Dengue Syndrome Research Articles

Dengue fever complicated by abscess formation: An atypical presentation

Abstract: Dengue fever is a mosquito-borne disease with a wide clinical spectrum, ranging from self-limiting mild sickness to expanded dengue syndrome (EDS). Despite extensive investigation into the immunological pathogenesis of dengue virus (DENV) infection, the precise mechanism remains unclear. DENV’s transitory reduction of host innate immunity could be the most likely cause of dengue-associated coinfections and/or superinfections. Furthermore, the dual infection can aggravate the clinical course of dengue fever. We document an unusual case of dengue fever in a 27-year-old healthy male, exacerbated by cellulitis and myositis involving the posterolateral compartment of the proximal and midcalf, which was later discovered to be an abscess. Blood culture showed methicillin-sensitive Staphylococcus aureus. This case shows the possibility of bacterial coinfections in dengue patients, especially in the context of immunosuppression, as well as the need for early recognition of atypical characteristics and the novel entity known as EDS.

Therapeutic plasma exchange in expanded dengue patients having acute liver failure: A case series.

Expanded dengue syndrome is a severe form of dengue fever that can cause acute liver failure and patients with this condition have a high mortality rate. This is because it can cause a cytokine storm, Unfortunately, standard treatments are often ineffective. Therapeutic plasma exchange is a procedure that removes cytokines and improves the patient's condition. Our study involved 15 patients with expanded dengue syndrome having acute liver failure, who were not responding to standard therapies. We treated them with plasmapheresis, and 11 of the patients showed significant improvement in liver function and survived. Unfortunately, the remaining four patients died owing to other complications. Early treatment is crucial for the best possible outcome.

Dengue-Associated Acute Necrotizing Encephalopathy Is an Acute Necrotizing Encephalopathy Variant Rather than a Mimic: Evidence From a Systematic Review

BackgroundBilateral hemorrhagic thalamic lesions in dengue encephalitis resemble lesions seen in acute necrotizing encephalopathy (ANE). We investigate whether dengue-associated ANE (DANE) should be considered an ANE variant or a mimic. MethodsSystematic review of dengue encephalitis literature from PubMed and SCOPUS (inception to December 31, 2022). Diagnostic criteria for ANE, acute encephalitis (AE), acute disseminated encephalomyelitis (ADEM), and infection-triggered encephalopathy syndromes were applied. ResultsData on 162 patients (median age 20 [0.4 to 79] years; 69 [42.3%] female; 72 [44.4%] aged ≤18 years) from 103 articles were analyzed. DANE (62, 38.3%) was the commonest, followed by AE (56, 34.6%) and ADEM (27, 16.7%). The main clinical features were fever (100%), thrombocytopenia (79.0%), headache (57.8%), and seizures (43.7%). Patients with DANE had earlier neurological deterioration (3.5 [1 to 8] vs 5 [1 to 14] days in other encephalitis syndromes, P = 0.0127), seizures (54.2% vs 37.4%, P = 0.0471), higher cerebrospinal fluid (CSF) protein (0.92 [0.18 to 4.8] vs 0.73 [1 to 16] g/L, P = 0.0469), thalamic (100% vs 8.0%) and hemorrhagic brain lesions (73.3% vs 7.5%, P < 0.0001). CSF pleocytosis and positive CSF dengue IgM/viral polymerase chain reaction were reported in 66.7% and 78.6% with DANE. Mortality was 16.1% in DANE, and 40.6% of survivors had disability. High-risk ANE severity scores predicted poor outcomes (positive predictive value 64.3% [95% confidence interval 38.8% to 83.7%]). ConclusionDANE differs from other dengue encephalitis syndromes and is clinicoradiologically indistinguishable from sporadic ANE with sufficient evidence to be considered an ANE variant.

Dengue rhabdomyolysis successfully treated with hemoperfusion using CytoSorb® in combination with continuous renal replacement therapy: a case report

