Dengue Fever

A previously well 7-month-old baby girl presented with a 2-day history of fever with a maximum temperature of 103.4 F, coryza, and occasional cough. There was no family history of a similar illness. The child was feeding well, had a good urine output, and physical examination was normal. She was diagnosed with probable upper respiratory tract infection and prescribed paracetamol and investigated in view of high fever. The initial laboratory data revealed: hemoglobin11.2 g/dL, hematocrit 33.6%, white blood cell count 3400/mm3 absolute neutrophil count 1452/mm3, platelets 115,000/mm3, and C-reactive protein 0.6 mg/dL. Urine routine was normal and culture showed no growth. The child came back after 48 h with continued fever, flushing, and reduced play activity. Dengue fever was suspected and blood investigations were sent. The infant was hospitalized and managed symptomatically and monitored. Dengue NS1Ag and serology for IgM antibodies were positive. At 24 h of hospitalization, she became drowsy and her urine output was 0.4 mL/kg/h and capillary filling time (CFT) was 3 s. Her peripheries were cold, and blood pressure was 90/70 mmHg. The hemoglobin level was 13.6 g/dL, hematocrit 40.8%, and platelet count 32,000/mm3. Intravenous crystalloids were administered according to the WHO protocol, and her urine output and CFT improved. However, 12 h later, she again developed cold peripheries and her CFT was again prolonged. She was shifted to the intensive care unit, resuscitated with crystalloids, and closely monitored. The patient improved hemodynamically after 24-h management and was discharged asymptomatic after 48 h.