Changing clinical profile of Dengue infection: A newer perspective in the pediatric population

Abstract

Background: Traditionally complications of Dengue infection is limited to vascular and haematological system. The present study describes the changing clinico-epidemiological and laboratory profile of children hospitalized with dengue infec- tion. Methods: Prospective observational study of children hospitalized with a diagnosis of dengue illness from October to December, 2010 at a tertiary care centre in Kolkata. Results: Of 50 children admitted with dengue infection, 24 had dengue fever (DF), 18 dengue hemorrhagic fever (DHF) and 8 had dengue shock syndrome (DSS). The mean age of affected children was 6.25 ± 3.34 years, mostly being males from rural areas. The common clinical manifestations were fever, rash, body ache, hemorrhagic manifestations and oedema. While headache and body ache was commoner among DF cases, rash and hemorrhagic manifesta- tions were significantly more among DHF group. Incidence of altered sensorium, neck rigidity, fulminant hepatitis, and sple- nomegaly were significantly higher among the DHF/DSS group. 12% case fatality rate was found. Conclusion: Clinical mani- festations of dengue seem to be changing. Fever, rash and bodyache are not the only clinical presentations. Encephalopathy, encephalitis, 6 th cranial nerve palsy, fulminant hepatic failure, acute acalculous cholecystitis, myocarditis, myelitis, spleno- megaly are some unusual but novel presentations of dengue in pediatric population that clinician in endemic area should be aware of though they are not mentioned in conventional guidelines Dengue is no longer restricted to urban areas but has propensity to spread to rural areas also.