Muhammad Faheem Afzal, Muhammad Ashraf Sultan.
Haemorrhagic Manifestations of Dengue Haemorrhagic Fever in Children.
Infect Dis J Jan ;22(2):563-5.

Objective: The World Health Organization (WHO) declares dengue fever and dengue hemorrhagic fever to be endemic in South Asia. Pakistan has faced world’s largest epidemic of dengue in 2011. We aim to determine the haemorrhagic manifestations of dengue haemorrhagic fever (DHF) in children. Methodology: This cross sectional study was conducted in the department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore from May to October 2011. A total 50 children of age ≤12 years consistent with clinical case definition of DHF were enrolled by consecutive sampling. Haemorrhagic manifestations (Positive tourniquet test, petechiae, ecchymoses or purpura, or bleeding from mucosa, gastrointestinal tract, injection sites, or other locations) were recorded. Diagnosis of dengue infection was confirmed by acute phase serum sample for dengue IgM & IgG (ELISA). Results: Among 50 cases of DHF, mean age was 6±2 years. Majority (62%) were >5 years of age. Among haemorrhagic manifestations, petechiae was the most common observation (70%) followed by positive tourniquet test (50%) and mucosal bleed (30%) while GI bleed was observed in 4% cases only. As the severity of DHF increased, positivity of tourniquet test decreased. In non-shock patients, tourniquet test was positive in 67% of patients while it was positive only in 34% of patients with shock. Mucosal bleed was observed in severe cases (46%). Major bleed was uncommon. Conclusion: Petechiae was the most common (70%) haemorrhagic manifestation observed in children with DHF.

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