Dengue fever in paediatric patient [Case Presentation ]
Creators: name: Soomro, Umar
Publisher: name: Zenodo
Year: 2020
Subjects: Dengue

description: <strong>Introduction</strong> A 9-month old infant was presented to the OPD on 18<sup>th</sup>-November 2019, with clinical manifestations of fever, vomiting and loose stools since a week. <strong>Clinical Presentation</strong> The fever was described as intermittent fever which used to aggravated during the evening hours and subside during the day time. The patient had non projectile vomiting and loose stools after which he was prescribed Flagyl and Zinc to alleviate the symptoms. The mother also complained of generalized rash over the body after 2 days of the onset of fever which resembled an allergic reaction. However, the rash subsided after 2 days. The child was then prescribed with Oral Zinc and IV fluids after which the intensity of fever, frequency of vomiting and loose stools improved. Whereas, the blood samples were sent on regular basis. On examination, the patient seemed to be lethargic, weak and irritable. On CNS examination, Glasgow Coma Scale (GCS) was 15/15, motor and sensory examination were unremarkable. On CVS examination, pulses were found to be weak, peripheries were cold and the patient had increased heart beats per minute, of around 150/bpm. S1 and S2 sounds were audible and Capillary Refill Time (CRT) was 2-3 seconds. On Respiratory examination, respiratory rate was 55 breaths per minute (bpm), vesicular breathing, with no additional sounds. The temperature was 99 degree Fahrenheit, with no signs of pallor, jaundice or cyanosis. However, CVS and Respiratory exam gave a clue of the patient being in compensatory shock. <strong>Investigations</strong> Lab investigations for Salmonella and Cholera reported no traces, Urine D/R was normal. A complete blood picture reported normal except for platelets, a decreased number of platelets (around 54 x10<sup>9</sup>) were reported. Our final diagnosis was Dengue fever, until it was confirmed by the Dengue NS-1 antigen test. <strong>Dengue</strong> Dengue fever is the most common vector borne diseases and is major health problem in the tropical and subtropical areas around the world.[i] Dengue fever also known as the “Break-bone fever” is an illness caused by an infection by a virus (Flavi virus) transmitted by the mosquito Aedes Aegypti or rarely Aedes Albopictus. Flaviridae is a family of viruses. Humans and other mammals serve as host natural hosts. They are primarily spread through arthropod vectors. The incubation period of dengue fever is about 3-14 days, it can result on infection with any of the four types of its stereotypes of Dengue Virus (DENV 1-4).[ii] Dengue illness is classified into Dengue fever, which is a febrile illness or to Dengue hemorrhagic fever/ Dengue shock syndrome.[iii] Dengue fever presents with complains of headaches, high grade fever, eye pain, vomiting, muscle/joints pain, positive tourniquet test and settles within 2 weeks of onset. Dengue hemorrhagic fever presents with similar symptoms of dengue in addition with spontaneous bleeding and small number of patients need hospital care. Whereas, in Dengue Shock Syndrome presentations are similar to dengue fever, characteristically rapid pulse, clammy cold skin, decreased blood pressure and a very small number of patient need ICU care. <strong>Life Cycle and Transmission</strong> The female mosquito lays around 100-120 eggs in the containers (above the water level), as many as 5 times during its lifetime. The eggs survive for up to 6 months and submerged in water, they hatch within 24 hours to become larva. After 6 days, they grow into Pupa (transformation stage between immature and mature stage) and further 2 days, into an adult mosquito. The mosquito bites the dengue infected person, it then ingests blood with the dengue virus and takes 8-10 days for the virus to incubate. Dengue infected person bites another person and that person gets dengue 4-13 later. <strong>Management</strong> There is no specific treatment for Dengue fever, however, we mostly follow the conservative therapy such as fluid intake to avoid dehydration from vomiting and fever. Acetaminophen can alleviate pain and reduce fever. Blood monitoring and blood transfusion in severe cases to replace the blood loss.[iv] <strong>Prevention</strong> Using of mosquito nets, spray and repellents Draining of stagnant water sites Wearing full sleeved clothes from at dawn and dusk Fumigation
description: {"references": ["Anurag Jhanjee, MS Bhatia, Shruti Shrivastava et al. Study of Psychiatric Symptomatology in Dengue Patients. Delhi Psychiatry. 2013;16(01).", "Khawaja, Uzzam Ahmed, Mukarram, Muhammad Shariq, &amp; Ghauri, Muhammad Ishaq.(2020. Evaluating Depression and Anxiety in patients diagnosed with dengue, using the PHQ-9 GAD-7 Questionnaire (Version 1.00) [Data set]. Zenodo. http://doi.org/10.5281/zenodo.3911869", "Hashmi AM, Butt Z, Idrees Z, Niazi M, Yousaf Z, Haider SF, Bhatti MR. Anxiety, and depression symptoms in patients with dengue fever and their correlation with symptoms severity. Int J Psychiatry Med. 2012(3). 199-210. Doi: 10.2190/PM.44.3.b.", "https://www.mayoclinic.org/diseases-conditions/dengue-fever/diagnosis-treatment/drc-20353084"]}