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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 116 - 119
A Study on the Relationship Between Organomegaly, Dengue Severity, and Dengue Seropositivity in a Rural Tertiary Care Hospital in Western Maharashtra.
 ,
 ,
1
Head of the Department, Department of Pediatrics, Dr. Vitthal Rao Vikhe Patil Pravara Rural Hospital, Loni, Maharashtra, India,
2
Post graduate student, Department of Pediatrics, Dr. Vitthal Rao Vikhe Patil Pravara Rural Hospital, Loni, Maharashtra, India,
3
Assistant Professor, Department of Pediatrics, Dr. Vitthal Rao Vikhe Patil Pravara Rural Hospital, Loni, Maharashtra, India,
Under a Creative Commons license
Open Access
Received
Nov. 9, 2024
Revised
Nov. 25, 2024
Accepted
Dec. 3, 2024
Published
Jan. 11, 2025
Abstract

Background: Dengue fever, caused by arthropod-borne viruses, presents as a mild illness with fever, muscle pain, rash, and swollen lymph nodes, while its severe form, dengue hemorrhagic fever, can be fatal due to capillary permeability and hemostasis issues. Infants aged 4-9 months face higher risks of severe dengue, with symptoms like convulsions and liver dysfunction being more common and fatal. Aim & Objectives: A Study on the Relationship Between Organomegaly, Dengue Severity, and Dengue Seropositivity in a Rural Tertiary Care Hospital in Western Maharashtra. Methodology: This descriptive longitudinal study was conducted over a period of two years, from June 2022 to May 2024, in the Department of Paediatrics at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. The inclusion criteria consisted of all male and female patients under one year of age with a laboratory-confirmed diagnosis of Dengue Fever, provided their parents gave written informed consent. The exclusion criteria included infants presenting with other viral exanthematous fevers or dengue-like illnesses with a negative laboratory test. Result: The study examined 79 infants admitted with dengue between June 2022 and May 2024, accounting for 12% of all infantile dengue cases. The average age of the infants was 7.5 months. Dengue fever without warning signs constituted 55.7% of the cases, while 26.6% had dengue with warning signs, and 17.7% were diagnosed with severe dengue. Severe outcomes were linked to hepatomegaly and splenomegaly. Conclusion: Infants with dengue frequently exhibit non-specific symptoms, making diagnosis challenging. While IgM positivity was commonly observed, NS1 positivity was associated with increased severity and mortality. Early detection of NS1 was vital for effective management. Hepatosplenomegaly were found to be linked to greater severity and higher mortality rates. Timely diagnosis, close monitoring, and proper supportive care are crucial for improving outcomes in the management of infantile dengue.

Keywords
INTRODUCTION

Dengue fever, caused by arthropod-borne viruses, is typically a mild illness with symptoms like biphasic fever, muscle and joint pain, rash, and swollen lymph nodes. However, severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), can be fatal and are characterized by capillary leakage and hemostasis abnormalities. The primary vector for dengue is Aedes aegypti, which can transmit the virus after an incubation period of 10-14 days.1

 

Dengue cases have significantly increased over the past two decades, with the WHO reporting an eightfold rise in cases from 2000 to 2019. The disease primarily affects younger populations in developing countries, especially infants aged 4-9 months, who are at higher risk of severe disease. Symptoms such as convulsions, liver dysfunction, and a higher fatality rate are more common in infants, with a fatality rate four times higher than in older children. Severe dengue is associated with bleeding, cyanosis, ascites, and shock.2

 

While maternal antibodies typically provide some protection, infants born to mothers with prior dengue infection are at higher risk of severe disease due to antibody-dependent enhancement. In Asia, more than 50 million cases of DHF occur annually, with 90% affecting children under 15. In India, dengue cases increased significantly from 2020 to 2021, with Maharashtra seeing a rise from 3,500 to 12,700 cases.3

 

To better understand dengue in infants, a descriptive longitudinal study was conducted to assess the epidemiology, clinical features, disease severity, and outcomes of dengue infection in infants over a two-year period.

METHODOLOGY

This longitudinal descriptive observational study was conducted in the Pediatric Department of Pravara Rural Hospital, Loni, over a 24-month period from June 2022 to May 2024. The study aimed to assess the clinical profile, laboratory findings, and outcomes of infants (<1 year old) diagnosed with dengue fever. Written informed consent was obtained from parents or guardians prior to enrollment.

