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Correspondence

Indian Pediatr 2014;51: 937-938

Atypical Manifestations of Dengue Fever


Sriram Pothapregada

Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Email: [email protected] 

 
 


We read with interest, the recently published article on the atypical manifestation of dengue fever in children [1]. The authors have highlighted the occurrence of atypical manifestations like splenomegaly, neurological abnor-malities, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulopathy (DIC), diarrhea and myopathy. In this context, we would like to share our experience of the atypical manifestations during the epidemic of dengue fever at Puducherry in 2012-13. During the dengue fever epidemic, atypical manifestations were seen in 16 children (15.2%) and out of them splenomegaly (21.2%), biphasic fever (12.6%) and diarrhea (11.4%) was the most common; 32.3% of children with severe dengue infection had bleeding. The common mode of presentation of severe dengue infection was with features of peripheral circulatory failure (47.6%) and hypotension (30.3%) without bleeding. ARDS, myocarditis and DIC were seen in four children, five children had encephalopathy and refractory shock, and three children had myositis. Ultrasound abdomen showed gall bladder wall edema in 24% of cases. There were six deaths; common causes for poor outcome were ARDS, multiorgan failure, DIC and refractory shock.

Since many children of dengue hemorrhagic fever had features of peripheral circulatory failure without spontaneous bleed, we found it difficult to classify them according to the dengue hemorrhagic fever guidelines given by World Health Organization in 2011 [2]. Our clinical experience suggests a need to relook at the classification of dengue fever and its management guidelines. With recent epidemics showing the changing pattern of presentation, atypical manifestations occur more often than previously reported [3]. The awareness regarding atypical manifestations of dengue fever is lacking among the health care personnel at primary health centers from where these cases are more often referred. Since the case fatality rate in children with severe dengue infection is high, pediatricians have a very important role to play to reduce the disease burden, and the minimum we can do is to update the health care personnel and community at various forums, about the various atypical manifestations of dengue for prompt recognition and management.

References

1. Pawaria A, Mishra D, Juneja M, Meena J. Atypical manifestations of dengue fever. Indian Pediatr. 2014;51:495-6.

2. World Health Organization. Dengue Hemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. 2nd edn. Geneva: World Health Organization, 2011.

3. Balasubramanian S, Ramachandran B, Amperayani S. Dengue viral infection in Children - A perspective. Arch Dis Child. 2012;97:907-12.

 

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