Authored by: Dr. Parag Dekate

Director of Pediatrics & Head of Pediatric Intensive Care Unit

DENGUE FEVER IN CHILDREN OUR OLD EMEMY

In current times of COVID having fever makes all of us anxious specifically if it’s our kids, but currently the scare of Dengue fever making lot of parents and doctors more scared that COVID. As dengue is endemic/epidemic tropical fever (infection still very prevalent in Hyderabad (India) and can lead to very critical disease if not attended immediately.

In spite of listening to all stories of dengue fever around us, it really doesn’t hit you until one of your own contracts this deadly disease. 

STORY:

There are several stories comes in my mind when I think about dengue but when my own daughter had this disease it made me to think about how bad this disease is and what are the complications of this disease, what helps and what complicates these kids and admitting them timely so that they don’t deteriorate is the most important thing about this disease. 

STORY OF ONE OF OUR PATIENT COMING TO KIMS CUDDLES:

It was a regular day. When I came from my work I found my 10 years old daughter is little dull and having fever of 100F, Generally, once she is back from her basketball classes, she will inform me all events about her day including what happened during her basketball training, but that day she was looking very dull and she straight way went to bed and said I don’t feel like eating, I thought that she might be tired that’s why she is dull and feeling little feverish.  After coming home she usually pay with her pet but that day she was not in mood of playing with him, and it has never happened in past few years they I understood that something is wrong and she is not well. After 1 hour when I checked her she was having high fever of 103F and she was burning all over. 

I gave her Paracetamol and gave her little tepid sponging to reduce the fever early. That night she persisted to had intermittent fever throughout the night ranging between 101-104F and I gave almost 4 doses of Paracetamol to her. Next day she started complaining headache and pain around eyes and by the end of the day she started having rash all around the body. Her oral intake was very minimal and her urine colour turned very dark. She became so weak that she was not able to walk and preferring to in bed. 

I understood this is not some routine infection and something is not good, I decided to take my daughter to the hospital immediately.

Once I reached KIMS Cuddles Hospital, Kondapur, Pediatrician saw him in emergency room, checked his vitals which showed low BP, they immediately put IV cannula gave IVF and did some test and shifted her to Pediatric Intensive Care Unit as she was having Dengue Shock Syndrome (Dengue fever with low BP)

My daughter had dengue fever, her packed cell volume (PCV, Blood thickness) was more and his platelets were falling down rapidly, his liver showing some swelling and her body was getting swollen. 

Thankfully though my daughter had critical Dengue because of of timely intervention of my Pediatrician & KIMS CUDDLES hospital, my daughter was there in PICU for 3 days and then for 2 days in room. With all intense and appropriate management her fever began coming down. They serially monitored her blood thickness and platelet count. And within a week we were back home.  

It’s definitely not an illness that you would want anyone to endure, especially children. And remember the real problem start or child becomes sicker when the fever subsides. Over the time you start recovering the weakness lingers on for a long period which can take a toll on your child’s health and well-being.

What is Dengue Fever?

Dengue fever is self-limiting viral infection and is caused by a bite of mosquito transmitting virus in body of individual. It’s common in Tropical areas like India. The virus can cause symptoms like fever, headaches, rashes, and pain throughout the body.

Dengue Fever Transmission:

Dengue fever is transmitted through the bite of an Aedes Aegypti mosquito infected with the dengue virus.

When an Aedes mosquito bites a person who has already been infected with a dengue virus, the mosquito can also become a carrier of the virus. If this mosquito then goes on to bite someone else, the person gets infected by the dengue fever. This virus however cannot spread directly from person to person.

Dengue Fever Signs & Symptoms:

Most of dengue patient get milder symptoms but it can cause serious disease in May in the form of disease called Dengue Hemorrhagic Fever or DHF Dengue Shock Syndrome. This form of dengue can end up being life-threatening and needs to be treated immediately.

While symptoms of dengue in kids and those who are experiencing the disease for the first time are mild, older kids, adults, and those who have had a previous infection may have moderate to severe symptoms.

Below are some common signs and symptoms of dengue in kids that a parent should look out for

  1. High fever, can even be as high as 105 degrees F. Most common initial symptoms are like flue like high-grade fever, runny nose, cough, and weakness.
  2. Severe headache- Sometimes kids get retro-orbital pain, joint pain, abdominal pain and severe muscle or body pain. 
  3. Change in behavior- Children may exhibit more irritability and fussiness than usual.
  4. Poor feeding, lethargy, decreased acceptance of fluids, passing high coloured urine
  5. Rashes over the body- A common symptom of dengue fever is an itchy skin rash that appears in patches. Usually rash appears on day 2-3 of fever and sometimes its diffuse and unrecognizable. 
  6. Bleeding manifestation, though uncommon, common site of bleeding are nose, gums, sometimes in motion and urine.
  7. Mild bruising
  8. Abdominal pain
  9. Calm and cold peripheries like hand and feet, change in colour of peripheries or dusky peripheries
  10. Sometimes some patient might have abnormal movements called as seizures
  11. Decrease urine output or passing very high coloured urine
  12. Breathing difficulty, mainly during late phase of disease.

