|
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.
|
|
|
|