Dengue positivity and Laboratory assessment of disease severity of paediatric appendicitis cases presenting with right iliac fossa pain, hospitalized in public children hospitals in Yangon

Background: Many surgical diseases and some medical diseases including dengue can present right iliac fossa (RIF) pain in children. Treating such children with right decision to select medical or surgical treatment requires rapid and accurate diagnosis which can be made by assessing clinical, dengue serological and haematological features. Objective: This study was conducted with the objective to find out the applicability of basic laboratory tests in assessment of disease severity and dengue positivity of paediatric appendicitis cases. Materials and Methods: A cross-sectional study was conducted at surgical wards of Yangon Children Hospital and Yankin Children Hospital during August-October 2024 recruiting all children with acute RIF pain. Participants were physically examined and their abdomens were ultrasonographically investigated. Their sera were tested for dengue serological markers by Standard™ Q Dengue Duo Test (SD, Korea). Dengue non-structural protein-1 antigen (NS1 Ag) positive sera were subjected to serotyping by conventional reverse-transcriptase polymerase chain reaction. Complete blood count of participants was investigated by haematology analyzer (SYSMEX XN-550). Data analysis was done by SPSS-16. Association between categorical variables was tested by Fisher’s Exact Test. Results: There were 61 children with RIF pain, of which 36 children were eligible to participate in the study. Their mean age was 9.7 ± 2.1 years. Their clinical features were RIF pain (100%, n = 36/36), fever (58%, n = 21/36), vomiting (53%, n = 19/36) and constipation (11%, n = 4/36). Twenty out of 36 participants (56%) were cured by medication and sixteen (44%) by surgery. According to post-operative and ultrasonographic findings, the commonest cause was uncomplicated appendicitis (61%, n = 22/36) followed by perforated appendicitis (19%, n = 7/36). Dengue NS1 Ag was detected in only one child (3%) whose abdominal ultrasonography showed no abnormality but blood picture showed moderate thrombocytopenia (70,000 thrombocytes per microliter of blood). The dengue virus detected in that case belonged to serotype 3. Compared to uncomplicated appendicitis cases, perforated appendicitis cases were more likely to have fever (p = 0.023), a leukocyte count greater than 19,000 cells per microliter of blood (p = 0.0004), a neutrophil count greater than 15,000 cells per microliter of blood (p = 0.0004), a lymphocyte count less than 1,000 cells per microliter of blood (p = 0.0339) and a neutrophil-to-lymphocyte ratio greater than 9 (p = 0.018). Conclusion: This study generated the information applicable in diagnosis of children with acute RIF pain including dengue and assessment of the disease severity of appendicitis especially in resource limited hospital settings. Keywords: assessment of disease severity, dengue positivity of paediatric appendicitis cases, Yangon Children Hospital, Yankin Children Hospital