Dengue in Paediatric Patients with Hematologic and Oncologic Disorders: Insights from a Single-Center Study
Hari Gaire, Anuj Singh, Silky Jain, Nita RadhakrishnanAbstract
Background
Dengue fever has become a significant global health concern owing to its widespread distribution and potential for severe outbreaks. Dengue can cause a wide range of symptoms, from mild fever to severe dengue (dengue haemorrhagic fever or dengue shock syndrome). Both dengue and hematologic/oncologic conditions can be associated with prolonged fever, thrombocytopenia and coagulation abnormalities. Prior chemotherapy, transfusion associated iron overload poses significant risk of having dengue related complications and organ dysfunction in this vulnerable population. Comprehensive understanding of the clinical profile, natural history and outcomes associated with dengue in this risk population is essential.
Methods
All pediatric patients with underlying hemato-oncologic disorder who were diagnosed with Dengue in past 3 years were retrospectively evaluated. ELISA for Dengue NS1 antigen and IgM antibody was performed for diagnosing. Haematocrit and Platelet Count were monitored closely monitored to guide treatment. Additional biochemical test including liver function time, electrolytes and coagulation studies were done as per clinical status. Patients were classified as per WHO under 3 categories Dengue with no warning sign, Dengue with warning signs and Severe Dengue. Treatment was provided as per standard guidelines. Rising level rather than absolute value of Hematocrit was taken as warning sign in this population
Results
A total of 61 pediatric patients were studied, including 28 cases with leukemia, 16 with thalassemia, 7 with aplastic anemia, 4 with hemophilia, 3 with lymphoma, 2 with solid tumors, and 1 with immune thrombocytopenia (ITP). In leukemia cohort, 16 (57%) cases didn’t had any warning signs, 10 cases (35%) had dengue with warning signs managed with fluid supplementation and 2 (7%) required extensive support of IV fluids, antibiotics, blood products, ionotropic and respiratory support. Mean duration of chemotherapy delay was 7.2 days in this group of patients. Among patients with Aplastic Anemia, 4 cases (57%) experienced bleeding manifestation and required platelet transfusion, while 1 case had severe dengue with shock with hepatic dysfunction and succumbed to illness. Among thalassaemia, 7 cases (43%) had warning signs and 1 case had fulminant hepatitis and acute liver failure leading to death. Patients with Hemophilia, lymphoma and solid tumors displayed no warning signs and were managed conservatively. Overall mean duration of Fever in these children was 5.4 days (SD 1.2).
Conclusion
Due to the heightened risk of bleeding manifestation and organ dysfunction, Early recognition, vigilant monitoring, and tailored supportive care are essential to mitigate complications in this vulnerable population.