THE CLINICAL PROFILE OF DENGUE PATIENTS IN CHILDREN

Background: To study the clinical profile of dengue in children Methods: The hospital based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: Based on the symptoms, the most common symptoms noticed were fever 94.00% followed by myalgia 85.00% decreased appetite 83%, retroorbital pain in 84.0% and vomiting 81.00% Conclusion: It concluded that common symptoms observed were fever, myalgia, decreased appetite and headache The common complications presented were hepatic dysfunction and shock with no mortality indicating the presence of less virulent organisms..


Introduction
India is one of the seven countries in the South-East Asia region regularly reporting incidence of dengue outbreaks due to its high incidence which constantly threatens the health care system. The first confirmed case of dengue fever in India dates back to 1940s, and since then more and more new cases have been reported which mostly occurs in epidemics often resulting in high morbidity and mortality. 1,2 Fatal form of the disease, severe dengue fever has been reported in India from time to time in Kolkata, Delhi, and Chennai. All the four serotypes of the virus have been in circulation and reported in Tamil Nadu. During all these epidemics infection occurred in all the age groups and more so in adults in the age group of 16 -60 years. 3,4

Material and Methods
Study Design:Hospital-based cross-sectional study.

Inclusion criteria
• Children with age group of 0-18 years. Admitted with symptoms of dengue fever based on WHO criteria. NS1 antigen and IgM dengue antibody positive, cases by ELISA technique.

Exclusion criteria
• Children with IgG dengue antibody positive.
• Children with enteric fever and malaria  Abdominal distension 67 67.00 Based on the symptoms, the most common symptoms noticed were fever 94.00% followed by myalgia 85.00% decreased appetite 83%, retroorbital pain in 84.0% and vomiting 81.00% According to complications, in dengue positive cases, bleeding was the most common complication seen in 52.00% cases while shock, myocarditis, and convulsion were present in 34.00%, 3.00% and 1.00% of cases respectively.

Discussion
Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. Since the first confirmed case of dengue in India, during the 1940s, intermittent reports from Delhi, Ludhiana, Mangalore, Vellore and from other states have been published. The diagnosis is by clinical profile but they can present with varied manifestation 5-6 .
There is a steady increase in the outbreak of dengue fever over the years and so among children. This is due to the rapid urbanization with unplanned construction activities and poor sanitation facilities contributing fertile breeding grounds for mosquitoes. Due to an increase in the awareness among health care professionals following the initial epidemic and the availability of diagnostic tests have contributed to the increased diagnosis 7 .
A outbreak of dengue fever during pre-monsoon and monsoon season reported due to stagnation of water after a bouts of rainfall which facilitate vector breeding. This highlight the preventive measures against dengue fever should be taken during water stagnation periods after the initial bouts of rainfall and at the end of monsoon.
In our study mean age was 10.51±2.16 year in dengue positive cases. This may be due to out-door activities of these children, where chances of getting bitten by mosquitoes are more. Similar finding was observed in other studies [8][9][10] .
Boys were slightly more affected then girls were also observed by Selvan et al 10  According to complications, According to complications, in dengue positive cases, bleeding was the most common complication seen in 51.00% cases while shock, myocarditis, and convulsion were present in 34.00%, 3.00% and 1.00% of cases respectively.
Raj et al 11 observed that shock was the most common and difficult to treat complication despite appropriate fluid management in accordance with WHO regimen. 20(10.2%) children had shock, of which 7 were refractory to fluid therapy and blood products (whole blood, packed cell volume, FFP) given as indicated.

Conclusion
It concluded that common symptoms observed were fever, myalgia, decreased appetite and headache The common complications presented were hepatic dysfunction and shock with no mortality indicating the presence of less virulent organisms..