CLINICAL PROFILE AND DISEASE COURSE OF DENGUE IN HOSPITALIZED CHILDREN AT A TERTIARY CARE CENTER IN NORTH INDIA: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Dengue fever, pediatric dengue, severe dengue, clinical profile, WHO classification, thrombocytopenia, plasma leakage, liver enzymes
Abstract
Background: Dengue is one of the most rapidly spreading mosquito-borne viral diseases worldwide and represents a major cause of pediatric morbidity and hospitalization in tropical countries. The clinical spectrum of dengue ranges from mild febrile illness to severe dengue characterized by plasma leakage, hemorrhage, shock, and organ dysfunction. Early identification of clinical and laboratory predictors of severity is essential for timely intervention and improved outcomes in children.
Objectives: To evaluate the clinical profile, laboratory parameters, disease severity, and outcomes of dengue infection in children admitted to a tertiary care hospital in North India.
Methods: A hospital-based prospective observational study was conducted in the Department of Paediatrics, Rajshree Medical Research Institute, Bareilly, Uttar Pradesh, from June 2024 to June 2025. A total of 309 laboratory-confirmed dengue cases in children aged <18 years were enrolled. Data regarding demographic characteristics, clinical manifestations, warning signs, laboratory investigations, imaging findings, WHO 2009 dengue severity classification, and clinical outcomes were collected and analyzed. Statistical analysis was performed using chi-square test and one-way ANOVA, with a p-value <0.05 considered statistically significant.
Results: Of the 309 children, 51.1% had dengue without warning signs, 31.1% had dengue with warning signs, and 17.8% had severe dengue. Age and gender were not significantly associated with disease severity. Abdominal pain, gastrointestinal bleeding, mucosal bleeding, respiratory distress, altered sensorium, and convulsions were significantly associated with severe dengue (p<0.05). Signs of plasma leakage such as pleural effusion, ascites, hepatomegaly, and splenomegaly also correlated with severity. Severe thrombocytopenia and elevated liver enzymes (AST and ALT) were significantly more common in severe dengue. Recovery occurred in 98.4% of cases, and mortality was 1.6%, with all deaths occurring in the severe dengue group.
Conclusion: Abdominal pain, bleeding manifestations, neurological symptoms, respiratory distress, plasma leakage signs, thrombocytopenia, and elevated liver enzymes are important predictors of severe dengue in children. Early recognition of these indicators can facilitate timely intervention and reduce dengue-related morbidity and mortality in pediatric populations.
References
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2. Haider N, Hasan MN, Onyango J, Billah M, Khan S, Papakonstantinou D, Paudyal P, Asaduzzaman M. Global dengue epidemic worsens with record 14 million cases and 9000 deaths reported in 2024. Int J Infect Dis. 2025;158:107940.
3. Government of India. National Center for Vector Borne Diseases Control (NCVBDC). Dengue situation in India: Dengue cases and deaths in the country since 2019 [Internet]. New Delhi: Department of Health & Family Welfare; 2025 [cited 2025 Aug].
4. Kumar M, Verma RK, Nirjhar S, Singh M. Dengue in children and young adults: a cross-sectional study from the western part of Uttar Pradesh. J Family Med Prim Care. 2020;9(1):293-297.
5. Sinha B, Goyal N, Kumar M, Choudhary A, Arya A, Revi A, Dutta A, More D, Rongsen-Chandola T. Incidence of lab-confirmed dengue fever in a pediatric cohort in Delhi, India. PLoS Negl Trop Dis. 2022;16(4):e0010333.
6. Bashar MA, Begam N. Dengue outbreak of 2023 in the state of Uttar Pradesh, North India: lesson learnt and way forwards. Int J Community Med Public Health. 2025;12(2):1128-1130
7. Murhekar MV, Joshua V, Kanagasabai K, Shete V, Ravi M, Ramachandran R, et al. Epidemiology of dengue fever in India, based on laboratory surveillance data, 2014–2017. Wellcome Open Res. 2019;4:114.
