Correlation of Laboratory Profile and Clinical Features in Dengue Viral Illness in the Pediatric Population: A Retrospective Analysis
Keyur D Mahajan, Rajan Joshi
Keywords :
Clinical features in pediatric dengue, Dengue fever, Laboratory profile in pediatric dengue, Serum ferritin in dengue
Citation Information :
Mahajan KD, Joshi R. Correlation of Laboratory Profile and Clinical Features in Dengue Viral Illness in the Pediatric Population: A Retrospective Analysis. Pediatr Inf Dis 2023; 5 (3):71-78.
Objective: To study the correlation between laboratory profile and clinical features in dengue viral illness in the pediatric population.
Materials and methods: A retrospective study was conducted on pediatric patients, ranging from 0 to 16 years old, diagnosed with dengue viral illness and admitted to the pediatric care unit between January and December of 2022. The outcome of interest measured was the correlation between laboratory profile and clinical features of dengue patients. Depending on data distribution, appropriate tests were applied for analysis. Data were collected from hospital software records according to the set pro forma. The medical notes and the Laboratory Information System were evaluated using a tool for standard assessment.
Conclusion: The presentation of dengue viral illness can vary, and it is crucial to diagnose it early for effective patient management. Upon admission, common clinical presentations include fever, nausea, vomiting, abdominal pain, body ache, leg pains, and retro-orbital pain. However, there was no association between presenting complaints and progression to severe illness. Although all five patients who died from the disease were females, it is inconclusive if sex is a significant risk factor for severe disease. Likewise, the patient's age has no association with the progression to severe disease. Platelet count, serum (Sr) albumin, Sr glutamic-oxaloacetic transaminase (SGOT)/Sr glutamic pyruvic transaminase (SGPT), prothrombin time (PT) international normalized ratio (INR), and Sr ferritin levels are all excellent predictors of prognosis for severe dengue. Peak Sr ferritin levels indicating the highest immune response were seen on day 5 of illness and were not affected by the age or sex of the patient.
Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature 2013;496(7446):504–507. DOI: 10.1038/nature12060
Brady OJ, Gething PW, Bhatt S, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 2012;6(8):e1760. DOI: 10.1371/journal.pntd.0001760
Khan S, Akbar SMF, Yahiro T, et al. Dengue infections during COVID-19 period: reflection of reality or elusive data due to effect of pandemic. Int J Environ Res Public Health 2022;19(17): DOI: 10.3390/ijerph191710768
WHO Dengue Guidelines. In: Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition. Geneva2009.
Sangkaew S, Ming D, Boonyasiri A, et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. Lancet Infect Dis 2021;21(7):1014–1026. DOI: 10.1016/S1473-3099(20)30601-0
Srisuphanunt M, Puttaruk P, Kooltheat N, et al. Prognostic indicators for the early prediction of severe dengue infection: a retrospective study in a university hospital in Thailand. Trop Med Infect Dis 2022;7(8): DOI: 10.3390/tropicalmed7080162
Petchiappan V HT, Thangavelu S. Can serum ferritin levels predict the severity of dengue early? an observational study. Int J Res Med Sci 2019;7(3):876–881. DOI: 10.18203/2320-6012.ijrms20190940
Murmu AR, Mubarak R. Correlation between serum ferritin level and severity of dengue fever in a tertiary care center: an observational study. Int J Res Med Sci 2021;9(6):1735–1740. DOI: 10.18203/2320-6012.ijrms20212244
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne. Diseases (DVBD). 2023. https://www.cdc.gov/dengue/index.html
Wang SM, Sekaran SD. Early diagnosis of dengue infection using a commercial dengue duo rapid test kit for the detection of NS1, IGM, and IGG. Am J Trop Med Hyg 2010;83(3):690–695. DOI: 10.4269/ajtmh.2010.10-0117
Ruchusatsawat K, Benjamungkalarak T, Phunikom N, et al. A performance comparison between fluorescent immunoassay and immunochromatography for rapid dengue detection in clinical specimens. Sci Rep 2022;12(1):17299. DOI: 10.1038/s41598-022-21581-x
Kurane I, Rothman AL, Livingston PG, et al. Immunopathologic mechanisms of dengue hemorrhagic fever and dengue shock syndrome. Arch Virol Suppl 1994;9:59–64. DOI: 10.1007/978-3-7091-9326-6_7
Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis 2006;19(5):429–436. DOI: 10.1097/01.qco.0000244047.31135.fa
Dejnirattisai W, Jumnainsong A, Onsirisakul N, et al. Cross-reacting antibodies enhance dengue virus infection in humans. Science 2010;328(5979):745–748. DOI: 10.1126/science.1185181
Halstead SB, O’Rourke EJ. Dengue viruses and mononuclear phagocytes. I. Infection enhancement by non-neutralizing antibody. J Exp Med 1977;146(1):201–217. DOI: 10.1084/jem.146.1.201
Vaughn DW, Green S, Kalayanarooj S, et al. Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity. J Infect Dis 2000;181(1):2–9. DOI: 10.1086/315215
Libraty DH, Endy TP, Houng HS, et al. Differing influences of virus burden and immune activation on disease severity in secondary dengue-3 virus infections. J Infect Dis 2002;185(9):1213–1221. DOI: 10.1086/340365
Rigau-Pérez JG, Clark GG, Gubler DJ, et al. Dengue and dengue haemorrhagic fever. Lancet 1998;352(9132):971–977. DOI: 10.1016/s0140-6736(97)12483-7
Kalayanarooj S, Vaughn DW, Nimmannitya S, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 1997;176(2):313–321. DOI: 10.1086/514047
Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, et al. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J 2007;26(4):283–292. DOI: 10.1097/01.inf.0000258612.26743.10
Yip W. Dengue hemorrhageic fever: current approaches to management. Med Prog 1980.
