Several doctors have seen a spike in dengue fever in children this monsoon. Dr Sagar Lad, paediatric intensivist at Pune’s Jehangir hospital, said the situation is slightly more challenging as most of these patients do not present symptoms of direct dengue.
“There are many layers to this and if not treated or tested on time this may get fatal too as the hidden dengue virus gets diagnosed at the very end, giving it enough time and space to cause other health problems,” Dr Lad told The Indian Express pointing to a specific rare case of dengue induced Acute Respiratory Distress Syndrome (ARDS) in Arush Wandhekar, a four-year-old boy from Maharashtra’s Ahmednagar .
This life threatening lung injury where the breathing becomes difficult and oxygen cannot enter the body caught this family from Ahmednagar unawares and they spent more than 10-12 days at Jehangir hospital praying for their boy to survive the severe dengue attack.
Arush’s maternal uncle Rahul Shinde said the authorities at Ahmednagar’s Siddhi Vinayak hospital referred them to Jehangir hospital when the child did not show signs of improvement.
“It is difficult to imagine what would have happened had we not come on time,” he added.
Dr Lad said the child was in a “state of shock as he had a poor pulse, low blood pressure and excessive drowsiness”.
“He received the required medicines and fluids to stabilize his blood pressure. A thorough diagnosis and evaluation confirmed it to be a case of dengue shock syndrome along with other complications. The initial tests showed very less platelet count close to 10,000 and there was a rapid drop in his blood pressure,” Dr Lad said.
“We gave the required medication and platelets to stabilize his condition, but suddenly his breathing deteriorated and we initiated a high-flow nasal cannula system. Later he showed respiratory failure and needed ventilator support,” he added.
Dr Lad said “there was a lot of water accumulation in his lungs that it became very difficult initially to ventilate him”.
“We had to drain out the water from his lungs and then we kept him under a ventilator. He required a very high setting of the ventilator. On further monitoring, we found out that his liver was showing abnormal functioning, his heart function was also getting compromised, by then the dengue virus had affected his brain cells too,” Dr Lad said.
“His blood tests showed that there was hyper ferritin or HLH (Hemophagocytic Lymphohistiocytosis) or Macrophage Activation Syndrome (MAS). This is a rare case of dengue where only two to three per cent of dengue cases can land up to HLH wherein the entire body’s blood cells gets affected, causing liver injury, heart injury, a drop in platelet count, abnormal clotting system, massive drop in blood pressure causing a refractory shock in the patient,” he added.
HLH is a life threatening condition and its diagnosis can be challenging because the initial symptoms may mimic other problems such as persistent fevers, rash, enlarged liver, low platelet count and altered mental functions.
“This is a life threatening complication seen in children as early as six months of age. However, if diagnosed early and treated aggressively it can definitely improve the outcome. Now considering this patient’s condition and criticality of the disease, he was aggressively treated for HLH. After 48 to 72 hours, he started showing improvement and recovered completely in a week’s time and was discharged four days ago,” Dr Lad said.
The other team members, including Dr Aarti Jindal, Dr Anita Malpani, Dr Salma Ahmed and Dr Gargi Deshpande, were also actively involved in managing the case along with Dr Lad.