Thursday, 18 January 2018 09:27

The new behavior of Dengue

The behavior of Dengue Haemorrhagic Fever has changed drastically during the current dengue epidemic. We have encountered lot of children with abnormal disease behavior making it a real challenge to detect and mange the disease. The differences we observed are

1. Patient entering the critical phase very early in the disease course (like day 2, even in day 1)

2. Commencement of the critical phase before platelet crossing 100,000/microlitre (Sometimes even far above 150,000/microlitre )

3. WBC count remaining high above 5000/microlitre throughout the disease course
4. Abnormally prolonged viraemia where both fever and NS1 postivity continues beyond 7th day of the illness.

5. Settlement of fever early in disease course, but platelets continuing to drop and patient entering critical phase later

6. Presence of Co-infection, mainly LRTI and tonsillitis which is misleading.

7. Abnormally short critical phase where patient enter recovery phase or equilibrium phase early ( Here risk is patient suffering fluid overload due to attribution of changes in parameters to critical phase. However we haven't encountered prolonged critical phase much)

8. Rapid leaking where patient suffers shock within 12 hours without evidence of bleeding (we had one who suffered shock in 6 hours and had platelet count of 160000 and 9% rise in haematocrit at the time of event.)

Detection of these patients and prompt management succeeded due to following steps

1. Having high index of suspicion eventhough patients history is different from usual behavior of DHF

2. Suspecting DHF in patients who have other focus of infection or negative NS1 report when they are too ill for the diagnosed disease

3. Taking haematocrit into consideration eventhough platelet count or WBC count does not support dengues fever or far above for patient to be in or near critical phase.

4. Paying close attention during febrile phase and any abnormality like undue tachycardia, low urine output, very ill look, unexplainable PCV/Hct rise ..etc and suspecting of DHF

5. Prompt anf frequent use of Ultrasound Scanning when ever DHF is suspected.

Please use the above information and observations for benefit of your patients

I would like to share the credit of above information and observations to whole team at Professorial Paediatric Unit, Colombo North Teaching Hospital; consultants, senior registrar, registrars, SHOs, HOs (who bear the biggest burden of disease monitoring) and nurses and other staff.

Credit - Kasun Jayasundara

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