Paediatric Dengue

Oops, almost forgot that I was here on medical elective!

I spent last week on the Infectious Diseases ward and learnt all about Dengue Haemorrhagic Fever from the Head of ID and Cambodian expert on the disease. So that'll be really handy if I come back to Cambodia one day. Otherwise, in my very un-tropical part of the world, I'll be lucky if I ever see it again.

Basically, there are four subtypes of Dengue (D1-D4). Your primary infection is the first time you get infected, and you'll develop "classic dengue" which isn't particularly dangerous. But then if you get infected with a different subtype, your body mounts a huge and inappropriate immune response, releasing histamine which causes capillary leakage. 

This leads to oedema, pleural and peritoneal effusions (and an increased haematocrit to >20% from the baseline from haemoconcentration). Platelet count drops, so you bruise easily and develop petechiae (little red spots), and risk DIC ("consumption coagulopathy") and massive internal bleeding. Your liver becomes painful and enlarged due to microabscesses. You get joint pains, headache, eye pain, lose your appetite and have no energy. You're treated with fluids and an almost-therapeutic dose of paracetamol to help with the pain (not too much because your liver is inflamed).

And to top it all off, you're four years old and people with white coats keep coming around making you cry.

And that's paediatric dengue.