Abnormal clinical manifestations of dengue hemorrhagic fever in children.

Abstract

Introduction. Recently, dengue hemorrhagic fever with unusual neurological and hepatic manifestations has been reported in children, with a concomitant increase in morbidity and mortality.
Objective. To describe unusual clinical manifestations of dengue hemorrhagic fever in children.
Materials And Methods. These manifestations were systematically scrutinized in dengue cases occurring between 1992-2004 in the Pediatrics Department of the University Hospital of Santander, Bucaramanga, Colombia. Case reports were examined of 913 patients with clinical symptoms of dengue hemorrhagic fever. They were classified according to standard criteria for dengue hemorrhagic fever and grouped according to the main organs or systems that were affected. Clinical presentation, laboratory results and medical evolution were summarized.
Results. Of the 913 cases, 168 showed abnormal clinical manifestations; these were predominant in male school age children and associated mainly with grades III and IV of dengue hemorrhagic fever. The most frequent manifestations were as follows: hepatitis--53 cases (27%), neurological alterations--49 (25%), renal impairment--14 (7%), cardiac involvement--15 (8%), pulmonary alterations--18 (9%), alithiasic cholecistitis--18 (9%), haemophagocitic syndrome--5 (2.5%), pancreatitis--2 (1%), and acute abdominal pain--21 (11%). Ten patients died.
Conclusions. The results were compared with data from other endemoepidemic countries of dengue. The significance and importance of abnormal dengue were explored, as well as the difficult retrospective diagnoses. Hepatic and neurological manifestations were recognized as frequently involved in elevated morbidity and mortality. Physicians working in endemic zones should be aware of them in order to recognize them.