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 admitted to a teaching hospital in Lucknow, India. A total of 139 children with suspected dengue were admitted during this period, of which 124 could be tested by dengue IgM capture ELISA and 102 were positive. However, only 80 of these 102 patients could be followed up. Average age was 5.9 (±3.1) years and 87.5% of them were from rural areas. The male:female ratio was 1.6:1. Seizures were observed in 45% cases, altered sensorium in 53.7%, vomiting in 41.2%, haemorrhage in 38.8%, skin rash in 37.5%, abdominal pain in 25%, headache in 18.8% and jaundice 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 hypotension in 10.0% cases. The investigations revealed a low platelet count of less than 100 000/mm 3 in 60.3% cases. Mean liver enzyme levels were mildly raised. Definitions of WHO criteria for DHF were present in 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 of encephalopathy, edema, splenomegaly and prolonged fever rather than the typical dengue presentation. These features were not noted during the past epidemics and in previous years.