Email this article 
Hide
Show all
Atypical Manifestations of Dengue Fever: A Narrative Review
Abstract
Dengue fever (DF) is an arboviral infection caused by one of four serotypes of the dengue virus. The worldwide burden of DF is high with a low fatality rate. It is endemic in tropical and sub-tropical regions. It is transmitted by mosquito bites. After a certain incubation period, it produces typical symptoms of fever, body ache, and headache with low blood pressure and thrombocytopenia. However, there are several atypical manifestations of DF such as acalculous cholecystitis, hepatitis, fulminant hepatic failure, acute pancreatitis, febrile diarrhea, encephalopathy, seizure, meningitis, encephalitis, acute motor weakness, myocarditis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and myositis, which are often overlooked leading to delayed diagnosis and high morbidity and mortality. This narrative review has compiled different atypical manifestations of DF. This article would be beneficial for clinicians to diagnose DF with atypical presentations early and save many lives by timely interventions.
Keywords
Full Text:
PDFReferences
World Health Organization. Ten threats to global health in 2019. [Online]. Available from: https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019. [Cited on 21 November 2019].
World Health Organization. Dengue and severe dengue. [Online]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue. [Cited on 3 November 2019].
Dejnirattisai W, Duangchinda T, Lin CL, Vasanawathana S, Jones M, et al. A complex interplay among virus, dendritic cells, T cells, and cytokines in dengue virus infections. J Immunol.2008; 181(9):pp.5865-74. https://pubmed.ncbi.nlm.nih.gov/18941175/
Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis.2006; 19(5):pp.429-36. https://pubmed.ncbi.nlm.nih.gov/16940865/
Restrepo BN, Ramirez RE, Arboleda M, Alvarez G, Ospina M, et al. Serum levels of cytokines in two ethnic groups with dengue virus infection. Am J Trop Med Hyg.2008; 79(5):pp.673-7. https://www.unboundmedicine.com/medline/citation/18981502/
Dejnirattisai W, Jumnainsong A, Onsirisakul N, Fitton P, Vasanawathana S, et al. Cross-reacting antibodies enhance dengue virus infection in humans. Science.2010; 328(5979):pp.745-8. https://pubmed.ncbi.nlm.nih.gov/20448183/
Schmidt AC. Response to dengue fever--the good, the bad, and the ugly?. N Engl J Med.2010; 363(5):pp.484-7. https://pubmed.ncbi.nlm.nih.gov/20818870/
Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol.2008; 62:pp.71-92. https://pubmed.ncbi.nlm.nih.gov/18429680/
Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health.2007; 12(9):pp.1087–95. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-3156.2007.01891.x
Nimmagadda SS, Mahabala C, Boloor A, Raghuram PM, Nayak U A. Atypical Manifestations of Dengue Fever (DF) - Where Do We Stand Today? J Clin Diagn Res.2014; 8(1):pp.71-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939591/
Souza LJ De, Alves JG, Bastos DA, Wallace E. Aminotransferase changes and acute hepatitis in patients with dengue fever: Analysis of 1,585 cases. Braz J Infect Dis.2004; 8:pp.156–63. https://pubmed.ncbi.nlm.nih.gov/15361994/
Koh FH, Misli H, Chong VH. Acute acalculous cholecystitis secondary to dengue fever. Brunei Int Med J.2011; 7(1):pp.45–49.
