Publication:

Atypical hepatic, cardiac, and renal manifestations in pediatric dengue: a prospective study

Background Dengue fever is the most prevalent arboviral infection worldwide and is characterized by a broad clinical spectrum, ranging from self-limiting febrile illness to severe, life-threatening complications. In recent years, there has been growing recognition of atypical presentations, collectively referred to as expanded dengue syndrome (EDS), encompassing involvement of organs such as the liver, heart, and kidneys. The aim of this study was to evaluate the atypical hepatic, cardiac, and renal manifestations in children with dengue infection.

Methods This prospective cohort study included 100 pediatric patients with serologically confirmed dengue infection. All participants underwent detailed clinical assessment along with laboratory investigations, including complete blood counts (CBC), liver function tests (LFT), renal function tests (RFT), coagulation profiles, and electrocardiographic (ECG)evaluation.

Results The mean age of the study population was 8.65±3.34 years, with a slight male predominance (55%). Serological analysis showed that 72% of patients were positive for NS1 antigen alone, whereas 28% demonstrated both NS1 and IgM positivity. Hepatic involvement was common, with elevated SGOT levels observed in 51% of cases, while SGPT elevation was noted in only 6%. Hematological abnormalities were prominent, with anemia detected in 93% and thrombocytopenia in 86% of patients. Renal involvement was relatively infrequent; elevated serum creatinine was seen in 9% of cases, and proteinuria in 1%. No electrocardiographic abnormalities were identified in the study cohort. On subgroup analysis, patients with combined NS1 and IgM positivity had significantly lower platelet counts (p=0.0397) and hemoglobin levels (p<0.0001) compared to those with isolated NS1 positivity.

Conclusions Hepatic transaminitis and hematological cytopenias constitute common systemic manifestations, with occasional atypical involvement in pediatric dengue. Concurrent positivity for NS1 antigen and IgM antibody is associated with a more severe clinical profile, suggesting its potential role as a marker of disease severity.