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Published on: April 28, 2019
Dengue in children: a systematic review of clinical and laboratory factors associated with severity
Mayumi Duarte Wakimoto1, Luiz Antonio Bastos Camacho2, Lusiele Guaraldo1
1a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
Insights
Severe dengue in children poses significant risks. This review identified key clinical signs like hepatomegaly and laboratory markers such as thrombocytopenia, crucial for early detection and management of severe dengue.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Dengue fever is a serious viral illness with increased severity risk in pediatric populations.
- Effective management relies on early identification of critical indicators and prompt fluid therapy.
Purpose of the Study:
- To systematically review and consolidate clinical and laboratory parameters associated with severe dengue in children.
- To evaluate the utility of established warning signs in predicting severe dengue outcomes.
Main Methods:
- A comprehensive literature search was conducted, identifying 527 studies.
- 21 studies (3 cohort, 3 case-control, 14 cross-sectional) were selected for analysis.
- Geographical distribution: 18 studies from Asia, 3 from the Americas.
Main Results:
- Hepatomegaly, lethargy, abdominal pain, and bleeding were consistently identified as clinical indicators of severe dengue.
- Laboratory findings including hemoconcentration and thrombocytopenia were independently associated with disease severity.
- These parameters were frequently cited across multiple studies, confirming their significance.
Conclusions:
- The identified clinical and laboratory parameters, including warning signs from WHO 2009 Guidelines, are vital for assessing dengue severity in children.
- Early recognition of these indicators supports timely intervention and improves patient outcomes.
- The findings reinforce the value of the WHO 2009 classification system for managing severe dengue.
Abstract:
Dengue is a potentially life-threatening illness, and children are at higher risk of severity. This review aimed to systematize the identified clinical and laboratory parameters associated with severe dengue in children, as monitoring these signs and fluid-replacement therapy are actually the cornerstones of dengue treatment. Of the 527 studies initially reviewed, 21 were selected as follows: three cohort studies, three case-control studies, 14 cross-sectional studies and one not defined. Eighteen studies were carried out in Asia and three in the Americas. Hepatomegaly, lethargy, abdominal pain, bleeding, hemoconcentration and thrombocytopenia, all referenced as warning signs in the WHO 2009 Guidelines, were the clinical and laboratory parameters independently associated with severity in more than one study. The recognition of these known warning signs associated to severe dengue disease underlines the usefulness of the WHO 2009 classification.
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