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

Dengue infection should be considered in the differential diagnosis of febrile neutropenia in endemic areas, even in the absence of warning signs. A retrospective audit was done on medical records of patients (age 14 y or younger) who were diagnosed with dengue fever from April 1, 2023 to March 31, 2024 in a tertiary care cancer center. Patients fulfilling the WHO 2009 criteria of dengue fever and confirmation with detection of either IgM or NS1 were included. Data regarding symptomatology, clinical course, laboratory values, and outcome were analyzed. Twenty-three patients were diagnosed with dengue. Primary malignancy was mainly B-ALL (n=16; 69%). Thirteen patients (56.6%) had criteria fulfilling dengue without warning signs, 5 (21.7%) had dengue with warning signs, and 5 (21.7%) had severe dengue. All patients were treated as inpatients with intravenous fluids and supportive care. Five patients (21.7%) with shock required IVF at 10 mL/kg/h. Two patients (8%) had blood culture positivity and were managed based on the susceptibility pattern. Median delay in chemotherapy was 6 days. The mean duration of hospital stay was 7 days. Three patients (13%) had features of HLH. One patient succumbed to multiorgan failure (with HLH and MDR Klebsiella sepsis).