Seronegative dengue cases in children – a retrospective analysis in a tertiary care center in Puducherry

Abstract

Objectives: This study was undertaken to know the clinical profile and outcome of seronegative dengue cases in children, admitted to a tertiary care teaching hospital in Puducherry.

Materials and methods: This is a hospital-based, retrospective, descriptive study, done on seronegative dengue cases, of children aged 1 to 15 years of age, admitted and treated in the pediatric department and pediatric intensive care unit from June 2017 - December 2019, in Sri Venkateshwaraa Medical College :and Research Centre, Puducherry.

Results: About 75 children were suspected of dengue fever during the study period and those blood samples were sent for dengue serology. Only 16 cases (21.3%) were reported to be dengue serology positive. The remaining 59 (78.6%) were dengue serology negative. A total of about 33 children who fulfilled the inclusion criteria were studied and the results were analyzed. It was seen that, male children outnumbered (69.6%), females (30.3%). Maximum numbers of cases were seen among 11-15 years of age (51.5%), followed by (36.3%) in 6 to 10 years of age and (12.1%) in 1-5 years of age. The most common symptom at presentation was, fever seen in (100%) of cases, followed by anorexia in (81.8%), generalized myalgia (63.6%), headache (42.4%), pain abdomen (30.3%), vomiting in (18.1%). Rare symptoms were, loose stools in (15.1%), cough (9%), rashes (6%). The most common sign was hepatomegaly (90.9%), followed by splenomegaly (36.3%), pedal edema (27.2%), pleural effusion (15.1%), ascites (12.1%) and hypotension, altered sensorium and bleeding in (3%) of cases. It was seen that (63.6%) of patients were discharged in < 5 days, most of them belong to DF without warning signs. About (36.3%) were discharged after 5 days of admission; most of them had DF warning signs. According to the outcome, it was seen that (84.8%) were discharged, (2.1%) went against medical advice and (3%) of severe dengue was discharged at request.

Conclusion: The current study has revealed that seronegative dengue cases are more common than seropositive cases in children. They present with common symptoms and rarely atypical symptoms. Clinical diagnosis is more important because of the increasing trend of seronegative dengue cases in children, either because of late or atypical presentation and since the burden of dengue is being underestimated. A high index of clinical suspicion is needed, in spite of seronegativity in children with dengue, in order to reduce the morbidity and improve the outcome in epidemics as well as in daily clinical practice.