimoto MD, Camacho LAB, Guaraldo L, Damasceno LS, Brasil P. Dengue in children: a systematic review of clinical and laboratory factors associated with severity. Expert Rev Anti-Infect Ther. 2015;13(12):1441–56.PubMedCrossRef
24.
25.
Ahmed FU, Mahmood CB, Das SJ, Hoque SM, Zaman R, Hasan MS. Dengue and dengue haemorrhagic fever in children during the 2000 outbreak in Chittagong, Bangladesh. Dengue Bull. 2001;25(2):33–9.
26.
Hoque S, Sarkar PK, Nawshad ASM, Ahmed U. Clinical profile and outcome of dengue in children admitted in pediatric intensive care unit in Dhaka shishu (children) hospital, Dhaka, Bangladesh. Int J Med Heal Res. 2019;5(12):97–101.
27.
Shultana K, Motiur Rahman AZM, Al Baki A, Shohidul Islam Khan M, Deb B, Chowdhury D, et al. Dengue Infection in Children: Clinical Profile and Outcome in Dhaka City. Am J Pediatr. 2019;5(3):111.CrossRef
28.
Afroze S, Shakur S, Wahab A, Shakur S. Clinical profile of dengue and predictors of its severity among children. Am J Pediatr. 2019;5(4):219–23.CrossRef
29.
30.
World Health Organization, Regional Office for South-East Asia. Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and expanded edition. New Delhi PP - New Delhi: WHO Regional Office for South-East Asia; 2011. Available from: https://​apps.​who.​int/​iris/​handle/​10665/​204894.
31.
Kadam DB, Salvi S, Chandanwale A. Expanded dengue. J Assoc Physicians India. 2016;64(July):59–63.PubMed
32.
Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Heal. 2007;12(9):1087–95.CrossRef
33.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.PubMedCrossRef
34.
Varatharaj A. Encephalitis in the clinical spectrum of dengue infection. Neurol India. 2010;58(4):585–91.PubMedCrossRef
35.
Ramabhatta S, Palaniappan S, Hanumantharayappa N, Begum SV. The Clinical and serological profile of pediatric dengue. Indian J Pediatr. 2017;84(12):897–901.PubMedCrossRef
36.
Adam AS, Pasaribu S, Wijaya H, Pasaribu AP. Warning sign as a predictor of dengue infection severity in children. Med J Indones. 2018;27(2):101–7.CrossRef
37.
Alvarado-Castro VM, Ramírez-Hernández E, Paredes-Solís S, Legorreta-Soberanis J, Saldaña-Herrera VG, Salas-Franco LS, et al. Clinical profile of dengue and predictive severity variables among children at a secondary care hospital of Chilpancingo, Guerrero, Mexico: case series. Boletín Médico Del Hosp Infant México (English Ed). 2016;73(4):237–42.
38.
Shah GS, Islam S, Das BK. Clinical and laboratory profile of dengue infection in children. Kathmandu Univ Med J (KUMJ). 2016;4(1):40–3.
39.
Anker M, Arima Y. Male-female differences in the number of reported incident dengue fever cases in six Asian countries. West Pacific Surveill response J. 2011;2(2):17–23.
40.
Masud S, Adams AM, Chowdhury M. Gender , socioeconomic development and health-seeking behaviour in Bangladesh. Soc Sci Med. 2000;51:361–71.CrossRef
41.
Mishra S, Ramanathan R, Agarwalla SK. Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India. Scientifica (Cairo). 2016;2016:1–6.
42.
Manna M. Access to Public Health Facilities in Bangladesh: A Study on Facility Utilisation and Burden of Treatment. Bangladesh Dev Stud. 2013;XXXVI(4):25–80.
43.
Karim S, Hoque M, Hoque E, Begum H, Rahman S, Shah T, et al. The distribution of ABO and Rhesus blood groups among blood donor attending transfusion medicine department of Dhaka Medical College Hospital in 2014. J Dhaka Med Coll. 2015;24(1):53–6.CrossRef
44.
