Dengue fever in children

Dengue fever is a significant cause of morbidity and mortality in Sri Lankan children. Therefore it never hurts to refresh and update our knowledge on this potentially life-threatening disease, especially since the rainy season is upon us, allowing mosquito breeding grounds to thrive and paving the way to increase incidence of dengue fever. Today we will consult Dr. Maheshaka Wijayawardena, Consultant Pediatrician at Base Hospital, Wathupitiwala on Dengue and its impact on children.

“Dengue is a viral fever borne by the mosquitoes Aedesaegypti and Aedesalbopictus. The Dengue virus has four different strains and any child who has had dengue once has a risk of acquiring the disease 3 more times during his life,” explains Dr. Wijayawardena.

Differentiating Dengue from other viral fevers is a difficult task because most of the viral fevers have similar features at the beginning. Even though it was said earlier that dengue is unlikely to present with Flu like symptoms, it has been proven to be false. Initial presentation of dengue can vary from viral fever without other symptoms to diarrheal illness or fever with cold symptoms; therefore we have to be extra careful, states the doctor.

Not every patient who acquires dengue fever develops the feared ‘bad dengue’ or Dengue Hemorrhagic Fever (DHF). “In fact more than 99% of the patients with dengue fever follow a benign course which resolves spontaneously as any other viral illness,” reassures Dr.Wijayawardena. But a minority of the patients go on to the ‘critical phase’ of dengue and have to be carefully monitored until the critical period has passed. 

One key feature of DHF is that while most patients having a benign viral fever start recovering as soon as the fever resolves, in DHF, this marks the beginning of entering into Critical phase. So the child will remain ill even after the fever has subsided.

Dropping of platelet levels below 100,000 along with increasing thickness of blood, as indicated by rising haematocrit are also signs that the child may be entering a critical phase. “Even though many parents and even members of the healthcare staff are worried about the dropping of platelet levels, the major risk is in thickening of the blood, which can lead to shock and even death”, Dr. Wijayawardena stresses.

Dengue, like many other viral illnesses, does not have a specific treatment. Close monitoring and maintaining of optimum hydration is the mainstay of treatment in dengue. While taking inadequate fluid may lead to organ failure and shock, over-hydration can also cause complications like heart failure while the child is recovering. Other complications like internal bleeding, liver and kidney failure and altered consciousness (encephalopathy) can also occur rarely. 

It is found that children who have already been in prolonged shock when admitting to hospital, very young children, children who are obese, children who are suffering from chronic illnesses like kidney and liver disease are more susceptible to suffer complications of dengue. 

Prevention of the spread of dengue plays a crucial part in fighting dengue. Keeping the environment around the house and the school clean, using of mosquito repellent during day time and using mosquito nets while sleeping can help in preventing dengue fever. Trials are underway to develop a successful vaccine to fight dengue and hopefully will be available to the general public in the near future, according to the doctor. Meanwhile, keeping a child with fever well hydrated and on bed rest, doing a full blood count if  the fever lasts for 3 days or more, seeking medical care if the child is ill, even after the fever resolves are important. “Even though Dengue is a serious illness, early suspicion and timely interventions can save lives”, Dr. Wijayawardena concludes.