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Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh

BACKGROUND: The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis an...

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Autores principales: Khan, Md. Abdullah Saeed, Al Mosabbir, Abdullah, Raheem, Enayetur, Ahmed, Ahsan, Rouf, Rashawan Raziur, Hasan, Mahmudul, Alam, Fawzia Bente, Hannan, Nahida, Yesmin, Sabrina, Amin, Robed, Ahsan, Nazmul, Anwar, Sayeeda, Afroza, Syeda, Hossain, Mohammad Sorowar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555185/
https://www.ncbi.nlm.nih.gov/pubmed/34715835
http://dx.doi.org/10.1186/s12887-021-02947-y
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author Khan, Md. Abdullah Saeed
Al Mosabbir, Abdullah
Raheem, Enayetur
Ahmed, Ahsan
Rouf, Rashawan Raziur
Hasan, Mahmudul
Alam, Fawzia Bente
Hannan, Nahida
Yesmin, Sabrina
Amin, Robed
Ahsan, Nazmul
Anwar, Sayeeda
Afroza, Syeda
Hossain, Mohammad Sorowar
author_facet Khan, Md. Abdullah Saeed
Al Mosabbir, Abdullah
Raheem, Enayetur
Ahmed, Ahsan
Rouf, Rashawan Raziur
Hasan, Mahmudul
Alam, Fawzia Bente
Hannan, Nahida
Yesmin, Sabrina
Amin, Robed
Ahsan, Nazmul
Anwar, Sayeeda
Afroza, Syeda
Hossain, Mohammad Sorowar
author_sort Khan, Md. Abdullah Saeed
collection PubMed
description BACKGROUND: The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019. METHODS: We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data. RESULTS: Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm(3)) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity. CONCLUSIONS: Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02947-y.
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spelling pubmed-85551852021-10-29 Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh Khan, Md. Abdullah Saeed Al Mosabbir, Abdullah Raheem, Enayetur Ahmed, Ahsan Rouf, Rashawan Raziur Hasan, Mahmudul Alam, Fawzia Bente Hannan, Nahida Yesmin, Sabrina Amin, Robed Ahsan, Nazmul Anwar, Sayeeda Afroza, Syeda Hossain, Mohammad Sorowar BMC Pediatr Research BACKGROUND: The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019. METHODS: We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data. RESULTS: Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm(3)) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity. CONCLUSIONS: Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02947-y. BioMed Central 2021-10-29 /pmc/articles/PMC8555185/ /pubmed/34715835 http://dx.doi.org/10.1186/s12887-021-02947-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Khan, Md. Abdullah Saeed
Al Mosabbir, Abdullah
Raheem, Enayetur
Ahmed, Ahsan
Rouf, Rashawan Raziur
Hasan, Mahmudul
Alam, Fawzia Bente
Hannan, Nahida
Yesmin, Sabrina
Amin, Robed
Ahsan, Nazmul
Anwar, Sayeeda
Afroza, Syeda
Hossain, Mohammad Sorowar
Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title_full Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title_fullStr Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title_full_unstemmed Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title_short Clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in Bangladesh
title_sort clinical spectrum and predictors of severity of dengue among children in 2019 outbreak: a multicenter hospital-based study in bangladesh
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555185/
https://www.ncbi.nlm.nih.gov/pubmed/34715835
http://dx.doi.org/10.1186/s12887-021-02947-y
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