Dengue Infection in Pediatric Patients With Malignancies: A Single-center Retrospective Study

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Hematology

Background:

• Febrile neutropenia is a common complication in pediatric cancer patients.
• Dengue virus infection can present with non-specific symptoms, mimicking other febrile illnesses.
• Early and accurate diagnosis of dengue is crucial for appropriate management in immunocompromised children.

Purpose of the Study:

• To evaluate the clinical presentation and outcomes of dengue fever in pediatric cancer patients.
• To assess the role of dengue in the differential diagnosis of febrile neutropenia.
• To highlight the importance of considering dengue in endemic areas, irrespective of warning signs.

Main Methods:

• Retrospective audit of medical records of pediatric patients (age ≤14 years) diagnosed with dengue fever.
• Inclusion criteria: WHO 2009 dengue criteria and confirmation via IgM or NS1 detection.
• Analysis of symptomatology, clinical course, laboratory values, and patient outcomes.

Main Results:

• Twenty-three pediatric cancer patients were diagnosed with dengue; 69% had B-acute lymphoblastic leukemia (B-ALL).
• Over half (56.6%) presented with dengue without warning signs; 21.7% had dengue with warning signs, and 21.7% had severe dengue.
• Median delay in chemotherapy was 6 days; 13% developed hemophagocytic lymphohistiocytosis (HLH). One patient died from multiorgan failure.

Conclusions:

• Dengue should be considered in the differential diagnosis of febrile neutropenia in pediatric cancer patients in endemic areas.
• Prompt recognition and management of dengue are essential, even in the absence of classic dengue warning signs.
• Dengue infection can lead to severe complications like HLH and sepsis in this vulnerable population.