Dipta TF, Iqbal MR, Hossain AZ, Rahman MT, Chowdhury S. Distribution of phenotypic and genotypic ABO and Rhesus blood groups among Bangladeshi population. Ibrahim Med Coll J. 2011;5(2):59–62.CrossRef
45.
Khode V, Ruikar K, Kabbin G. Association of ABO Rh blood group with dengue fever and dengue hemorrhagic fever: a case-control study. J Appl Hematol. 2013;4(4):145.CrossRef
46.
Ravichandran S, Ramya SR, Kanungo R. Association of ABO blood groups with dengue fever and its complications in a tertiary care hospital. J Lab Physicians. 2019;11(03):265–9.PubMedPubMedCentralCrossRef
47.
Kalayanarooj S, Gibbons RV, Vaughn D, Green S, Nisalak A, Jarman RG, et al. Blood group AB is associated with increased risk for severe dengue disease in secondary infections. J Infect Dis. 2007;195(7):1014–7.PubMedCrossRef
48.
Karunakaran A, Ilyas WM, Sheen SF, Jose NK, Nujum ZT. Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala. India J Infect Public Health. 2014;7(2):114–20.PubMedCrossRef
49.
Al Awaidy ST, Al Obeidani I, Bawikar S, Al Mahrouqi S, Al Busaidy SS, Al Baqlani S, et al. Dengue epidemiological trend in Oman: a 13-year national surveillance and strategic proposition of imported cases. Trop Dr. 2014;44(4):190–5.
50.
Yolanda N, Alfan H. Initial clinical and laboratory profiles to predict pediatric dengue infection severity. Paediatr Indones. 2017;57(6):303–9.CrossRef
51.
Chen C-H, Huang Y-C, Kuo K-C, Li C-C. Clinical features and dynamic ordinary laboratory tests differentiating dengue fever from other febrile illnesses in children. J Microbiol Immunol Infect. 2018;51(5):614–20.PubMedCrossRef
52.
Zhang H, Zhou YP, Peng HJ, Zhang XH, Zhou FY, Liu ZH, et al. Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis. Biomed Res Int. 2014;2014:104.
53.
Ahmed S, Arif F, Yahya Y, Rehman A, Abbas K, Ashraf S, et al. Dengue fever outbreak in Karachi 2006 - a study of profile and outcome of children under 15 years of age. J Pak Med Assoc. 2008;58(1):4–8.PubMed
54.
Sahana KS, Sujatha R. Clinical profile of dengue among children according to revised WHO classification: analysis of a 2012 outbreak from southern India. Indian J Pediatr. 2015;82(2):109–13.PubMedCrossRef
55.
56.
57.
Metadata
Title
Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
Authors
Md. Abdullah Saeed Khan
Abdullah Al Mosabbir
Enayetur Raheem
Ahsan Ahmed
Rashawan Raziur Rouf
Mahmudul Hasan
Fawzia Bente Alam
Nahida Hannan
Sabrina Yesmin
Robed Amin
Nazmul Ahsan
Sayeeda Anwar
Syeda Afroza
Mohammad Sorowar Hossain
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02947-y

Other articles of this Issue 1/2021

BMC Pediatrics 1/2021 Go to the issue

Research article

Etiologic distribution and clinical characteristics of pediatric diabetes in 276 children and adolescents with diabetes at a single academic center

Research article

Bone density, fractures and the associated factors in iranian children and adolescent with Osteogenesis Imperfecta

Research

Estimating the burden of pediatric HIV in an ‘A’ category district in India: an epidemiological study

Research article

Th cytokine profile in childhood-onset systemic lupus erythematosus

Study protocol

The facial nerve palsy and cortisone evaluation (FACE) study in children: protocol for a randomized, placebo-controlled, multicenter trial, in a Borrelia burgdorferi endemic area

Case report

Conjunctival granulomatous capillary haemangioma in children: case report and review of the literature