ABSTRACT
Dengue fever has become a major public health concern during the last few years with an alarming increase in the incidence in 2017. The state of Kerala was one among the top of the list in India reported to have severe dengue infection. The two main districts in Kerala with high prevalence were Thiruvananthapuram and Palakkad, of which latter is the main referring area to our institution. This study was conducted to evaluate the clinical and demographic profile of children affected with dengue fever and determine the predictors of severity.METHODSThis is a hospital based prospective study done at the Department of Paediatrics, Government Medical College, Trissur, during the Monsoon season in 2017. Children diagnosed to have Dengue fever and confirmed by NS1 Ag test or IgM Elisa were included. Children were classified into 3 clinical groups and compared. Comparison was also made in 2 groups as dengue with warning signs and severe dengue as per WHO 2015 clinical guidelines, to find out the predictors of severity. Qualitative data was analysed and expressed in proportions and quantitative data in mean and standard deviation. Chi-square (χ2) test was used to evaluate the association between qualitative variables and ANOVA for quantitative variables. p value less than 0.05 was considered significant. SPSS 16.0 software was used for statistical analysis.RESULTSA total of 235 children were included. 77 children (32.9%) had mild dengue fever, 106 (45.29%) had DWS and 52 (22.22%) were having DSS). Mean age was 6.61± 3.497 years. 19 cases (8.2 %) were Infants below 1 year of age. Majority of children had normal nutritional status. Myalgia, tiredness, vomiting, diarrhoea, abdominal pain, flushing, bleeding, oedema, hypotension, were found to be the common clinical manifestations. Thrombocytopenia, elevated serum hepatic enzymes both SGOT and SGPT, abnormal renal function tests, low sodium, hypoalbuminemia, hypoglycaemia, abnormal radiological findings were found to be the predictors of severity. We had many cases of expanded dengue syndrome including 3 cases of Hemophagocytic lymphohistiocytosis (HLH). The mortality was 0.6%.CONCLUSIONSDengue fever can affect children irrespective of their age or nutritional status. Older children and male sex were found to be more affected. There are definite clinical and lab parameters which can predict the severity in Dengue fever. Though severe illness is associated with high morbidity early diagnosis and timely appropriate clinical management, correction of dehydration along with proper referral system can save the children. The mortality can be reduced to zero even in patients having expanded dengue syndrome and Dengue shock syndrome. None of the comorbidities had affected the outcome.
ABSTRACT
Background: Leptospirosis is a common zoonosis caused by bacteria, Leptospira. The core determinants of the disease are the presence of carrier animals, environmental factors and the interaction between man, carrier and the environment. Understanding the type of relation between these factors and leptospirosis will help in controlling the disease. The current study intends to find the trend of leptospirosis cases, to forecast the disease and to correlate number of cases of leptospirosis with meteorological factors.Methods: The data of leptospirosis cases and the meteorological factors in Thrissur district were collected and entered in MS- Excel and statistical analysis was done using SPSS-16.0. For analysing the trend and to forecast the same, time series analysis method was used. The correctness of the model was tested using Ljung-Box statistics.Results: Time series chart, autocorrelation and partial autocorrelation show leptospirosis follows a seasonal trend. Forecasting of leptospirosis cases from July 2018 to May 2019 made by the model matched with original number reported in Thrissur district. Cross correlation of total rainfall and total rainy days showed that leptospirosis peak approximately 1 month after the onset or together with the rain (lag-1 and 0, r0.471 and 0.380 for total rainfall, lag-1 and 0, r0.501 and 0.469 for total rainy days). Humidity positively affects number of leptospirosis cases (lag-1 and 0, r0.464 and 0.435). June to October, seasonally adjusted factor (SAF) was >100% with highest SAF in August (202.2%).Conclusions: Leptospirosis shows a seasonal trend with more cases in June to October and correlates with change in meteorological factors of the region.