 

Study Population and Methodology

The study included all hospitalized infants with laboratory-confirmed dengue fever, diagnosed through positive Dengue NS1 antigen or IgM/IgG antibodies against the Dengue virus. Infants with other viral exanthematous fevers or dengue-like illnesses and negative laboratory tests were excluded.

 

Demographic details and clinical information, including history, physical examination findings were documented using a pre-designed proforma.

 

Fluid Management

A detailed fluid chart was maintained for all patients. Intravenous fluids were administered based on clinical needs, and hemoglobin and hematocrit levels were closely monitored to detect hemoconcentration during the critical phase or hemodilution during recovery.

 

Grading of Severity

Cases were classified into three categories based on WHO criteria: Dengue without warning signs, Dengue with warning signs, and Severe Dengue.

RESULTS

1) We conducted a descriptive longitudinal study examining the clinico-investigative profile of 79 infantile dengue patients admitted during the period from June 2022 to May 2024.

 

Out of the 650 dengue-positive cases admitted in the pediatric age group (0-12 years) in our study, 12% (n=79) were infants.

 

TABLE 1: TOTAL CASES

Cases

Frequency (n)

Percentage

Total no. of dengue cases among 0-12 years

650

100%

Infants

79

12.15%

>1 year

571

87.85%

 

2) Dengue fever without warning signs constituted 55.7% (n=44) of the cases. Dengue fever with warning signs accounted for 26.6% (n=21), while severe dengue was observed in 17.7% (n=14).

 

Graph 2: Distribution according to the severity of dengue

 

Table 3: Distribution according to the Dengue Sero-positivity

Sero-Positivity

Number (n)

Percentage (%)

IgM Positive

44

55.7%

NS 1 Positive

35

44.3%

Total

79

100%

 

3) In our study, IgM was positive in 55.7% (n=44) of the cases, while NS1 antigen was positive in 44.3% (n=35).

 

Table 4 (a): Organomegaly

Organomegaly

Total (n=79)

 

Hepatomegaly

Present

21

27%

Absent

58

73%

Splenomegaly

Present

9

11%

Absent

70

89%

 

4) This study revealed hepatomegaly in 27% (n=21) and splenomegaly in 11% (n=9). 73% (n=58) had no hepatomegaly, and 89% (n=70) showed no splenomegaly.

 

On comparing Organomegaly with severity of dengue, Among those with dengue fever without warning signs (n=44), 3 patients had hepatomegaly, and 2 had spleenomegaly.

 

In the group with dengue fever with warning signs (n=21), 8 patients had hepatomegaly, and 1 had splenomegaly.  Among patients with severe dengue (n=14), 10 had hepatomegaly, and 6 had splenomegaly.  The differences observed were statistically significant with (P<0.001) for both hepatomegaly and splenomegaly with severity of dengue.

 

Graph 4 (b) : Association between organomegaly and severity of dengue

 

Table 4 (c): Association between Organomegaly and dengue positivity

Organomegaly

IgM Positive (n=44)

NS 1 Positive (n=35)

Total (n=79)

P value

Hepatomegaly

Present

6

15

21

0.005

Absent

38

20

58

Splenomegaly

Present

1

8

9

0.009

Absent

43

27

70

 

Among IgM positive(n=44), 6 had hepatomegaly, while among NS1 positive(n=20), 15 had hepatomegaly. This difference in hepatomegaly incidence between IgM and NS1 positive groups was statistically significant (P = 0.005).

 

For splenomegaly, among IgM positive(n=44), 1 had splenomegaly, compared to 8 among NS1 positive patients(n=35).  This difference in splenomegaly incidence between IgM and NS1 positive groups was also statistically significant (P = 0.009).

DISCUSSION

We meticulously explored the clinico-investigative profiles of 79 infant dengue patients admitted during the study period from June 2022 to May 2024.

 

Among the 650 dengue-positive cases in the pediatric age group (0-12 years) in our study, 12% (79 cases) were infants. This finding aligns with the results of studies by Manjunath J. Kulkarni et al.4 (12%) and Abhishek Gupta et al. 5(10%). However, studies conducted by L. Kabilan et al.6 (20%), Anne M. Hause et al.7 (20%), and Nabaneeta Dash et al.8 (25%) reported a significantly higher incidence of dengue in infants.

