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Gastrointestinal Manifestations and Prognostic Factors for Severe Dengue in Thai Children
Kittiya Setrkraising1, Chatporn Kittitrakul2
1Department of Pediatrics, Charoenkrung Pracharak Hospital, Bangkok, Thailand.
Insights
Gastrointestinal symptoms like anorexia and vomiting are common in children with dengue. Vomiting, ascites, and specific lab values predict severe dengue, requiring close monitoring in pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Dengue is a major public health concern in tropical regions, particularly affecting children aged 5-14 in Thailand.
- Gastrointestinal (GI) manifestations are frequently observed in dengue infections, potentially complicating diagnosis and management in pediatric populations.
Purpose of the Study:
- To determine the prevalence of GI symptoms in children diagnosed with dengue.
- To identify prognostic factors associated with severe dengue infection in pediatric patients.
Main Methods:
- Retrospective review of medical records for children (0-14 years) hospitalized with dengue infection from 2019-2022.
- Classification of dengue severity based on 2009 WHO guidelines.
- Logistic regression analysis to assess associations between clinical/laboratory data and severe dengue.
Main Results:
- Out of 556 dengue cases, 8.6% were severe. Common GI symptoms included anorexia (91.7%), vomiting (57.6%), and abdominal pain (38.3%).
- Vomiting, ascites, AST >450 U/L, and low serum albumin (<3.5 g/dL) were significantly linked to severe dengue.
- Younger children (<5 years) showed fewer typical GI symptoms, posing diagnostic challenges.
Conclusions:
- GI manifestations are prevalent in pediatric dengue, with specific symptoms and lab findings indicating higher risk for severe disease.
- Close monitoring is crucial for children with dengue exhibiting vomiting, ascites, or abnormal liver enzymes and albumin levels to prevent severe outcomes.
Abstract:
Dengue infection poses a significant public health challenge in tropical countries. In Thailand, children ages 5-14 years are among the groups with the highest incidence of dengue. This study aimed to determine the prevalence of gastrointestinal (GI) manifestations in children with dengue infection and assess prognostic factors for severe dengue. We reviewed the medical records of children ages 0-14 years who were hospitalized with a diagnosis of dengue infection between 2019 and 2022 at Charoenkrung Pracharak Hospital in Bangkok, Thailand. Dengue severity was classified according to the 2009 WHO dengue guidelines. Clinical manifestations and laboratory data were analyzed for their association with severe dengue using a logistic regression model. The study included 556 dengue cases, with 48 cases (8.6%) classified as severe dengue. The mean age (SD) of patients was 9.9 (3.7) years. The most common GI symptoms were anorexia (91.7%) and vomiting (57.6%) followed by abdominal pain (38.3%), and diarrhea (33.3%). GI bleeding was found in 3.2% of patients. Hepatomegaly and ascites were found in 20.9% and 2.9% of patients, respectively. Acute liver failure and acalculous cholecystitis were found in 0.4% and 0.2% of patients, respectively. Children younger than 5 years of age exhibited a lower prevalence of vomiting and abdominal pain compared with older children, making the diagnosis of dengue more challenging. Vomiting, ascites, aspartate aminotransferase >450 U/L, and serum albumin <3.5 g/dL were significantly associated with severe dengue infection. Children with dengue infection presenting any of these factors should be closely monitored for severe dengue.
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