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Original ArticleOpen Access
Clinical Presentations of Dengue Hemorrhagic Fever in Infants Compared to Children
Kalayanarooj S 
,
Nimmannitya S
,
Nimmannitya S SIRIPEN KALAYANAROOJ, MD*,
SUCHITRA NIMMANNITYA, MD*
Background
: Dengue infections are endemic in Thailand. Infants are at risk of developing
dengue fever (DF) and dengue hemorrhagic fever (DHF). Many infants have severe DHF with unusual
manifestations and may suffer from complications and even death because of difficulties in early diag-
nosis and improper management.
Objective
: To study the incidence of infants DHF and to compare clinical and laboratory
findings of DHF between infants and children in order to improve diagnosis and management of infants
with DHF.
Material and Method
:A retrospective review of hospital charts of DHF patients who were
admitted to the Children's Hospital between 1995-1999 was carried out. Only confirmed DHF cases,
either by serologic or virologic studies were included. Clinical and laboratory findings were compared
using the standard software package SPSS.
Results
:There were 4,595 confirmed dengue patients admitted to the Children's Hospital
during this 5-year period and among these 245 infants were under one year old (5.3% ). Unusual presen-
tations of DHF including upper respiratory tract infection (URI) symptoms, diarrhea, convulsions and
encephalopathy were found more in the infants (4.5%, 13.1%, 12.7% and 4.1%) than in the children
( 1.7%, 2.0%, 2.0% and 0.6%) but shock was found less in the infants (25%) than in the children
(30.9%). The percentages of Tourniquet test positive and low WBC
(~
5,000 cells/mm3
)
which help in
the early diagnosis of dengue were less in the infants (50.2% and 26.8%) than in the children (92.2%
and 71.9% ). Liver involvement and/or dysfunction were found more in the infants as shown by mean
aspartate aminotransferase/alanine aminotransferase (AST/ ALT) elevation and prolonged pro-
thrombin time. Duration of IV fluid was shorter in the infants than in the children (21.9
vs
38.2 hours).
Complications of fluid overload were found more often in the infants than in the children (9%
vs
3.6% ).
The case fatality rate was 1.2 in the infants and 0.3 in the children.
Conclusion
: Management of infants with DHF is critical because early diagnosis is rather
difficult and they sometimes present with unusual manifestations (convulsions, encephalopathy and
8674
S.
KALA YANAROOJ
&
S.
SUCHITRA NIMMANNITYA, MD*
Background
: Dengue infections are endemic in Thailand. Infants are at risk of developing
dengue fever (DF) and dengue hemorrhagic fever (DHF). Many infants have severe DHF with unusual
manifestations and may suffer from complications and even death because of difficulties in early diag-
nosis and improper management.
Objective
: To study the incidence of infants DHF and to compare clinical and laboratory
findings of DHF between infants and children in order to improve diagnosis and management of infants
with DHF.
Material and Method
:A retrospective review of hospital charts of DHF patients who were
admitted to the Children's Hospital between 1995-1999 was carried out. Only confirmed DHF cases,
either by serologic or virologic studies were included. Clinical and laboratory findings were compared
using the standard software package SPSS.
Results
:There were 4,595 confirmed dengue patients admitted to the Children's Hospital
during this 5-year period and among these 245 infants were under one year old (5.3% ). Unusual presen-
tations of DHF including upper respiratory tract infection (URI) symptoms, diarrhea, convulsions and
encephalopathy were found more in the infants (4.5%, 13.1%, 12.7% and 4.1%) than in the children
( 1.7%, 2.0%, 2.0% and 0.6%) but shock was found less in the infants (25%) than in the children
(30.9%). The percentages of Tourniquet test positive and low WBC
(~
5,000 cells/mm3
)
which help in
the early diagnosis of dengue were less in the infants (50.2% and 26.8%) than in the children (92.2%
and 71.9% ). Liver involvement and/or dysfunction were found more in the infants as shown by mean
aspartate aminotransferase/alanine aminotransferase (AST/ ALT) elevation and prolonged pro-
thrombin time. Duration of IV fluid was shorter in the infants than in the children (21.9
vs
38.2 hours).
Complications of fluid overload were found more often in the infants than in the children (9%
vs
3.6% ).
The case fatality rate was 1.2 in the infants and 0.3 in the children.
Conclusion
: Management of infants with DHF is critical because early diagnosis is rather
difficult and they sometimes present with unusual manifestations (convulsions, encephalopathy and
8674
S.
KALA YANAROOJ
&
S.
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