Background Dengue is a tropical disease and can cause complications including shock. The incidence of dengue is increasing in UK due to increased travel to endemic areas. We present the case of a 8 year old male child admitted with Dengue Haemorrhagic fever on return from India.
Case Presentation We present the case of a 8 year old male child admitted with fever and being unwell for 10 days. He did not have any other symptoms such as abdominal pain, vomiting, diarrhoea, cough, cold or rashes. He had returned from travel to Bangalore, India where he stayed for 3 weeks. There was no significant family history. His systemic examination was normal with no evidence of hepatosplenomegaly.
Investigations Blood tests on admission were unremarkable. Investigations for malaria, typhoid, hepatitis and pneumonia were all negative. He developed thrombocytopenia in the following days and developed petechiae and nose bleeds. Serology and PCR for dengue was sent which was positive.
Treatment He was started on intravenous ceftriaxone. Treatment was mainly supportive, in the form of intravenous fluids and fever control. He received a platelet transfusion for thrombocytopenia with clinical evidence of bleeding in form of epistaxis and petechiae.
Outcome and follow-up As his symptoms improved and his blood values normalised, the child was discharged with open access. He was reviewed in the clinic and is doing well.
Discussion Dengue fever is endemic to the tropical regions and is mainly transmitted by the Aedes aegypti mosquito. Dengue fever is on the rise in UK due to increased travel to endemic areas. The diagnosis of Dengue fever is suggested by leucopenia, thrombocytopenia and raised liver function tests. The diagnosis of dengue is confirmed by PCR and the presence of antibodies in serum. Supportive management is the main treatment for complications such as Dengue haemorrhagic fever and Dengue shock syndrome.
Dengue fever needs to be excluded in any child presenting with fever who is returning from an endemic area.
Dengue fever can present with a mild illness initially, but early diagnosis is important to start the supportive therapy and close monitoring as these children can have rapid clinical deterioration.
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