Introduction:

the clinical presentation of dengue has a broad clinical spectrum, and uncommon manifestations have been reported, becoming more frequent as the disease progresses. These are not often reported due to the lack of awareness among medical professionals. In 2024, Argentina experienced the largest dengue epidemic ever reported.

Objectives:

the objective of this study was to study the clinical profile and evolution of patients with atypical and severe manifestations of dengue.

Methodology:

we retrospectively analyzed the clinical records of all children from 0 to 18 years of age with probable or confirmed dengue hospitalized in a tertiary pediatric hospital in the City of Buenos Aires, Argentina, between January 2023 and April 2024. Diagnosis was made by immunochromatography (NS1 and IgM), ELFA (IgM and IgG) and PCR. The study was approved by the hospital’s ethics and academics committee. Data were analyzed using EpiInfo 7.2.

Results: of 213 children hospitalized with dengue, 7% presented with severe dengue. Atypical manifestations of the disease were diagnosed in 37 cases (17%). The average age was 6.5 years (SD 5.2) and the M:F ratio was 1.1:1. The most frequent manifestations of severe dengue were shock (80%), bleeding (20%) and multiple organ failure (6%). The most common atypical manifestations were hepatitis (24%), febrile diarrhea with blood (17%), seizures (7%), myositis (7%), pneumonia (7%) and febrile infant without focus (7%). Other atypical manifestations were ataxia, meningitis, acute respiratory distress syndrome (ARDS), myocarditis, lymphadenitis, prolonged fever, pleural and pericardial effusion. One patient with severe dengue died from the infection (0.4%).

Conclusions:

atypical manifestations of dengue should not be considered rare, and clinicians should have a high level of suspicion and consider early and appropriate management to avoid a fatal outcome in cases of severe dengue.

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