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Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome
Ira Shah1, G C Deshpande, P N Tardeja
1Department of Pediatrics, B. J. Wadia Hospital for Children, Parel, Mumbai, India. irashah86@hotmail.com
Insights
Dengue is rising in Mumbai, especially in children. Early detection of dengue shock syndrome (DSS) markers like younger age and altered sensorium can improve outcomes and reduce mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Dengue fever is a growing public health concern in Mumbai, particularly during the post-monsoon season.
- A rise in pediatric dengue cases necessitates understanding clinical features and outcomes.
Purpose of the Study:
- To identify clinical and laboratory features of dengue in children.
- To determine predictive markers for dengue shock syndrome (DSS).
- To analyze outcomes and mortality in pediatric dengue patients.
Main Methods:
- Prospective study of 51 suspected dengue cases in pediatric wards.
- Dengue IgM antibody testing via ELISA for diagnosis.
- Classification of patients into dengue fever (DF), dengue hemorrhagic fever (DHF), and DSS based on WHO criteria.
Main Results:
- 39 out of 51 cases tested positive for dengue IgM.
- Predominant features included fever, hepatomegaly, vomiting, bleeding, rash, thrombocytopenia, elevated liver enzymes, and coagulopathy.
- Predictive markers for DSS were younger age, altered sensorium, paralytic ileus, and deranged PT.
- DSS subgroup had a 16.6% case fatality rate; DF and DHF subgroups had no deaths.
Conclusions:
- Dengue endemicity is increasing in Mumbai, affecting children significantly.
- Prompt diagnosis, monitoring, and supportive care are crucial for reducing dengue mortality.
- Identifying DSS predictive markers allows for timely intervention and improved patient outcomes.
- Mosquito control and sanitation are essential for epidemic prevention.
Abstract:
An alarming rise of dengue has been seen in Mumbai during the post-monsoon season. We undertook this prospective study in the pediatric wards and pediatric intensive care unit of B. J. Wadia Hospital for Children between 27 August 2003 and 10 October 2003 to determine the clinical features, laboratory abnormalities, and outcome of children affected with dengue and to determine the predictive markers for dengue shock syndrome. Fifty-one suspected dengue cases were tested for positivity of dengue by determination of dengue IgM antibodies by ELISA test. These positive cases were analysed for common clinical features, laboratory derangements, and outcome. Patients were subdivided into three subgroups: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) as per WHO classification. Predictive markers for DSS were also determined. Thirty-nine patients had a positive dengue IgM titre, 20 patients had DHF, 18 patients had DSS, and one patient had DF The mean age of presentation was 4.9 years. Fever, hepatomegaly, vomiting, bleeding tendencies, erythematous rash, thrombocytopenia, elevated liver enzymes, and deranged PT and PTT were the predominant clinical and laboratory features. Predictive markers for DSS were younger age at onset, altered sensorium, paralytic ileus, and significantly deranged PT. Patients with DSS also had a longer recovery period and required more supportive management in the form of component therapy and ionotropic support. All three patients who died belonged to the DSS subgroup with case fatality rate for DSS being 16.6 per cent. None of the patients in the DHF or DF subgroup died. Endemicity of dengue fever is on the rise in Mumbai with increased incidence among children. Appropriate investigations, strict monitoring and prompt supportive management can reduce mortality in dengue. Predictive markers of DSS can reduce the mortality if promptly treated. Also prevention of transmission by mosquito control and maintaining water sanitation is required to effectively control this epidemic.
