GASTROINTESTINAL MANIFESTATIONS OF DENGUE FEVER IN CHILDREN OF BANGLADESH

Dr. Md. Wahiduzzaman Mazuumder*, Md. Nazmul Hassan, Md. Rafiqul Islam and ASM Bazlul Karim3

ABSTRACT

Background: Dengue is a mosquito borne viral fever and dengue epidemics are becoming more frequent over the time. Gastrointestinal (GI) manifestations usually the common manifestation and mostly missed due to lack of awareness and knowledge. This study is carried out the gastrointestinal manifestation and its correlation with the different types of dengue fever. Methods: This is a prospective observational study done on 103 serologically confirmed dengue virus infected children admitted in BSMMU. Children were examined clinically, and laboratory data was collected in respect of GI manifestation till they got discharged and analyzed by SPSS version 25, after approval from departmental review board. Results: The study participants were 103 (n=103) consecutive cases of dengue fever, out of which 59 (57%) cases were dengue fever, 27 (26%) were DHF and 17 (17%) were cases of DSS. Mean age was 8.44 ± 4.47 years and of them 58 (56.3%) were males and 45 (43.7) were females. Male to female ratio was 1.3:1. 81 (78.6%) patients were from urban and 22 (21.4%) came from rural areas. GI manifestations were noted in all cases of the study participants. Most common presentation were anorexia 80 (78%) & Vomiting 74 (72%) followed by abdominal pain 60 (58%) & diarrhea 25 (24%). GI bleeding manifesting as hematemesis and melena were found 9 (9%) and 7 (7%) patients. Ascites, Hepatomegaly and acute pancreatitis were found 20 (19%), 24 (23%) and 3 (3%) respectively. Among them GI bleeding (hematemesis & melena) (p-0.001 & p-0.000), Ascites (p-0.000), hepatomegaly (p-0.000) were found significantly associated with dengue severity. Hypoalbuminemia, hypocalcaemia and electrolyte imbalance was found in 20(19.4%), 30 (29.1%) and 16 (15.5%) cases respectively and all are statistically significant with severe dengue fever (p-value 0.000, 0.002 & 0.037 respectively). Conclusion: Gastrointestinal manifestations are very common in Dengue fever; in our study 100% of the patients had these symptoms. Atypical GI manifestations like hepatitis, acute pancreatitis are quite common than once thought of, are often missed. GI bleeding (hematemesis & melena), Ascites, hepatomegaly, hypoalbuminemia, hypocalcaemia and electrolyte imbalance might be used as predictors of severe dengue fever.

Keywords: Dengue fever; GI manifestation; Hepatomegaly; Liver enzymes; Acute pancreatitis; Children.