How to differentiate Dengue fever from MIS-C,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist ,Mohan Nagar,Ghaziabad,Delhi NCR

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How to differentiate Dengue fever from MIS-C,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist ,Mohan Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 25 Oct, 2021 - Professionals Guide, - 0 Comment

Severe Dengue fever and Multisystem inflammatory syndrome in children(MIS-C) both are the states of cytokine storm

Both these conditions present almost similarly,clinically

In the period of September-October 2021 both disease conditions are being seen frequently in India

Severe Dengue fever is caused by Dengue virus ,transmitted into human through Aedes mosquito bites

MIS-C is a post COVID 19 state

It is very important to differentiate between these two conditions for the treatment purposes as the treatment of these two are entirely different
In cases of severe Dengue fever the mainstay of treatment is aggressive fluid therapy with crystalloid ,colloid and when needed ionotrops and platelet transfusion if severe thrombocytopenia.
In contrast,aggressive fluid therapy may be life threatening in MIS-C,in which there may be left ventricular dysfunction.In this condition, the mainstay of treatment is intravenous steroid with or without IVIG.Other medications required are low molecular heparin and aspirin.

If there is fever with prominent vomiting,myalgia,erthmatous rashes,profound weakness and on investigations there is leucopenia,severe thrombocytopenia,hemoconcentration and raised serum Ferritin,it is indicative of severe Dengue fever. Positive NS1 antigen and or IgM antibody for Dengue virus confirms the diagnosis
If there is conjuntival injections,swelling of hands and feet,altered sensorium and diarrhoea along with fever, and on investigations leucocytosis,fibrogienemia,raised serum D-Dimer,raised serum IL6 ,it is leading towards the diagnosis of MIS-C. Positive RT-PCR or antibody againt COVID 19 confirms the diagnosis.

REFERENCES:1.Indian Pediatrics:volume 58;15 october 2021
2. Ahmed M, Advani S, Moreira , et al. Multisystem
inflammatory syndrome in children: A systematic review. E
Clin Med. 2020;26:100527.
3. Mishra S, Ramanathan R, Agarwalla SK. Clinical profile of
dengue fever in children: A study from southern Odisha,
India. Scientifica (Cairo). 2016;2016:6391594.

Dengue fever/MIS-C,DR D.K.JHA,M.D.,Pediatrician and Pediatric Pulmonologist Delhi

DR DEV KUMAR JHA - 21 Oct, 2021 - INFECTIOUS DISEASES,Pediatric Emergency, - 0 Comment

In the period of october 2021,both Dengue fever and Multi system inflammatory syndrome in children(MIS-C) are being seen in children in Delhi,India

Clinical and laboratory features are overlapping for both these diseases

It is important to differentiate between these as management entirely differs for both

In case of Dengue fever the cornerstone of management is aggressive fluid therapy with crystalloid and colloid with ionotrops if fluid therapy does not work and platelet transfusion if needed.

In cases of MIS-C, the cornerstone of management is steroids and IVIG(Immunoglobulins).Aggressive fluid management may be detrimental in cases of shock with cardiac dysfunction.

Fever are common in both but swellings of feet and hands,diarrhoea,conjuntival injections and altered sensorium along with the laboratory findings of hyperinflammation like highly raised CRP,Leukocytosis,raised D-Dimer are pointers towards MIS-C .In this situations,anti COVID antibody should be done and if positive ,confirms the diagnosis of MIS-C

If fever is associated with vomiting ,erythmatous rashes,myalgia along with the laboratory findings of leucopenia ,severe thrombocytopenia,hemoconcentration , raised serum ferritin level,it points towards the diagnosis of Dengue fever and NS1 antigen and or anti Den IgM should be done which when positive confirms the diagnosis of Dengue fever

In comparision to MIS-C,serum Ferritin level is higher in Dengue fever

References:

1. Ahmed M, Advani S, Moreira A, et al. Multisystem
inflammatory syndrome in children: A systematic review. E
Clin Med. 2020;26:100527.

2.Mishra S, Ramanathan R, Agarwalla SK. Clinical profile of
dengue fever in children: A study from southern Odisha,
India. Scientifica (Cairo). 2016;2016:6391594

3.Indian Pediatrics,volume 58,15 October,2021

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