Clinico-Aetiological profile of children with fever and rash with special reference to dengue

Abstract

Aim: Fever with rash is a common presentation in paediatric patients with a variety of differential diagnosis ranging from minor to life-threatening illnesses. Establishing an early diagnosis particularly of dengue infection, especially in a resource-limited setting is essential to reduce morbidity and mortality. The aim of this study is to evaluate the clinico-aetiological profile of children admitted with fever and rash and to find out different clinical and laboratory parameters for diagnosing dengue infection using screening tests. Methods: It is an observational cross-sectional study. All consecutive patients admitted to tertiary care centre during the study period (n = 120) between age group 1 month and 12 years were evaluated with detailed history and clinical examination and relevant investigations. For screening dengue infection, various clinical and laboratory parameters were used to find the best combination comprising the desired sensitivity, specificity, positive and negative predictive values (NPV) and likelihood ratio. Results: The most commonly affected age group was below 5 years. Among 120 patients, 64% had a laboratory-confirmed diagnosis out of which 45% patients were of viral aetiology, 10% patients had bacterial aetiology and 9% had non-infectious aetiology. Among viral infections, 18 patients were diagnosed as dengue immunoglobulin M enzyme-linked immunosorbent assay positive. Headache (100%), was the most common symptom followed by diarrhoea (83.3%), vomiting (83.3%) and altered sensorium (72.2%) in dengue-positive patients. All dengue patients had thrombocytopenia, 88.9% had leucopenia and liver function tests deranged in 77.8% of patients. The highest sensitivity and specificity values were found in the combination of fever, maculopapular rash, headache, absence of cough and thrombocytopenia (55.6% and 94.12%, respectively), followed by fever, maculopapular rash, headache, no cough, thrombocytopenia and leucopenia (with 50% sensitivity and 100% specificity). Both combinations also showed the highest values for positive and NPVs, positive likelihood ratio and maximum area under the curve using a receiver operating characteristic. Conclusion: Establishing the diagnosis of fever with rash in children can be challenging. A combination of parameters such as fever, maculopapular rash, headache, absence of cough, thrombocytopenia and leucopenia can be used as a screening tool for early diagnosis of dengue infection in a resource-limited setting.