Generally, the dengue symptoms and signs like fever, rash, and headache often referred to as the dengue triad is characteristic of dengue.

Another name for dengue fever is also dandy fever or break-bone fever owing to the severe bone and muscle pain it can cause. Often the pain can be so bad that it can feel equivalent to bones breaking.

Diagnosis and Treatment of Dengue Fever

The symptoms of dengue fever can be observed from 4 days to 2 weeks post being bitten by an infected mosquito, and generally lasts for about 2 to 7 days. Often the period after the fever begins to subside is crucial for those people with DHF (dengue hemorrhagic fever). Severe bleeding, gastrointestinal problems like nausea, vomiting or severe abdominal pain, and respiratory problems like difficulty in breathing. Also, a drop in blood pressure, dehydration, and heavy bleeding can happen if DHF goes untreated. These symptoms are life-threatening and need immediate medical attention.

What are the danger signs or when we should hospitalized children?

  1. High spiking fever lasting more than 2 days
  2. Poor oral acceptance or dehydration
  3. Child not passing urine for more than 8-10 hours
  4. Bluish discoloration of extremities or hand and leg getting cold
  5. Abnormal behaviour or seizures
  6. Bleeding from any site
  7. Persistent abdominal pain or vomiting
  8. Swelling over body

How Is Dengue Fever Diagnosed?

Clinical symptoms as discussed above

Blood test (as suggested by doctor) Most commonly dose blood test are Complete Blood Test (showing fall in WBC and platelet count with increasing PCV or Hemoglobin), C – reactive protein (to rule out other infection) and Specific Dengue test (Dengue NS1 antigen or Dengue IgM test)

Treatment of Dengue fever

Currently, there is no specific treatment for dengue fever. However, in most cases, dengue fever goes away within a 7-10 days. Not all dengue fever needs treatment or hospitalization. Almost 80% of patient with mild dengue get treated at home with hydration and as and when required Antipyretics (paracetamol). 

Patient with danger signs as explained above needs admission and evaluation. But if someone has severe symptoms, medical attention must be sought immediately, as it could be signs of DHF which can be life-threatening,

Hospitalized Management: 

  1. Intravenous fluid as per proper Dengue protocol (means IVF fluid are given in particular way)
  2. As and when required Paracetamol if temperature >100F
  3. Medications to take care of acidity of stomach 
  4. Frequently monitoring blood thickness level and platelet count and titrating IVF accordingly
  5. And if there is life threatening bleed supplementing with platelet and other blood products transfusion.
  6. Other general things to be taken care off
    1. Make sure your child is drinking enough fluids and water along with healthy meals.
    2. Ensuring that your child sleeps well is essential for his recovery. 
    3. A healthy diet and sufficient rest will help strengthen his immunity and destroy the virus.
    4. Pain relievers like acetaminophen may be prescribed if your child is experiencing unbearable muscle and joint aches associated with dengue fever. 
    5. Pain relievers like aspirin or ibuprofen should be avoided, as they can make bleeding happen.
    6. Including generous amounts of immunity building foods in your child’s diet, like citrus fruits, almonds, turmeric, garlic, etc. will help in strengthening your little ones’ immunity and aid in quick recovery.
    7. Lastly, efforts must be made to keep the infected child from being bitten by any mosquitoes as this will help in preventing the spread of dengue fever to others.

Can Dengue Fever Be Prevented?

As there are no vaccinations to prevent dengue fever, the best protection is to ensure that your child does not get bitten by an infected mosquito. Prevention is better than cure when it comes to dengue fever and there are several ways in which you can protect yourself and your family from this illness

  1. Use screen meshes on door frames and windows to keep mosquitoes out without compromising on the ventilation aspect. 
  2. Ensure good quality screens are installed, which are less likely to rip as mosquitoes can make way into your house even through the smallest possible opening. Also, fix any tears in the mesh or broken and damaged screens as soon as possible. 
  3. All un-screened windows and doors must be kept closed.
  4. Ensure kids are wearing long-sleeved shirts, long pants, shoes, and socks, whenever they step outside the house.
  5. Limit outdoor activities of kids especially in the hours around dawn and dusk when mosquitoes are most active. Keep the kids engage with fun indoor activities like board games etc.
  6. Don’t give mosquitoes places to breed in. They lay their eggs in stagnant water, so get rid of any sources of standing water like containers, mugs, basins, and pots, buckets including draining sinks and bathtubs too. Ensure that the water is removed or covered.

Taking the above-mentioned precautions to prevent your child from contracting the disease becomes crucial especially due to the lack of a cure or vaccine for dengue fever.

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