Dengue haemorrhagic fever in children in the 1996 Delhi epidemic.
An epidemic of dengue haemorrhagic fever (DHF) occurred in Delhi in 1996. A total of 240 children between the age of 4 months to 13 years of either sex, admitted in one hospital, were evaluated. Two hundred and sixteen (90%) children were from Delhi. A clinical diagnosis of dengue fever (DF) was made in 25 (10%), dengue fever with unusual bleeding (DFB) in 22 (9%), DHF in 80 (33%) and dengue shock syndrome (DSS) in 113 (47%) of the children strictly according to the WHO classification. The age peaked at 8 years. There was no association between various grades of severity of illness and age-groups though girls suffered from more severe illness. No association between severity of malnutrition and severity of illness was observed. Tourniquet test was positive in 40% with DF, 18% with DFB, 62% with DHF and 64% with DSS. In DSS haematemesis was present in 55 (49%), epistaxis in 39 (35%), melaena in 27 (24%) and ecchymosis in 34 (30%) patients. Children diagnosed as DFB had haematemesis and epistaxis in 12 (55%) and 10 (45%) respectively. Intravenous fluid requirement was clearly less in DFB patients than in DHF/DSS patients. Unusual clinical features in the form of jaundice were present in 7 (6%), hepatic encephalopathy in 6 (5%) and dengue encephalopathy in 6 (5%) patients. Dengue 2 virus was isolated from 10 of the 50 patients for whom viral culture was done on C6/36 clone of Aedes albopictus cell line. Eighteen patients suffering from DSS died giving an overall case fatality of 7.5%. The mortality rate in DHF/DSS was 9.3%. It is further suggested that DFB is a distinct entity. Most patients could be classified by the WHO classification if a retrospective packed cell volume was used to assess haemoconcentration. We suggest that development of area-specific criteria for diagnosis and management is desirable.
Kabra
S K
SK
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. skkabra@medinst.ernet.in
Jain
Y
Y
Pandey
R M
RM
Madhulika
Singhal
T
T
Tripathi
P
P
Broor
S
S
Seth
P
P
Seth
V
V
D000914:Antibodies, Viral / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006400:Hematocrit; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D009752:Nutritional Status; D010976:Platelet Count; D019595:Severe Dengue / Q000097:blood / Q000453:epidemiology*
D000914:Antibodies, Viral; D007075:Immunoglobulin M