Lanciotti RS, Calisher CH, Gubler DJ, et al. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 1992;30(3):545–551. DOI: 10.1128/jcm.30.3.545-551.1992
Young PR, Hilditch PA, Bletchly C, et al. An antigen capture enzyme-linked immunosorbent assay reveals high levels of the dengue virus protein NS1 in the sera of infected patients. J Clin Microbiol 2000;38(3):1053–1057. DOI: 10.1128/jcm.38.3.1053-1057.2000
Pothapregada S, Kamalakannan B, Thulasingham M, et al. Clinically profiling pediatric patients with dengue. J Glob Infect Dis 2016;8(3):115–120. DOI: 10.4103/0974-777x.188596
Anders KL, Nguyet NM, Chau NV, et al. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg 2011;84(1):127–134. DOI: 10.4269/ajtmh.2011.10-0476
Tantracheewathorn T, Tantracheewathorn S. Risk factors of dengue shock syndrome in children. J Med Assoc Thai. 2007;90(2):272–277.
Sekhar MC. Ferritin as a marker of severe dengue in children. Asian J Clin Pediatr Neonat 2020;8(3):7–11. DOI: 10.47009/ajcpn.2020.8.3.2
Chaiyaratana W, Chuansumrit A, Atamasirikul K, et al. Serum ferritin levels in children with dengue infection. Southeast Asian J Trop Med Public Health 2008;39(5):832–836.
Soundravally R, Agieshkumar B, Daisy M, et al. Ferritin levels predict severe dengue. Infection 2015;43(1):13–19. DOI: 10.1007/s15010-014-0683-4
Tien SM, Chang PC, Lai YC, et al. Therapeutic efficacy of humanized monoclonal antibodies targeting dengue virus nonstructural protein 1 in the mouse model. PLoS Pathog 2022;18(4):e1010469. DOI: 10.1371/journal.ppat.1010469
Wan SW, Chen PW, Chen CY, et al. Therapeutic effects of monoclonal antibody against dengue virus NS1 in a STAT1 knockout mouse model of dengue infection. J Immunol 2017;199(8):2834–2844. DOI: 10.4049/jimmunol.1601523
Kumar S, Sharma S, Bhardwaj N, et al. Advanced lyophilised loop mediated isothermal amplification (L-LAMP) based point of care technique for the detection of dengue virus. J Virol Methods 2021;293:114168. DOI: 10.1016/j.jviromet.2021.114168
Pirich CL, de Freitas RA, Torresi RM, et al. Piezoelectric immunochip coated with thin films of bacterial cellulose nanocrystals for dengue detection. Biosens Bioelectron 2017;92:47–53. DOI: 10.1016/j.bios.2017.01.068
Halstead S. Recent advances in understanding dengue. F1000Res 2019;8: DOI: 10.12688/f1000research.19197.1
Noble CG, Chen YL, Dong H, et al. Strategies for development of dengue virus inhibitors. Antiviral Res 2010;85(3):450–462. DOI: 10.1016/j.antiviral.2009.12.011
Crunkhorn S. Adenosine analogue blocks dengue infection. Nat Rev Drug Discov 2010;9(1):21. DOI: 10.1038/nrd3081
Reddy M, Sahai K, Malik A, et al. Comparative analysis of rapid dengue testing and ELISA for NS1 antigen and IgM in acute dengue infection. Int J Curr Microbiol App Sci 2016;5(10):931–937. DOI: 10.20546/ijcmas.2016.510.100