 

The higher incidence reported in the study by L. Kabilan et al.6 can be attributed to it being conducted during an epidemic. In contrast, the other two studies were conducted over a longer period of 10 years. Since dengue follows a 2-3 year cyclical trend once established in a region, as demonstrated by epidemiological studies (183), this extended timeframe likely contributed to the higher incidence observed in those studies.

 

Hepatomegaly was observed in 27% of cases in our study, a proportion similar to that reported by Manjunath J. Kulkarni et al.4 However, Cameron P. Simmons et al.9  documented hepatomegaly in all cases, and Nabaneeta Dash et al.8 reported it in 58%, both significantly higher than our findings. The higher incidence reported by Cameron P. Simmons et al.9 is likely due to the inclusion of more cases of DHF and DSS.

 

In our study, the association between hepatomegaly and splenomegaly with the severity of dengue was statistically significant (p=0.001), with hepatomegaly identified as a predictor of severe dengue. A significant association was also observed between dengue positivity and hepatomegaly (p=0.005) as well as splenomegaly (p=0.009).

 

Splenomegaly was found in 11% of cases in our study, compared to 18% reported by Nabaneeta Dash et al.8 and 19% by Manjunath J. Kulkarni et al.4, slightly higher proportions reflecting more cases of DHF and DSS in those studies.

 

The association of hepatomegaly with outcomes was also significant (p<0.001), as all six patients who died had hepatomegaly. Furthermore, among the six fatalities, three patients (50%) also exhibited splenomegaly.

CONCLUSION

Infants with dengue pose unique challenges for diagnosis due to non-specific symptoms that mimic upper respiratory and gastrointestinal viral illnesses. IgM-positive cases were more common, whereas NS1-positive cases were linked to greater severity and higher mortality rates.

 

The early detection of NS1 antigen emerged as a valuable and reliable diagnostic tool for guiding appropriate patient management. Hepatosplenomegaly was significantly associated with increased mortality.

 

Timely diagnosis, vigilant monitoring, and appropriate management with fluids, hematological support, and other supportive treatments can lead to favorable outcomes in addressing dengue fever, a critical health challenge of this millennium.

REFERENCES
  1. Halstead, Scott B. Nelson Textbook of Paediatrics, 21st ed., chapter 482, p. 2522.
  2. Gupta, Piyush, Aashima Dabas, and Piyush Gupta. PG Textbook of Paediatrics, 3rd ed., chapter 31.19, p. 1567.
  3. Government of India, Directorate General of Health Services, Ministry of Health & Family Welfare, National Center for Vector Borne Diseases Control. "Available at: https://ncvbdc.mohfw.gov.in/index4.php?lang=1&level=0&linkid=431&lid=3715."
  4. Kulkarni, M. J., et al. "Clinico-Epidemiological Profile of Children Hospitalized with Dengue." Indian Journal of Pediatrics, vol. 77, no. 10, 2010, pp. 1103-1107. doi: 10.1007/s12098-010-0202-2.
  5. Gupta, Abhishek. Dissertation Done in a Rural Medical College in Maharashtra.
  6. Kabilan, L., et al. "Dengue Disease Spectrum Among Infants in the 2001 Dengue Epidemic in Chennai, Tamil Nadu, India." Journal of Clinical Microbiology, vol. 41, no. 8, 2003, pp. 3919–3921. doi: 10.1128/JCM.41.8.3919-3921.2003.
  7. Hause, A. M., et al. "Epidemiology of Dengue Among Children Aged < 18 Months—Puerto Rico, 1999-2011." American Journal of Tropical Medicine and Hygiene, vol. 94, no. 2, 2016, pp. 404–408. doi: 10.4269/ajtmh.15-0382.
  8. Dash, N., et al. "Infant Dengue: A 10-Year Experience from a Tertiary Center in South India." American Journal of Tropical Medicine and Hygiene, vol. 105, no. 2, 2021, pp. 435–439. doi: 10.4269/ajtmh.21-0159.
  9. Simmons, C. P., et al. "Maternal Antibody and Viral Factors in the Pathogenesis of Dengue Virus in Infants." Journal of Infectious Diseases, vol. 196, no. 3, 2007, pp. 416–424. doi: 10.1086/519170.
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