In Mumbai, India there is an increase in dengue, malaria and leptospirosis during the monsoon season.1 Children present with fever, vomiting and hypotension, which makes it difficult to identify the aetiology. Thus, we undertook a study over a period of 1 month from 15 July 2005 to 14 August 2005 to determine the clinical and laboratory features of these illnesses. Thirty two patients with fever, vomiting, diarrhoea, bleeding manifestations, hypotension, hepatomegaly, splenomegaly, jaundice and/or oliguria were registered as probable cases of dengue, leptospirosis or malaria. Diagnosis of dengue was based on a positive IgM capture ELISA test.2 Diagnosis of leptospirosis was made on a positive leptospira TRI‐DOT test and confirmed by a positive leptospira IgM ELISA test. Diagnosis of malaria was based on demonstration of malarial parasites on peripheral blood smear or a positive OptiMAL test. Data were compared using the χ2 test for proportions and analysis of variance (one way ANOVA) for continuous data.
Eleven patients (34.4%) tested positive for dengue IgM, nine patients (28.1%) tested positive for leptospirosis and seven patients (21.9%) tested positive for malaria. Four (57.1%) of the seven patients with malaria had vivax malaria, two (28.6%) had falciparum malaria and one (14.3%) had mixed falciparum and vivax malaria. Two patients (6.3%) grew Pseudomona aeruginosa on blood culture and two patients (6.3%) had dysentery and giardiasis. Co‐infection was seen in six (19%) patients. Patients with dengue had the highest packed cell volume (PCV), whereas patients with malaria had a low PCV. Patients with malaria had the lowest platelet count, patients with dengue had a platelet count of less than 100 000/mm3 and patients with leptospirosis had a near normal platelet count. Blood urea nitrogen (BUN) and creatinine were elevated in patients with leptospirosis. Elevated serum glutamic pyruvic transaminase (SGPT) and hepatomegaly was seen in dengue and splenomegaly was seen in malaria. Other clinical and laboratory features are depicted in table 1.
Table 1 Clinical and laboratory abnormalities in dengue, leptospirosis and malaria.
| Dengue | Leptospirosis | Malaria | p value | |
|---|---|---|---|---|
| Age (years) | 4.6±3.4 | 7.6±4.5 | 7.7±2.5 | 0.2 |
| PCV on admission (%) | 36.7±7.5 | 30.6±7.4 | 17±5.6 | 0.005 |
| WBC (cells/mm3) | 12 111±5980 | 10 680±3504 | 8900±1735 | 0.76 |
| Platelet count (cells/mm3) | 97 555±74 453 | 116 200±88 302 | 66 667±62 140 | 0.02 |
| BUN (mg/dl) | 13.5±4.7 | 28.8±16 | 23.5±16.2 | 0.002 |
| Creatinine (mg%) | 0.7±0.2 | 1.8±0.9 | 0.9±0.2 | 0.0004 |
| Recovery (days) | 5.4±1.5 | 5.4±1.5 | 6.3±1.2 | 0.52 |
| Male | 5 (21%) | 5 (21%) | 2 (8%) | 0.28 |
| Female | 4 (50%) | 0 | 1 (13%) | |
| Hepatomegaly | 6 (42.9%) | 2 (14.3%) | 3 (21.4%) | 0.03 |
| Splenomegaly | 0 | 0 | 2 (50%) | 0.0005 |
| Elevated SGPT | 7 (58.3%) | 2 (16.7%) | 2 (16.7%) | 0.01 |
| Fresh frozen plasma | 3 (60%) | 0 | 0 | 0.01 |
| Ionotropes | 3 (42.9%) | 0 | 2 (28.6%) | 0.02 |
Values are mean±SD or n (%). BUN, blood urea nitrogen; PCV, packed cell volume; SGPT, serum glutamic pyruvic transaminase; WBC, white blood cells.
To conclude, patients with dengue had haemoconcentration, thrombocytopenia, elevated SGPT and hepatomegaly as reported in previous studies.1,3 Anaemia and splenomegaly in a child with fever and thrombocytopenia was predictive of malaria. Interestingly, patients with leptospirosis presented with fever and non‐oliguric renal failure and near normal platelet count. Renal failure in patients with leptospirosis is due to tubulointerstitial renal failure.4,5,6 All our patients recovered with penicillin and thus renal biopsy was not carried out. Although, our patients recovered within 4–5 days, those with dengue and malaria required ionotropic support. In addition, patients with dengue also required fresh frozen plasma because of bleeding.
Acknowledgements
The authors thank Dr Dod, Chief Senior Executive, B.J. Wadia Hospital for Children for giving permission for the publication of this article.
Footnotes
Competing interests: None.
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