BackgroundDengue fever is a mosquito-borne viral infection with a broad spectrum of clinical manifestations. Expanded dengue syndrome includes unusual manifestations that do not fall into the categories of dengue fever, dengue hemorrhagic fever, or dengue shock syndrome. Rhabdomyolysis causing acute renal failure in dengue is one such unusual manifestation, the pathophysiology of which is incompletely understood.Case presentationWe describe a 21-year-old Sri Lankan man with dengue fever who developed severe rhabdomyolysis and acute kidney injury with extremely high creatinine phosphokinase levels (> 2 million U/L). Management of this patient was challenging as his creatinine phosphokinase kept rising with persistent anuria despite hydration, intermittent hemodialysis, and, later, continuous venovenous hemodiafiltration. Further therapeutic options were explored, and CytoSorb® adsorber was added as an adjunct to continuous venovenous hemodiafiltration, following which we observed a marked reduction in his creatinine phosphokinase and myoglobin levels over the next 12 hours and complete renal recovery over the next 5 weeks.ConclusionWe report a rare case of significant rhabdomyolysis secondary to dengue infection leading to acute kidney injury. Continuous venovenous hemodiafiltration performed with the hemofilter Pecopen 140 was ineffective, and the addition of CytoSorb® adsorber as an adjunct therapy to continuous venovenous hemodiafiltration may have a potential benefit in removing high-molecular-weight proteins such as myoglobin.

Clinical and Laboratory Profile of Dengue Syndrome in Pediatric patients: Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Introduction: Dengue fever is a mosquito-borne arboviral (arthropod-borne virus) disease which is of global concern. This fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, arthralgia, rash, leukopenia, and lymphadenopathy. Aim of the study: This study aimed to evaluate the clinical and laboratory profile of dengue fever in children less than 15 years old admitted to an urban hospital. Methods: This retrospective study was conducted in the Department of Paediatrics of Anwer Khan Modern Medical College Hospital (AKMMCH), Dhaka, Bangladesh during the period from 4 April 2019 to 9 September 2019. They have followed up on the symptoms, platelet count and management of the patients. Data were analysed by using MS-Excel-2016. Result: In total 98 patients from both groups completed the study. In our study, we found a maximum of 54.08% were male, more than half 53(54.08%) patients were below five years of age, about 95(96.94%) of the patients had a fever. Maximum patients, 81(82.65%), were managed by I/V fluid, more than 72(73.47%) of the patients were managed by paracetamol. Others by antibiotics 16(16.33%), platelet transfusion 14(14.29%) and blood transfusion 12(12.24%). Other management also includes plasma, &amp; dopamine. Conclusion: These study children about 0-15 years of age more commonly suffer from dengue fever. As the vaccine is not available in Bangladesh, these patients need a timely diagnosis and critical monitoring during the disease course to prevent severity and mortality.

CLINICAL PROFILE OF EXPANDED DENGUE SYNDROME IN CHILDREN.

The objective is to study the clinical profile and outcome of expanded dengue syndrome (EDS) in children. We conducted a retrospective cohort study and enrolled consecutive children (1 month to 18 years) who presented with dengue fever for over 1 year. The diagnosis of dengue fever was confirmed by the presence of dengue NS1 antigen and/or dengue IgM positivity. Subsequently, we identified children exhibiting EDS according to the revised World Health Organization guidelines (2011). We compared the clinical and laboratory profiles of children diagnosed with EDS and those without EDS. Of 178 children with dengue fever, 33 (18.5%) had EDS [95% confidence interval (CI): 13.1%-25.0%]. In these 33 children, neurological involvement was the most common manifestation [n = 16/33 (49%, 95% CI: 32%-65%)], namely encephalopathy, febrile seizures and encephalitis, respectively. Gastrointestinal involvement was the second most common [n = 10/33 (30%, 95% CI: 17%-47%)], which included fulminant hepatic failure, acalculous cholecystitis and acute pancreatitis. Renal presentation [n = 7 (21%, 95% CI: 10%-37%)] was limited to acute kidney injury. Children with EDS were significantly anemic and had leukocytosis, hyperkalemia, azotemia, hyperbilirubinemia, raised serum transaminases and fluid-refractory shock than their non-EDS counterparts. Children with EDS had a trend toward higher mortality (P = 0.07) and the survivors had a longer duration of hospital stay (5 days vs. 4 days in non-EDS, P = 0.001). In conclusion, we observed a high prevalence (18.5%) of EDS among children hospitalized for dengue fever. The common manifestations of EDS include neurological, renal and gastrointestinal involvement. Children with EDS showed a trend toward higher mortality and longer duration of hospital stay than children without EDS.

Expanded Dengue Syndrome with Pulmonary Manifestations: A Case Report

Dengue fever is a vector-borne disease that is spread by mosquito called Aedes-egypti. It belongs to Flavivirus family, of which 4 serotypes have been identified. Its incubation period ranges from 7 to 10 days. Currently, dengue fever causes more illness and death than any other arbovirus disease of humans Dengue viruses are distributed world wide in tropical regions. It is currently endemic in 128 countries, mostly developing countries, putting an estimated 3.97 billion people at risk each year. Changing and increasing incidences are associated with rapid urban population growth, overcrowding, and lax mosquito control measures.