8. Palaniyandi M, Sharmila T, Manivel P, Thirumalai P, Anand PH. Mapping the geographical distribution and seasonal variation of dengue and chikungunya vector mosquitoes (Aedes aegypti and Aedes albopictus) in the epidemic hotspot regions of India: a step towards the vector control and sustainable health. Appl Ecol Environ Sci. 2020;8(6):428-440.
9. Government of India. National Center for Vector Borne Diseases Control (NCVBDC). National guidelines for clinical management of dengue fever 2023 [Internet]. New Delhi: Directorate General of Health Services, Ministry of Health & Family Welfare; 2023 [cited 2025 Aug]. Available from: https://ncvbdc.mohfw.gov.in
10. Tayal A, Kabra SK, Lodha R. Management of dengue: an updated review. Indian J Pediatr. 2023;90(2):168-177.
11. Htun TP, Xiong Z, Pang J. Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis. Emerg Microbes Infect. 2021;10(1):1116–1128
12. Kularatne SA, Dalugama C. Dengue infection: global importance, immunopathology and management. Clin Med (Lond). 2022;22(1):9–13.
13. Deng J, Zhang H, Wang Y, Liu Q, Du M, Yan W, et al. Global, regional, and national burden of dengue infection in children and adolescents: an analysis of the Global Burden of Disease Study 2021. eClinicalMedicine. 2024;78:102943
14. Roy MP, Gupta R, Chopra N, Meena SK, Aggarwal KC. Seasonal variation and dengue burden in paediatric patients in New Delhi. J Trop Pediatr. 2017;63(4):1–6
15. Karyanti MR, Uiterwaal CSPM, Hadinegoro SR, Widyahening IS, Saldi SRF, Heesterbeek JAP, et al. The value of warning signs from the WHO 2009 dengue classification in detecting severe dengue in children. Pediatr Infect Dis J. 2024;43(7):630–634
16. Sreenivasan P, Geetha S, Kumar AS. WHO 2009 warning signs as predictors of time taken for progression to severe dengue in children. Indian Pediatr. 2020;57(10):899–903.
17. Agrawal VK, Prusty BSK, Reddy CHS, Reddy GKM, Agrawal RK, Bandaru VCSS. Clinical profile and predictors of severe dengue disease: a study from South India. Caspian J Intern Med. 2018;9(4):334–340
18. Pothapregada S, Sivapurapu V, Banupriya K, Thulasingham M. Role of early warning signs in children with severe dengue infection. Int J Contemp Pediatr. 2018;5(4):1423–1430.
19. Kamble RB, Javali NS. Clinical profile, predictors of DHF and outcome of dengue fever in children at government tertiary care centre. MedPulse Int J Pediatr. 2019;11(1):16–19.
20. Tejaswini M, Sahana KS, Saldanha PRM. Clinical and laboratory profile of children with dengue fever admitted at a tertiary care hospital in Mangalore, Karnataka, India: a retrospective study. Int J Contemp Pediatr. 2020;7(3):611–615
21. Selvan T, Nagaraj MV, Saravanan P, Somashekar. A study of clinical profile of dengue fever in children. Int J Contemp Pediatr. 2017;4(2):534–537
22. Anand R, Selvakumar L, Sagayaraj B, Sujatha B, Porchelvan. A study of clinical and laboratory profiles of dengue fever in children. Int J Pediatr Res. 2018;5(4):230–236
23. Mishra S, Ramanathan R, Agarwalla SK. Clinical profile of dengue fever in children: a study from Southern Odisha, India. Scientifica (Cairo). 2016;2016:6391594
24. Srinivasa K, Ajay J, Manjunath GA. Clinical profile and outcome of dengue among hospitalized children: a single centre prospective study. J Pediatr Res. 2017;4(2):143–148.
25. Bhat M, Otiv A. Clinical and laboratory profile of dengue fever in children in a tertiary care hospital of Navi Mumbai, India. Int J Contemp Pediatr. 2020;7(8):1747–1752.
