Hematological Manifestations of Dengue, Malaria and Enteric Fever in Children Presenting To a Tertiary Care Hospital, Pakistan

Abstract

Objective: Dengue fever, Malaria and Enteric fever are common pediatric acute febrile illnesses, pre- senting with overlapping clinical manifestations. The hematological parameters of these disease may give a clue to the specific diagnosis before definitive investigations are available. We designed this study to determine the hematological predictors of dengue fever, malaria and enteric fever in pediatric inpatient population.

Methods: We collected data for this observational study from May to October 2022 from Pediatrics De- partment, Dr. RKMP Civil Hospital Karachi. We reviewed the medical records of patients 1 month to 12 years of age admitted with definitive diagnosis of dengue, malaria and/or enteric fever. We re- corded the demographic and clinical variables and hematologic parameters of Complete Blood Count and calculated the P value and sensitivity / specificity of each parameter in SPSS 22.0, for differentiating the three diseases.

Results: A total of 205 patients were included in the study, out of which 82 (40%) had malaria, 71 (34.6%) had dengue and 52 (25.4%) had enteric fever. Male gender was predominant in 73.6%. Patients with dengue fever mostly had normal hemoglobin (>11gm/dl) with a higher hematocrit, lymphopenia (<40%) and thrombocytopenia (50,000-100000/ul), while in enteric fever moderate anemia (7-9gm/dl) with normal TLC and platelet count was mostly found and for malaria severe anemia (<7gm/dl) and thrombocytopenia (<50,000/ul) with a normal TLC count were predictive of disease (P value<0.05).

Conclusion: Lymphopenia and Thrombocytopenia are predictors of dengue fever, moderate anemia with preserved platelet count suggests enteric fever while severe anemia and thrombocytopenia should predict malaria in the appropriate clinical setting. Key words: Dengue, Malaria, Enteric fever, Anemia, Thrombocytopenia