title: Clinical Profile of Atypical Manifestations of Dengue Fever.
abstract: OBJECTIVE
  To study the clinical profile and outcome of the atypical manifestations of dengue fever in children.
  
  
  METHODS
  All children (0-12 y of age) diagnosed and confirmed as dengue fever at a tertiary care hospital at Puducherry, between the 1st of August 2012 and January 31st 2015 were reviewed retrospectively from hospital case records as per the revised World Health Organization (WHO) guidelines 2011 for dengue fever. The diagnosis was confirmed by NS1 antigen-based ELISA test or dengue serology for IgM and IgG antibodies and the data was analyzed using SPSS 16.0 statistical software.
  
  
  RESULTS
  Out of 254 children admitted with dengue fever, non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Atypical manifestations were seen in 106 cases (41.7 %). Mean age of presentation was 6.9(3.3) y. M: F ratio was 1.2:1. The common manifestations of severe dengue infection were shock (37.4 %), bleeding (20.1 %) and multi-organ dysfunction (2.4 %). The most common atypical manifestations of dengue fever were lymphadenopathy (41.7 %), splenomegaly (21.2 %), biphasic fever (18.1 %), hepatitis (11.4 %), febrile diarrhea (6.3 %), refractory shock (2.4 %) and impaired consciousness (1.9 %). The other atypical manifestations present were portal hypertension, acalculous cholecystitis, appendicitis, acute respiratory distress syndrome (ARDS), myocarditis, pericardial effusion, paroxysmal supraventricular tachycardia (PSVT), myositis, acute kidney injury (AKI), hemophagocytic syndrome and disseminated intravascular coagulopathy (DIC). Platelet count did not always correlate well with the severity of bleeding. There were six deaths (2.4 %) and out of them four presented with impaired consciousness (66.6 %). The common causes for poor outcome were multiorgan failure, encephalopathy and refractory shock.
  
  
  CONCLUSIONS
  The atypical manifestations of dengue fever are no more a rare entity. Clinicians should have a high index of suspicion and vigilance for atypical manifestations of dengue fever as lack of timely detection and management could be fatal. Impaired consciousness was the most ominous atypical manifestation of severe dengue infection.
authors.affiliation: Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Kathirkamam, Puducherry, 605009, India. psriram_ped@yahoo.co.in.
authors.forename: Sriram
authors.initials: S
authors.lastname: Pothapregada
authors.affiliation: Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Kathirkamam, Puducherry, 605009, India.
authors.forename: Banupriya
authors.initials: B
authors.lastname: Kamalakannan
authors.affiliation: Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.|Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Kathirkamam, Puducherry, India.
authors.forename: Mahalakshmy
authors.initials: M
authors.lastname: Thulasingam
mesh_terms: D002648:Child; D002675:Child, Preschool; D003715:Dengue; D005260:Female; D006470:Hemorrhage; D006801:Humans; D008297:Male; D010976:Platelet Count; D019595:Severe Dengue / Q000150:complications*; D013163:Splenomegaly
keywords: Atypical manifestations; Dengue fever; Encephalopathy; Hepatitis; Myocarditis; Myositis