Unusual clinical manifestations of dengue infection in children in a tertiary care hospital in northeast Thailand

Abstract

Background: Dengue virus infection has been a public health concern in Thailand. In the past decades, there has been recent interest concerning unusual clinical manifestations in both dengue fever (DF) and dengue hemorrhagic fever (DHF).Objective: We described the unusual clinical manifestations and outcomes of children with dengue admitted to a tertiary care hospital in northeast Thailand.Materials and Methods: A study was conducted on the 73 patients with serologically confirmed dengue infection admitted to Srinagarind Hospital, a tertiary care facility in northeast Thailand between January 2007 and August 2011.Results: Of the 73 children examined, 42 (57%) were boys and 31 were girls. Their age ranged from 8 months to 14 years (median 11 years). Nine patients developed neurological symptoms, 6 patients had altered consciousness, and 3 patients convulsion. Among 9 patients with neurological symptoms, 1 patient had acute kidney injury, 1 had hepatic failure, and 1 had kidney and liver involvement, mostly associated with fluid resuscitation or prolonged shock. Apart from neurological symptoms, one patient developed infection associated hemophagocytic syndrome and was treated with intravenous immunoglobulin. Two patients died from multiple organ failure, and 1 patient was brought back home in a moribund condition. The other patients recovered completely.Conclusion: Altered consciousness was the most commonly observed unusual neurological manifestation. Patients who did not develop acute kidney injury or liver failure had mild clinical courses and recovered from neurological symptoms without sequelae. Acute kidney injury was associated with fluid overload and/or prolonged shock. Careful fluid management and close monitoring for complications resulted in favorable outcomes.

Clinical spectrum of dengue fever in hospitalized children in Mukalla city, Yemen after the attack of Chapala cyclone Nov. 2015

“…In this study, all patients presented with fever (100%) similar to other studies [11,17,[20][21][22] and in contrast to others in which fever forms 94.6% [23] and 66.6% [19] of patients. Headache in 37 cases (30.1%) was the second most common general manifestation in our study followed by retro-orbital pain, injected conjunctiva, blurring vision, and maculopapular skin rash in a lower percentage.…”

“…Disturbed level of consciousness was reported as the commonest neurological manifestation [21]. In our study, seizure was the commonest finding followed by the disturbance of consciousness.…”

“…Overall, mortality was reported as 7.6% [20] and 4.1% [21]. Other studies showed no significant mortality [11,17].…”

“…Diarrhea was not recognized as a common clinical manifestation in dengue infection [10,16,23,25]. Duangmala et al [21] reported an increasing incidence of diarrhea reaching 28.8% among dengue patients, with 19% of them having diarrhea as the main presenting symptom. In our study, diarrhea was an associated complaint in 18.7% of cases.…”

Clinical predictors of severe dengue: a systematic review and meta-analysis

“…Studies have used different definitions for mucosal bleeding and clinical fluid accumulation. Some studies used specific conditions like epistaxis [26,27] or gum bleeding [28,29] to refer to mucosal bleeding, while others have grouped them as mucosal bleeding [30,31]. Similarly, clinical fluid accumulation was defined as ascites [24,32] or pleural effusion or combined as clinical fluid accumulation [17,33].…”