Chronic Dengue Syndrome: A Narrative Review

Dengue fever (DF) is a dynamic disease. As the disease progresses, the course of treatment changes. Symptoms range from mild (e.g., fever, headache, retroorbital pain, nausea, vomiting, rash, myalgia, arthralgia) to severe body pain (e.g., rash fever), severe (e.g., dengue hemorrhagic fever) (DHF) and dengue shock syndrome. It changes. (DSS). DHF and DSS are associated with poor outcomes. Although there is a classification of dengue into DF, DHF, and DSS, overlap has been observed between the different presentations. In dengue, end organ damage such as liver, kidney, heart, brain, and bone marrow involvements are often reported along with blood plasma or hemorrhage. Order support system. The World Health Organization recognized these unusual symptoms and coined the term "Extended Dengue Syndrome" (EDS) to encompass atypical manifestations of neurological, renal, hepatic or other isolated diseases that occur with or simultaneously with serious diseases. Co-infections or other diseases in the host. EDS is now recognized worldwide as a common cause of dengue fever, and information continues to appear in medical journals. This review discusses this aspect of dengue fever, which covers the spectrum of symptoms in the body. This review article will help increase clinicians' knowledge about EDS and facilitate early detection and intervention.

A Case of Dengue Meningitis Manifested as a Part of Expanded Dengue Syndrome

Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retro orbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported called expanded dengue syndrome. We report a 35 years old lady with atypical and rare presentation of dengue disease marked by meningitis. Condition improved after conservative treatment. Neurological complications in dengue are now increasingly observed with the most common case is aseptic meningitis. Dengue meningitis is self-limiting in almost all cases. Hepatic failure rarely dominates the clinical picture in adults. The main mechanism of dengue meningitis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for neurological complications in patients with dengue illness and should manage this accordingly

Effect of Carica Papaya Leaves Juice on Plasma Leakage and Platelet Count among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to be increase platelet count and improve haematocrit. Objective: This study aimed to determine the effect of Carica papaya leaf juice on plasma leakage and platelet count in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p&gt;.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p&lt;.001. Haematocrit values become significantly normal in group A then group B by 72 hours and p˂.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p&lt;.001. Conclusion: Administration of Carica papaya leaf juice increase platelet count, maintain .......

Effect of Carica Papaya Leaves Juice on Duration of Hospital Stay among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to increase platelet count, reduce complication and duration of Hospital stay. Objective: This study aimed to determine the effect of Carica papaya leaf juice on duration of Hospital stay in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p&gt;.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p &lt;0.001. Haematocrit values become significantly normal in group A than group B by 72 hours and p value ˂0.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p &lt;0.001. Conclusion: Administration of Carica papaya leaf juice shorten hospitalization in patients with Dengue fever and Dengue haemorrhagic fever.

A curious case of expanded dengue syndrome.

Dengue fever (DF) primarily presents with fever, headache, malaise, bleeding manifestations and haemoconcentration. World Health Organization (WHO) classifies DF according to levels of severity: (a) without warning signs; (b) with warning signs, such as abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing haematocrit and thrombocytopenia; and (c) severe dengue with severe plasma leakage, severe bleeding or organ failure. Atypical clinical presentations of DF are defined as expanded dengue syndrome: this includes renal, cardiac, hepatic or cerebral damage. We report such a severe case where a young man developed acute kidney injury, acute fulminant liver failure and acute pancreatitis secondary to DF, but recovered.

Fluid management strategy in dengue acute respiratory distress syndrome with chronic kidney disease: A case report

Abstract Pulmonary manifestation in dengue is due to the involvement of both the upper and lower airways. Severe forms of dengue infection (pleural effusion, dengue hemorrhagic shock syndrome, and acute respiratory distress syndrome [ARDS]) are mainly due to the involvement of the lower respiratory tract. ARDS is a well-known respiratory complication following dengue infection. Patients with chronic kidney disease (CKD) diagnosed with dengue had a higher risk of unfavorable outcomes. Pulmonary involvement is one of the life-threatening complications in patients having CKD that contributes to increasing the mortality rate. Dysregulation of cytokines and apoptotic signaling pathway is a nonclassical mechanism of the kidney–lung crosstalk that results in the development of acute kidney injury in patients having ARDS. Severe worsening of renal function is common in CKD patients with dengue. Here, we discuss fluid management strategy in a patient having CKD who developed ARDS following dengue infection. The difficulty in the therapeutic dilemma is attributable to ambiguity in liberal versus conservative fluid therapy, contributing to a high risk of mortality. The narrow window of fluid tolerance in CKD patients further complicates the resuscitation strategy in patients with dengue ARDS.