26. Nagaraj N, Mulagun S, Attar MA. Clinical profile and outcome of pediatric dengue with hemorrhagic complications. Int J Med Pharm Res. 2025;6(5):265–270
27. Lakra MS, Karotkar SA, Lakhkar B, Dhawan V, Lakra A. To study ultrasound and chest X‑ray findings and their role in the diagnosis of dengue fever in children. J Family Med Prim Care. 2023;12(9):1938–1942
28. Kaagaard MD, Matos LO, Evangelista MVP, Wegener A, Holm AE, Vestergaard LS, et al. Frequency of pleural effusion in dengue patients by severity, age and imaging modality: a systematic review and meta-analysis. BMC Infect Dis. 2023;23:327.
29. Shokeen P, Yadav S, Verma CR, Masand R. Neurological complications in dengue fever. Int J Contemp Pediatr. 2018;5(3):983–987
30. Basu S, Mandal K, Basu A. Neurological manifestations of dengue fever in pediatric patients: an observational descriptive study at a tertiary health care centre. Int J Pharm Qual Assur. 2025;16(7):187–192
31. Lourembam R, Rahees VK, Singh SC. Dengue encephalitis as a sole presentation of dengue fever in a child: is it a separate clinical entity?. Int J Contemp Pediatr. 2023;10(12):1869–1871.
32. LNU P, Sehgal V, Bhalla Sehgal L, Gulati N, Kapila S. The spectrum of MRI findings in dengue encephalitis. Cureus. 2022;14(9):e29048.
33. Rodrigo C, Sigera C, Fernando D, Rajapakse S. Plasma leakage in dengue: a systematic review of prospective observational studies. BMC Infect Dis. 2021;21:1082
34. Rameshkumar R, Bhowmick R. Dengue fever in children – identify the devils hidden. J Pediatr Crit Care. 2021;8(5):215–216
35. Prashanth GP, Kumar TA, Murthy K, Ravi K, Bharathi T, Reddy K. Gall bladder wall edema in serologically proven dengue fever patients: an ultrasonographic study. J Clin Diagn Res. 2014;8(12):RC15–RC17.
36. Naaraayan SA, Sundar KC. Risk factors of severe dengue in children: a nested case–control study. J Pediatr Crit Care. 2021;8(2):248–252
37. Alam R, Fathema K, Yasmin A, Roy U, Hossen K, Rukunuzzaman M. Prediction of severity of dengue infection in children based on hepatic involvement. JGH Open. 2024;8(3):e13049.
38. Kumar S, Gupta R, Jain A, Bhoi S, Goel A, Aggarwal P, et al. Dengue infection presenting as acute liver failure in children: case series and review. J Family Med Prim Care. 2020;9(2):894–899.
39. Prasad D, Bhriguvanshi A. Clinical profile, liver dysfunction and outcome of dengue infection in children: a prospective observational study. Int J Contemp Pediatr. 2019;6(5):2016–2021.
40. Bhriguvanshi A, Prasad D. Prognostic role of liver function tests in pediatric dengue illness. Int J Infect Dis. 2021;101(Suppl 1):507–508
41. Uthraraj NS, Sriraam LM, Hiriyur Prakash M, Kumar M, Palanisamy U, Chettiakkapalayam Venkatachalam KU. Predictive factors for the complications of dengue fever in children: a retrospective analysis. Cureus. 2022;14(12):e33027.
42. Joshi AA, Divyashree BN, Gayathri BR. The hematocrit spectrum in dengue: a prospective study. Int J Sci Stud. 2018;5(10):33–37
43. Balakrishnan V, Simna L, Kailas L. The coagulation profile of children admitted with dengue fever and correlation with clinical severity. Int J Contemp Pediatr. 2017;4(6):2109–2113.
44. Shankar P, Prarthana B. Biochemical parameters (lactate dehydrogenase, serum albumin) as early predictor of severe dengue. Int J Contemp Pediatr. 2017;4(2):464–469.
45. Khaladkar A, Patil S, Paranjape A, Jagtap P, Asole B, Singh B, et al. D‑dimer: a clue for severe dengue/dengue shock syndrome, an observational study. Indian J Public Health Res Dev. 2025;16(1):48–52
46. Ahmed S, Arif F, Yahya Y, Rehman A, Abbas K, Ashraf S, et al. Dengue fever outbreak in Karachi 2006—a study of profile and outcome of children under 15 years of age. J Glob Infect Dis. 2016;8(3):115–121.
