Changing clinical manifestations of dengue infection in north India

Abstract

Dengue infection is endemic in many parts of India, including the state of Uttar Pradesh. This study describes the changing clinical picture of dengue viral infections observed by us in children admittedto a teaching hospital in Lucknow, India.A total of 139 children with suspected dengue were admitted during this period, of which 124 couldbe tested by dengue IgM capture ELISA and 102 were positive. However, only 80 of these 102 patientscould be followed up. Average age was 5.9 (‎±3.1)‎ years and 87.5% of them were from rural areas. Themale:female ratio was 1.6:1. Seizures were observed in 45% cases, altered sensorium in 53.7%, vomitingin 41.2%, haemorrhage in 38.8%, skin rash in 37.5%, abdominal pain in 25%, headache in 18.8% andjaundice in 2% cases. Gastrointestinal tract was the commonest site of bleeding. On examination,edema was present in 47.5% cases, hepatomegaly in 62.5%, splenomegaly in 60.0% and hypotensionin 10.0% cases. The investigations revealed a low platelet count of less than 100000/mm3 in 60.3%cases. Mean liver enzyme levels were mildly raised. Definitions of WHO criteria for DHF were presentin only 18 (‎22.5%)‎ cases. Mean total duration of fever in survivors was 14.9±7.3 days. The overall fatality rate in hospital was 5.0%.The results indicated a significant proportion of children presented with little-described features ofencephalopathy, edema, splenomegaly and prolonged fever rather than the typical dengue presentation.These features were not noted during the past epidemics and in previous years.