Clinical and laboratory profile of Expanded Dengue Syndrome: experience of 2019 outbreak from Dhaka, Bangladesh.

Bangladesh is afflicted with periodic dengue outbreak every few years and one of the worst upsurges was recorded in 2019 during which there was an increasing trend of dengue with unusual symptoms which were not so common before. This study aims to describe the experience of three tertiary care centres of Dhaka regarding the clinical and laboratory, hospital outcome and management profile of the Expanded Dengue Syndrome (EDS) cases admitted from the 2019 outbreak. The current work was a cross-sectional observational study which took place from August 1 to December 31 2019 at three major tertiary care centres in Dhaka, Bangladesh. Out of total 2017 screened dengue cases, 49 met the inclusion criteria and 39 were enrolled after taking informed written consent. Data was analysed using Microsoft Excel and Graph pad prism 9.3.1. A probability value of p<0.05 was considered statistically significant. Out of the 39 cases, majority were male (79.49%) with median (±IQR) age of 33(±9) years. Hypertension (4; 10.26%) was the most commonly associated co-morbidity. Among the systemic manifestations, most prevalent was hepatitis (38.49%) followed by encephalopathy (12.82%). Majority of the patients were suffering from primary infection (85%). Case fatality rate was 15.38%. Hepatitis and meningoencephalitis were the predominant cause of death. This study records the only known case report of Acute respiratory dress syndrome (ARDS) complicating dengue from Bangladesh. None of the patients from our cohort were managed by steroids. Only two (5.13%) out of 39 cases received antibiotics. In the year 2019, an unusual rise in EDS cases with about 15.4% fatalities were observed in this study. Hepatitis was the most common presentation and cause of death. Here, we report the first ARDS case encountered in Bangladesh. Despite the multifaceted presentation of EDS, indiscriminate use of antibiotics and steroid was minimal. Early recognition of multifarious features of EDS is important for choosing the targeted treatment option which can avert many deaths. The results of this study underline the necessity for more in-depth research into the risk factors that are contributing to mortality in EDS cases.

Demographic Profile of Patients with Dengue Fever Presented in a Tertiary Care Hospital of Bangladesh

Background: Dengue is an important tropical infection caused by an arbovirus having four serotypes (DENV-1, DENV-2, DENV-3, DENV-4) transmitted through the bite of infected female Aedes mosquito. Dengue is a challenging disease with multisystemic, varied, atypical, and sometimes life-threatening presentations. It presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Each year, thousands of dengue infections are reported and there are several outbreaks of dengue in several countries including Bangladesh and this imply the global importance of this infection. The objectives of this study was to determine the sociodemographic variables of patient suffering from DF during an epidemic outbreak. Methods: This hospital review analyzed the hospital records of DF cases of BIRDEM General Hospital, Dhaka from June 2019 to December 2019. Patients with suspected dengue fever attending at the outdoor/emergency or admitted indoor were taken as study subjects. Data were collected from hospital records. Study protocol was approved by the Institutional Review Board. All the relevant data regarding history and examination findings of the patients, the laboratory reports were collected. Statistical package for social science (SPSS) version 22, was used for data entry and statistical analysis. Results: Total 292 dengue patients were enrolled in this study. Mean age of all patient was 35.63±15.22 years (11-85 year) with male predominance (54.8%). Maximum patients were from urban residence (83.9%), non-smoker (73.6%), had active lifestyle (63.4%) and normal body mass index (68.5%). Overall, 65.1% patients had no comorbidity and 89.4% had no concurrent acute illness. Conclusion: Although the results of this study cannot be generalized to other cities of Bangladesh, our findings will allow public health agencies in Bangladesh to concentrate their efforts to battle against dengue. J Bangladesh Coll Phys Surg 2023; 41: 63-68

Management of Two Cases of Expanded Dengue Syndrome with Myocarditis, Arrhythmia and Heart Failure

Dengue infection may present as asymptomatic, dengue fever, dengue hemorrhagic fever and dengue shock syndrome. However, atypical manifestations in other organs called expanded dengue syndrome. One of the cardiac complications in dengue is myocarditis. Our two patients resented here with fever followed by chest pain, sweating and collapse of Blood pressure and their lab reports were quite similar such as low platelet, ECG change, raised Troponin I, low ejection fraction on echocardiography. They were rescued by injection intravenous Methylprednisolone therapy. Here we present this case series to improve recognition and prevent progression to fatal outcome. In this regards healthcare providers should maintain a high degree of suspicion regarding potential cardiac complications in patients with dengue fever J Bangladesh Coll Phys Surg 2023; 41: 109-113

