title: Atypical Manifestations of Dengue Fever (DF) - Where Do We Stand Today?
abstract: OBJECTIVE
  Dengue fever (DF) is transmitted by Aedes aegypti mosquitoes. With growing population, rapid urbanization and lack of appropriate sanitary measures, proliferation of mosquitoes and subsequent dengue infections have increased rampantly with an estimated 30-fold increase in incidence over last five decades. With rising disease burden, atypical manifestations have increased as well, which are missed most often due to lack of awareness. Our aim was to look for the atypical manifestations of dengue fever.
  
  
  METHODS
  A prospective hospital based observational study was conducted at hospitals of Kasturba Medical College in Mangalore over a period of two years (June-2010 to May-2012). One-hundred fifty ELISA confirmed IgM-dengue sero-positive cases satisfying WHO criteria were examined clinically and laboratory data assessed till they got discharged from hospital after ruling out other causes of fever. Atypical manifestations in dengue fever were noted and analyzed.
  
  
  RESULTS
  Most common symptoms noticed were myalgia, headache, rash, arthralgia, pain in abdomen and nausea. More than half of the study group had one or the other atypical manifestation. Liver function test derangement was most often seen. Most common atypical manifestation was hepatitis found in 40.6% patients. Febrile diarrhea, renal failure, Acalculous cholecystitis and conduction abnormalities of heart were among other common manifestations. Three patients died of multi-organ dysfunction, disseminated intravascular coagulation and shock. Platelet count did not correlate well with severity of bleeding. Overall recovery rate was good.
  
  
  CONCLUSIONS
  Some of the atypical manifestations of dengue fever are no more a rare entity. Clinical vigilance for these manifestations is important for timely detection and management as some of them could be fatal.
authors.affiliation: Postgraduate, Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal University, India .
authors.forename: Satya Sudhish
authors.initials: SS
authors.lastname: Nimmagadda
authors.affiliation: Professor, Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal University, India .
authors.forename: Chakrapani
authors.initials: C
authors.lastname: Mahabala
authors.affiliation: Assistant Professor, Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal University, India .
authors.forename: Archith
authors.initials: A
authors.lastname: Boloor
authors.affiliation: Associate Professor, Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal University, India .
authors.forename: Pavan Manibettu
authors.initials: PM
authors.lastname: Raghuram
authors.affiliation: Assistant Professor, Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal University, India .
authors.forename: Akshatha
authors.initials: A
authors.lastname: Nayak U
keywords: Aedes aegypti mosquitoes; Atypical manifestations; Dengue fever; Hepatitis