Wu KL, Changchien CS, Kuo CM, Chuah SK, Lu SN. Dengue fever with acute acalculous cholecystitis. Am J Trop Med Hyg.2003; 68(6):pp.657–60. https://pubmed.ncbi.nlm.nih.gov/12887023/
Bhatty S, Shaikh NA, Fatima M, Sumbhuani AK. Original Article Acute acalculous cholecystitis in dengue fever. J Pak Med Assoc.2009; 59(8):pp.519–21. https://pubmed.ncbi.nlm.nih.gov/19757695/
Shapiro MJ, Luchtefeld WB, Kurzweil S, Kaminski DL, Durham RM, et al. Acute acalculous cholecystitis in the critically ill. Am Surg.1994; 60:pp.335-9. https://pubmed.ncbi.nlm.nih.gov/8161083/
Torres JR, Liprandi F, Goncalvez AP. Atypical parotitis due to dengue virus. Clin Infect Dis.2000; 31(5):pp.28-29. https://pubmed.ncbi.nlm.nih.gov/11073786/
Gonzalez GR, Henao AF. Dengue hemorrhagic fever complicated by pancreatitis. Braz J Infect Dis.2011; 15(5):pp.490–92. https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702011000500015
Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN. Epigastric pain and sonographic assessment of the pancreas in dengue. J Clin Ultrasound.1997; 26(5):pp.257–9. https://pubmed.ncbi.nlm.nih.gov/9608369/
Gupta VK, Lalchandani A, Agrawal K. Neurological manifestations of dengue infection. Ann Trop Med Public Health.2015; 8:pp.117-21. http://www.atmph.org/text.asp?2015/8/4/117/162370
Chen WJ, Huang KP, Fang AH. Detection of IgM antibodies from cerebrospinal fluid and sera of dengue fever patients. Southeast Asian J Trop Med Public Health.1991; 22:pp.659-63. https://pubmed.ncbi.nlm.nih.gov/1820657/
Lum LC, Lam SK, Choy YS, George R, Harun F. Dengue encephalitis: A true entity? Am J Top Med Hyg.1996; 54:pp.256-9. https://pubmed.ncbi.nlm.nih.gov/8600761/
Jackson ST, Mullings A, Bennett F, Khan C, Gordon-Strachan G,
et l. Dengue infection in patients presenting with neurological manifestations in a dengue-endemic population. West Indian Med J.2008; 57:pp.373-6. https://pubmed.ncbi.nlm.nih.gov/19566019/
Kunishige M, Mitsui T, Tan BH, Leong HN, Takasaki T, et al. Preferential gray matter involvement in dengue myelitis. Neurology.2004; 63:pp.1980-1. https://pubmed.ncbi.nlm.nih.gov/15557535/
Soares CN, Cabral-Castro MJ, Peralta JM, Freitas MR, Puccioni-Sohler M. Meningitis determined by oligosymptomatic dengue virus type 3 infection: Report of a case. Int J Infect Dis.2010; 14:e150-2. https://pubmed.ncbi.nlm.nih.gov/19501535/
Mathew S, Pandian JD. Stroke in patients with dengue. J Stroke Cerebrovasc Dis.2010; 19:pp.253-6. https://pubmed.ncbi.nlm.nih.gov/20434057/
Tomar LR, Raizada A, Yadav A, Agarwal S. Dengue fever presenting as hypokalaemic muscle weakness. Trop J Med Res.2016; 19:pp.76-8. http://www.tjmrjournal.org/text.asp?2016/19/1/76/172058
Trung DT, Wills B. Systemic vascular leakage associated with dengue infection - the clinical perspective. Curr Top Microbiol Immunol.2010; 338:pp.57-66. https://pubmed.ncbi.nlm.nih.gov/19802578/
Mairuhu AT, Setiati TE, Koraka P, Hack CE, Leyte A, Faradz SM, et al. Increased PAI-I plasma levels and risk of death from dengue: No association with the 4G/5G promoter polymorphism. Thromb J.2005; 3:pp.17-25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308869/
Brito CA, Sobreira S, Cordeiro MT, Lucena-Silva N. Acute disseminated encephalomyelitis in classic dengue. Rev Soc Bras Med Trop.2007; 40:pp.236-8. https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822007000200019
Seet RC, Lim EC, Wilder-Smith EP. Acute transverse myelitis following dengue virus infection. J Clin Virol.2006; 35:pp.310-2.
de Aragao RE, Barreira IM, Lima LN, Rabelo LP, Pereira FB. Bilateral optic neuritis after dengue viral infection: Case report. Arq Bras Oftalmol.2010; 73:pp.175-8. https://pubmed.ncbi.nlm.nih.gov/20549049/
Ansari MK, Jha S, Nath A. Unilateral diaphragmatic paralysis following dengue infection. Neurol India.2010; 58:pp.596-8.
Donnio A, Beral L, Olindo S, Cabie A, Merle H. Dengue, a new etiology in oculomotor paralysis. Can J Ophthalmol.2010; 45:pp.183-4.
Bacsal KE, Chee SP, Cheng CL, Flores JV. Dengue-associated maculopathy. Arch Ophthalmol.2007; 125:pp.501-10. https://pubmed.ncbi.nlm.nih.gov/17420370/
Seet RC, Quek AM, Lim EC. Post-infectious fatigue syndrome in dengue infections. J Clin Virol.2007; 38:pp.2-6.
