Pediatric patients have been presented to me many a time with low platelet counts, low total counts, mild to moderate elevation of PCV, and hypotension. Surprisingly, the symptomatology and presentation is not as severe as that of Dengue, and recovery is rapid. Frequently there is evidence of a capillary leak. I ran the sero-testing for Dengue (including NS-1, IgM, IgG), Widal, MP, IFA (Chikungunya), and blood cultures however, all of these turn out to be negative.
Management line is the same as with Dengue- with Fluid support.
Are we dealing with a 'shift' in the dengue virus in Asia?.
Raised PCV is something that raises suspicion for capillary leak and more importantly Dengue. However other findings like Thrombocytopenia and low total counts are quite common in Vivax Malaria also. As more and more studies are demonstrating it now.I have also submitted a research brief for publication emphasizing transient thrombocytopenia without bleeding as a common occurance in vivax malaria.
Specially after the rainy season dengue fever is a frequent problem, we always investigate for dengue fever
Add Lepto MAT and ELISA for scrub typhus also in your list of investigations. These infections mimic dengue very closely.
very frequently we encounter patients with symptoms of dengue and more often during the season (july-december) and we do serological tests for NS1 Ag, IgM and IgG and many turn out to be seropositive for NS1/ IgG/IgM in different combinations
The common causes of acute febrile illness are Malaria , Dengue , Scrub typhus , Leptospirosis , Typhoid & community acquired sepsis due to pneumonia or UTI . The symptoms of your patients suggests Dengue , but are negative by investigations . Unfortunately , many of the tests to diagnose other infections , such as scrub typhus , typhoid & leptospirosis , become positive only after a week & many patients get discharged before the tests can be done . Only malaria & dengue can be diagnosed on 2nd or 3rd day as they are antigen based tests, while the rest are positive later , as they are antibody based tests .Did you give them any antibiotics ? Since these patients had severe illness , due to hypotension , do you have a policy to give empiric therapy ?If the tests for other infections are negative . It is probable that you are dealing with an unknown viral disease . The label of ' viral fever ' is commonly used & can be misleading & more research is needed to identify this group .
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