Dengue: Clinical Issues in Management

Dengue has been called the most important mosquito-transmitted viral disease in terms of morbidity and mortality. Dengue fever is a benign acute febrile syndrome. In a small proportion of cases, the virus causes increased vascular permeability that leads to a bleeding diathesis known as Dengue hemorrhagic fever (DHF). About 20% of DHF cases, the patient develops shock, known as the Dengue shock syndrome (DSS). DHF/DSS is predominantly a disease of children in south-east Asia, in contrast to classic Dengue fever where adults are more commonly affected. There are periodic epidemics reported from various parts of India and other parts of the world. Dengue is primarily an urban disease, but becoming rural as well. The pathogenesis of Dengue haemorrhagic fever is complex and not clearly delineated yet. Despite the description of Dengue for more than 100 years, effective prevention including a vaccine is still elusive. There was a recent outbreak in and around Kolkata, West Bengal during August to October 2005, where 5858 cases were diagnosed to have Dengue fever. The Department of Pediatrics, Apollo Gleneagles hospital, Kolkata had served as a referral centre for critically ill children with Dengue during this period. We had 107 children admitted with a diagnosis of Dengue including DHF/DSS. This gave us an opportunity to conduct the present study and revisit the clinical issues pertaining to management of Dengue in our Hospital.