47. Mathur K, Goyal V, Meena J, Mishra S. Study of risk factors and outcome of severe dengue in children at a tertiary care hospital. Int J Contemp Pediatr. 2018;5(5):1790–1794.
48. Centers for Disease Control and Prevention. Clinical features of dengue. Atlanta: CDC; 2025 May 15
49. Schaefer TJ, Panda PK, Wolford RW. Dengue fever. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Mar 6.
50. Senanayake MP, Jayamanne BDW, Jayasinghe CY, Wijesiriwardana B, Gunasena S. Dengue fever in children in the outpatient setting: clinical features and laboratory predictors of severity. PLoS One. 2023;18(1):e016805.
51. Lee IK, Liu JW, Yang KD. Clinical and laboratory characteristics and outcomes of dengue patients with gastrointestinal bleeding in southern Taiwan. J Formos Med Assoc. 2016;115(9):718–726
52. Alejandria MM. Dengue haemorrhagic fever or dengue shock syndrome in children. Clin Evid. 2015;2015:0917.
53. Bhalla A, Singh H, Suri V, Yaddanapudi L, Poddar B, Ghawat R, et al. ISCCM Position Statement: Management of severe dengue in intensive care unit. Indian J Crit Care Med. 2024;28(S2):S42–S58
54. Krishnappa S, Ashwath G, Nagaraj S. Clinical profile and outcome of dengue fever in children at a tertiary care hospital. Int J Contemp Pediatr. 2016;3(2):2989–2994
55. Sarada G, Suhasini M, Venkata Chetty A, Sudhakar G. A prospective observational study of clinical predictors of outcome in dengue in children. Int J Bioassays. 2015;4(7):4050–4054.
56. Sahu U P, Vatsana N, Kumar S, et al. (January 24, 2025) Dengue Disease Severity in Pediatric Patients With Different Blood Groups: A Study at a Tertiary Care Hospital in Jharkhand. Cureus 17(1): e77940
57. Mishra S, Ambey R, Khare A, et al. (June 30, 2025) Clinico-Epidemiological Profile of Dengue in Children of Age Group 0-14 Years Admitted in a Tertiary Care Hospital. Cureus 17(6): e87027
58. Sivaranjini KT, Shilpa C, Madhu PK, Raghavendra G, Ratageri VH. Adolescent dengue: Clinico-demographic insights and outcome trends. Karnataka Paediatr J. 2025;40:147-52.
59. Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Furuya‑Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta‑analysis. Infect Dis Poverty. 2021;10:123
60. World Health Organization. Dengue: global situation, surveillance and progress – 2024. Geneva: World Health Organization; 2025.
61. Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. Lancet Infect Dis. 2021;21(7):1014‑26
62. Arora SK, Nandan D, Sharma A, Benerjee P, Singh DP. Predictors of severe dengue amongst children as per the revised WHO classification. J Vector Borne Dis. 2021 Dec;58(4):329-334
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Published
Sep 30, 2026
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How to Cite
Dr Oindrilla Basu, & Dr Monica Agarwal. (2026). CLINICAL PROFILE AND DISEASE COURSE OF DENGUE IN HOSPITALIZED CHILDREN AT A TERTIARY CARE CENTER IN NORTH INDIA: A PROSPECTIVE OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 2100-2108. https://doi.org/10.69980/db2fte65
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Author Biographies
Dr Oindrilla Basu
Junior Resident, Department of Pediatrics, Atal Bihari Vajpayee Medical University
Dr Monica Agarwal
Professor and Head of Department, Department of Pediatrics, Rajshree Medical Research Institute Bareilly
How to Cite
Dr Oindrilla Basu, & Dr Monica Agarwal. (2026). CLINICAL PROFILE AND DISEASE COURSE OF DENGUE IN HOSPITALIZED CHILDREN AT A TERTIARY CARE CENTER IN NORTH INDIA: A PROSPECTIVE OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 2100-2108. https://doi.org/10.69980/db2fte65