Datta G, Mitra P. A Study on Cardiac Manifestations of Dengue Fever. J Assoc Physicians India.2019; 67:pp.14-16. https://pubmed.ncbi.nlm.nih.gov/31559761/
Wiwanikit. Dengue Cardiac Infection, A Brief Review. Acta Cardiol Sin.2008; 24:226. https://www.ijmedicine.com/index.php/ijam/article/view/535
Kaushik JS, Gupta P, Rajpal S, Bhatt S. Spontaneous resolution of sinoatrial exit block and atrioventricular dissociation in a child with dengue fever. Singapore Med J.2010; 51(9):e146-8. https://pubmed.ncbi.nlm.nih.gov/20938598/
Lum LC, Thong MK, Cheah YK, Lam SK. Dengue-associated adult respiratory distress syndrome. Ann Trop Paediatr.1995; 15(4):pp.335-9. https://pubmed.ncbi.nlm.nih.gov/8687212/
Miyata N, Yoshimura Y, Tachikawa N, Amano Y, Sakamoto Y,et al. Cavity Forming Pneumonia Due to Staphylococcus aureus Following Dengue Fever. Am J Trop Med Hyg.2015; 93(5):pp.1055-7. https://pubmed.ncbi.nlm.nih.gov/26304914/
Macedo RN, Rocha FA, Rolim DB, Vilar DC, Araújo FM, et al. Severe coinfection of melioidosis and dengue fever in Northeastern Brazil: first case report. Rev Soc Bras Med Trop.2012; 45(1):pp.132-3. https://doi.org/10.1590/S0037-86822012000100028
Wiwanitkit V. Lund Disease in Dengue. Journal of Resp Research.2015; 1(1):pp.7-9. http://www.ghrnet.org/index.php/jrr/article/view/1372/1791
Vachvanichsanong P, Thisyakorn U, Thisyakorn C. Dengue hemorrhagic fever and the kidney. Arch Virol.2016; 161(4):pp.771-8. https://pubmed.ncbi.nlm.nih.gov/26699788/
Eswarappa M, Reddy SB, John MM, Suryavara S, Madhyashatha RP. Renal manifestations of dengue viral infection. Saudi J Kidney Dis Transpl.2019; 30:pp.394-400. http://www.sjkdt.org/text.asp?2019/30/2/394/256847
Ramachandran B, Balasubramanian S, Abhishek N, Ravikumar KG, Ramanan AV. Profile of hemophagocytic lymphohistiocytosis in children in a tertiary care hospital in India. Indian Pediatr.2011; 48:pp.31–5. https://pubmed.ncbi.nlm.nih.gov/20972297/
Ray S, Kundu S, Saha M, Chakrabarti P. Hemophagocytic Syndrome in Classic Dengue Fever. J Glob Infect Dis.2011;3(4):pp.399–401. http://www.jgid.org/text.asp?2011/3/4/399/91068
Karras A, Hermine O. Macrophage activation syndrome. Rev Med Interne.2002; 23:pp.768–78. http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=235&doi=10.11648/j.ajlm.20200501.14
Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer.2007; 48(2):pp.124-31. https://pubmed.ncbi.nlm.nih.gov/16937360/
de Azeredo EL, Monteiro RQ, de-Oliveira Pinto LM. Thrombocytopenia in Dengue: Interrelationship between Virus and the Imbalance between Coagulation and Fibrinolysis and Inflammatory Mediators. Mediators Inflamm.2015; 2015: 313842. https://pubmed.ncbi.nlm.nih.gov/25999666/
Huang YH, Liu CC, Wang ST, Lei HY, Liu HL, et al. Activation of coagulation and fibrinolysis during dengue virus infection. J Med Virol.2001; 63(3):pp.247-51. https://pubmed.ncbi.nlm.nih.gov/11170065/
Rao IS, Loya AC, Ratnakar KS, Srinivasan VR. Lymph node infarction -a rare complication associated with disseminated intravascular coagulation in a case of dengue fever. BMC Clin Pathol.2005;5:11. https://bmcclinpathol.biomedcentral.com/articles/10.1186/1472-6890-5-11
Karakus A, Banga N, Voorn GP, Meinders AJ. Dengue shock syndrome and rhabdomyolysis. Neth J Med.2007; 65:pp.78-81. https://pubmed.ncbi.nlm.nih.gov/17379934/
Copyright (c) 2021 Journal of Biomedical and Clinical Sciences (JBCS)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright © 2016 AMDI Publisher, Universiti Sains Malaysia.
Disclaimer : This website has been updated to the best of our knowledge to be accurate. However, Universiti Sains Malaysia shall not be liable for any loss or damage caused by the usage of any information obtained from this web site.
Best viewed: Mozilla Firefox 4.0 & Google Chrome at 1024 × 768 resolution.