The changing clinico-demographic profile of dengue infection in children: a hospital-based study from eastern India

Radheshyam Purkait, Rajarshi Basu


Background: Many parts of India, including the eastern regions, are now endemic for the dengue infection with increased recognition of atypical neurological manifestations apart from the classical clinical features.

Methods: This prospective study was conducted in the department of paediatrics in a tertiary care teaching hospital in eastern India from July 2019 to November 2019 to determine the changing trends of the clinical features in the dengue patients of this region in the recent years among paediatric populations. All the serologically confirmed dengue patients admitted during this period satisfying the inclusion criteria were enrolled in the study population and classified as per new WHO-2009 classification into: dengue fever without warning signs (DF), dengue fever with warning signs (DFWS) and severe dengue (SD). Detailed history, clinical and laboratory parameters were recorded and analysed for all children.

Results: Out of the total of 110 cases, 16 cases (14.55%) were DF, 80 cases (72.73%) were DFWS and 14 cases (12.73%) were SD. The commonest age group affected (63.64 %) was between 4-<10 years. The male: female ratio of cases was 1.68:1. Besides classical clinical manifestations, we observed CNS involvement in nine cases (8.18%). Among them, five patients had dengue encephalitis, two patients had dengue encephalopathy, one patient had hypokalemic paralysis and one patient had Guillain-Barré syndrome. All the patients were treated as per standard guidelines.

Conclusions: Clinician must be aware of such association during dengue outbreak because early diagnosis and appropriate supportive care can reverse this potentially fatal disease.


Dengue outbreak, Encephalitis, Encephalopathy Guillain-Barre syndrome, Hypokalemic paralysis, Neurological manifestations

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World Health Organization. Dengue and severe dengue. Fact sheet no. 117, March 2014. Geneva: WHO, 2014. Available at: mediacentre/ factsheets/fs117/en/. Accessed on 15th January 2020.

Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta AK. An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi. Indian Pediatr. 1998;35:727-32.

Vedpathak VL, Soundale SG, Lakde RN, Deo DS, Khadilkar HA. Clinico-epidemiological profile of an outbreak of dengue fever in rural area of Ambajogai Mandai, District Beed. J Commun Dis. 2011;43(1):69-72.

Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai-a study of clinical profile and outcome. Indian Pediatr. 2002;39:1027-33.

Choudhary MC, Gupta E, Sharma S, Hasnain N, Agarwala P. Genetic signatures coupled with lineage shift characterise endemic evolution of Dengue virus serotype 2 during 2015 outbreak in Delhi, India. Trop Med Int Health. 2017;22(7):871-80.

Jain S, Mittal A, Sharma SK, Upadhyay AD, Pandey RM, Sinha S, et al. Predictors of dengue-related mortality and disease severity in a tertiary care center in North India. Open Forum Infect Dis. 2017;4(2):ofx056.

Basker P, Kolandaswamy KG. Study on the behavior of dengue viruses during outbreaks with reference to entomological and laboratory surveillance in the Cuddalore, Nagapattinam, and Tirunelveli Districts of Tamil Nadu, India. Osong Public Health Res Perspect. 2015;6(3):143-58.

Gunasekaran P, Kaveri K, Mohana S, Arunagiri K, Babu BV, Priya PP, et al. Dengue disease status in Chennai (2006-2008): a retrospective analysis. Indian J Med Res. 2011;133:322-5.

Ghosh SK, De S, Sarkar U, Ghosh M, Chatterjee MK, Samanta S. Clinical profile of dengue during 2005 outbreak in Kolkata and predictive markers of dengue haemorrhagic fever. J Indian Med Assoc. 2011;109(11):790-3.

Biswas DK, Bhunia R, Basu M. Dengue fever in a rural area of West Bengal, India, 2012: an outbreak investigation. WHO South East Asia J Public Health. 2014;3(1):46-50.

Saha K, Ghosh M, Firdaus R, Biswas A, Seth B, Bhattacharya D, et al. Changing pattern of dengue virus serotypes circulating during 2008-2012 and reappearance of dengue serotype 3 may cause outbreak in Kolkata, India. J Med Virol. 2016;88(10):1697-702.

Roy A, Sarkar D, Chakraborty S, Chaudhuri J, Ghosh P, Chakraborty S. Profile of hepatic involvement by dengue virus in dengue infected children. N Am J Med Sci. 2013;5(8):480-5.

Chatterjee N, Mukhopadhyay M, Ghosh S, Mondol M, Das C, Patar K. An observational study of dengue fever in a tertiary care hospital of eastern India. J Assoc Physicians India. 2014;62(3):224-7.

Samanta M, Kundu CK, Guha G, Chatterjee S. Unique neurological manifestations of dengue virus in pediatric population: a case series. J Trop Pediatr. 2012;58(5):398-401.

Pal S, Sen K, Biswas NM, Ghosal A, Rousan Jaman SK, Yashavantha Kumar KY. Clinico-radiological profile and outcome of dengue patients with central nervous system manifestations: A case series in an Eastern India tertiary care hospital. J Neurosci Rural Pract. 2016;7(1):114-24.

Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition. Geneva: World Health Organization; 2009.

Mishra S, Ramanathan R, Agarwalla SK. Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India. Scientifica (Cairo). 2016;2016:6391594.

Kale AV, Haseeb M, Sandeep Reddy C, Khan S, Golwalkar A, et al. clinical profile and outcome of dengue fever from a tertiary care centre at Aurangabad Maharashtra India: an observational study. IOSR J Dent Med Sci. 2014;13(9):14-9.

Jain P, Kuber D, Garg AK, Sharma GD, Agarwal AK. Manifestations of dengue fever: A hospital-based study. JIACM. 2015;16(3-4):204-8.

Kabilan L, Balasubramanian S, Keshava SM, Satyanarayana K. The 2001 dengue epidemic in Chennai. Indian J Pediatr. 2005;72(11):919-23.

Batra P, Saha A, Chaturvedi P, Vilhekar KY, Mendiratta DK. Outbreak of dengue infection in rural Maharashtra. Indian J Pediatr. 2007;74(8):794-5.

Daniel R, Rajamohanan, Philip AZ. A study of clinical. profile of dengue fever in Kollam, Kerala, India. Dengue Bulletin. 2005;29:197-202.

Salomon T, Dung NM, Vaughn DW, Kneen R, Thao LT, Raengsa Kulrach B. Neurological manifestations of dengue infection. Lancet. 2000;355:1053-9.

Murthy JM. Neurological complication of dengue infection. Neurol India. 2010;58:581-4.

Domingues RB, Kuster GW, Onuki-Castro FL, Souza VA, Levi JE, Pannuti CS. Involvement of the central nervous system in patients with dengue virus infection. J Neurol Sci. 2008;267(1-2):36-40.

Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. Lancet Neurol. 2013;12:906-19.

Cam BV, Fonsmark L, Hue NB, Phuong NT, Poulsen A, Heegaard ED. Prospective case-control study of encephalopathy in children with dengue hemorrhagic fever. Am J Trop Med Hyg 2001;65:848-51.

Thisyakorn U, Thisyakorn C, Limpitikul W, Nisalak A. Dengue infection with central nervous system manifestations. Southeast Asian J Trop Med Public Health. 1999;30:504-6.