Atypical manifestations of dengue fever in a recent dengue outbreak

Context: Dengue fever is highly prevalent in tropical and subtropical regions. The disease is caused by RNA virus, flavivirus and is transmitted by a mosquito to humans. Aims: The aim is to study the various atypical manifestations that can occur in dengue fever. Settings and Design : The patients presenting with acute febrile illness from September to December 2015 were admitted in a tertiary care hospital of North India and were screened for dengue fever. A total of 141 patients were screened for dengue fever out of which 61 patients were positive for dengue fever. A detailed history of each patient reporting to the hospital was taken followed by the general physical examination and systemic examination. Subjects and Methods: Complete blood count was performed in all patients and other investigations such as liver and kidney function test, chest X-ray, ultrasound, magnetic resonance imaging, and cerebrospinal fluid examination were done wherever required. Results: Atypical manifestations were present in 24 of 61 patients who were diagnosed positive for dengue fever (39.3%). Acalculous cholecystitis was the most common manifestation (32.7%), followed by encephalitis (6.5%) and hepatitis (3.2%). Transverse myelitis, acute respiratory distress syndrome, and renal failure had a frequency of 1.6%. There was no mortality as none of the patients had DSS in our study. Liver function tests (alkaline phosphatase and aspartate aminotransferase) were deranged in most patients (52.4%) out of which only 3.2% had raised serum bilirubin levels. Hepatomegaly was present in 19.6% of patients, and splenomegaly was observed in 3.2% of the patients. Conclusions: Dengue fever this year had various atypical manifestations – acalculous cholecystitis having the maximum occurrence. Neurological manifestations were also present. Transverse myelitis which is a rare manifestation was also observed.