Expanded Dengue Syndrome with Multiorgan Involvement in a Woman with Twin Intrauterine Fetal Death - A Case Report

Dengue is the most rapid mosquito-borne disease in the world. As per the WHO guidelines for dengue fever, a list of atypical or unusual manifestations, also termed ‘Expanded Dengue Syndrome’ (EDS), is mentioned. Pregnancy increases the risk of expanded dengue syndrome. A 32-year-old woman with IUFD (twin) at 36 weeks gestation with H/O 1 C/S was reported with expanded dengue syndrome with multiorgan involvement. She was referred to a tertiary centre with H/O high fever, loose emotion, less fetal movement, and dengue NS 1 antigen positive. She was eventually diagnosed as having expanded dengue syndrome with multiorgan involvement with IUFD (twin) at 36 weeks. The decision of LSCS was taken by a multidisciplinary approach. She was managed with FFP, platelet apheresis, therapeutic plasma exchange, and I/V antibiotics, in addition to liver &amp; neurological support in the ICU unit. This case emphasised the hazards of dengue infection in pregnant women, which needs special consideration. Early recognition with careful monitoring and multidisciplinary management are the key factors in a favourable outcome for a dengue patient. J Bangladesh Coll Phys Surg 2023; 41: 105-108

Serum Ferritin Level as a Predictor of Disease Severity in Patients with Dengue Infection

Background: Dengue infection is a major public health threat. The clinical spectrum of dengue infection is variable from mild fever to severe forms. Early laboratory diagnosis of dengue fever is important to provide appropriate treatment to the patients and to prevent potential complications. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. This study evaluated the performance of serum ferritin to predict the severity of dengue at an earlier stage as it is an inexpensive and easily accessible biomarker. Methods: Total 62 patients with diagnosis of dengue fever were enrolled after final selection. Serum ferritin levels of all the patients were measured on the day of admission. Patients were then divided into two groups on the basis of ferritin level. Group A comprising those with normal level and those having raised level were included in group B. Patients were then regularly followed up both clinically and biochemically during their hospital stay to see disease progression. Discharge from the hospital without complications or death of the patient during the hospital stay was the end point of the study. Every patient was managed according to the National Guideline for Clinical Management of Dengue Syndrome. Results: Most of the respondents (58.1%) belonged to the age group of 18-30 years with male predominance (69.4%). A significant association was found between the BMI of respondents &amp; the groups (p&lt;0.05). Highly significant association was reported among mucosal bleed (37.1%), clinical fluid accumulation (29.0%) &amp; liver enlargement (30.6%) with ferritin level (p&lt;0.001). A positive correlation was found between serum ferritin &amp; hematocrit level of the respondents (r=0.719; p&lt;0.001) and a negative correlation was found between serum ferritin &amp; platelet level of the respondents (r= -0.857; p&lt;0.001), both of which were highly significant. Patients with high level of ferritin .

Acute Necrotising Encephalitis: A life threatening manifestation of Dengue Fever

Dengue fever is an arthropod-borne illness spread by Aedes aegypti, most commonly occurring in the tropics and subtropical regions of the world. Dengue virus is a flavivirus that manifests itself in the human body, in the form of an asymptomatic illness to a fulminant hemorrhagic disease. Expanded dengue syndrome covers the unusual manifestations that usually does not fall into the typical dengue fever, dengue shock syndrome, or dengue hemorrhagic fever. These findings call for greater in-depth research into these connections in order to help high-risk patients to be recognized promptly when they present to the hospital. High clinical suspicion with early aggressive measures are the only ways to attempt in reducing further mortality and morbidity.

Acute Pancreatitis in the Spectrum of Expanded Dengue Syndrome

Abstract Infectious etiologies causing acute pancreatitis are rare and may include viruses, bacteria, parasites, and fungi. The lack of population studies makes it difficult to estimate the overall incidence of infection-related acute pancreatitis. Viruses are one of the most common causes of infection-related acute pancreatitis common being mumps, coxsackievirus, hepatotropic virus, cytomegalovirus, human immunodeficiency virus, varicella, and account for 65.3% of acute pancreatitis cases related to infectious etiologies. Dengue being one of the common infections in tropical countries has also shown an association with causing acute pancreatitis. We encountered and managed three such cases of expanded dengue syndrome complicating as acute pancreatitis in an academic hospital in the northern part of India.