• Kashan Arshad Department of Paediatrics, Allied Hospital, Faisalabad
  • Saifullah Sheikh Department of Paediatrics, Allied Hospital, Faisalabad
  • Syeda Umm-ul-Baneen Naqvi Department of Paediatrics, Allied Hospital, Faisalabad
  • Imran Sarwar Independent University Hospital, Faisalabad
  • Sulman Javaid Department of Paediatrics, Allied Hospital, Faisalabad
  • Madiha Asghar Department of Paediatrics, Allied Hospital, Faisalabad
  • Muhammad Asghar Butt Department of Paediatrics, Allied Hospital, Faisalabad


Background: Dengue Fever is caused by arthropod born viruses.According to World Health Organization approximately 50–100 million infections of dengue fever occur yearly. Objective of this study was to determine the frequency of splenomegaly in dengue fever in children. Methods: This cross sectional study was conducted at the Department of Paediatrics, Allied Hospital, Faisalabad, during a period from June 2012 to May 2013 by including 93 Children, aged 4–14 years presenting with fever of less than 14 days with thrombocytopenia and positive IgM or IgM and IgG dengue antibodies by ELISA. Patients were thoroughly evaluated by detailed history and clinical examination. Ultrasonography of the patients was performed to confirm the splenomegaly. The data was analysed to determine the frequency and percentage of disease. Results: Out of 93 children, 51 (54.8%) were male and 42 (45.2%) were female. The most common clinical presentation was noted is chills and rigors in 80 (86.02%). Unusual clinical features were encephalopathy in 37 (39.78%) followed by bleeding manifestations and upper respiratory tract infection (upper RTI). Splenomegaly was seen in 45 (48.4%) children. Conclusion: Dengue fever is increasingly presenting with atypical presentation like splenomegaly, encephalopathy, bleeding manifestations and upper RTI.Keywords: Dengue fever, Splenomegaly, Atypical presentation


Halstead SB. Infectious diseases. Dengue fever and dengue hemorrhagic fever. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, Editors. Nelson textbook of pediatrics 19thed. Philadelphia: Saunders; 2011.p.881–1239.

Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol. 2008;62:71–92.

Jahan F. Dengue fever (DF) in Pakistan. Asia Pac Fam Med 2011;10(1):1.

Jamil B, Hasan R, Zafar A, Bewley K, Chamberlain J, Mioulet V, et al. Dengue virus serotype 3, Karachi, Pakistan. Emerg Infect Dis 2007;13:182–3.

Karande S, Gandhi D, Kulkarni M, Bharadwaj R, Pol S, Thakare J, et al. Concurrent outbreak of leptospirosis and dengue in Mumbai, India 2002. J Trop Pediatr. 2005;51(3):174–81.

Khan HA, Hayat AS, Masood N, Solangi NM, Shaikh TZ. Frequency and clinical presentation of dengue fever at tertiary care hospital of Hyderabad/Jamshoro. J LiaquatUni Med Health Sci. 2010;9(2):88–94.

Tavakoli NP, Tobin EH, Wong SJ, Dupuis AP, Glasheen B, Kramer LD, et al. Identification of dengue virus in respiratory specimens from a patient who had recently traveled from a region where dengue virus infection is endemic. J Clin Microbiol. 2007;45(5):1523–7.

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 Pak Med Assoc 2008;58(1):4–8.

Faridi MM, Aggarwal A, Kumar M, Sarafrazul A. Clinical and biochemical profile of dengue haemorrhagic fever in children in Delhi. Trop Doct 2008;38(1):28–30.

Desruelles F, Lamaury J, Rondier M, Goursand R, Mahe A, Castanet J, et al. [Cutaneo-mucus manifestations of Dengue]. Ann Dermatol Venerol 1997;124(3):237–41.

Sen MK, Ojha UC, Chakrabarti S, Suri JC. Dengue Hemorrhagic fever (DHF) presenting with ARDS. Indian J Chest Dis Allied Sci 1999;41(2):115–9.

Setlik RF, Ouellette D, Morgan J, McAllister CK, Dorsey D, Agan BK, et al. Pulmonary hemorrhage syndrome associated with an autochthonous case of dengue hemorrhagic fever. South Med J 2004;97(7):688–91.

Miranda LE, Miranda SJ, Rolland M. Case Report: Spontaneous Rupture of the Spleen due to Dengue Fever. Braz J Infect Dis 2003;7(6):423–5.

Rao IS, Loya AC, Ratnakar KS, Srinivasan VR. Lymph node infarction--a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever. BMC Clin Pathol 2005;5:11.

Soares CN, Faria LC, Peralta JM, de Freitas MR, Puccioni-Sohler M. Dengue infection: neurological manifestations and cerebrospinal fluid (CSF) analysis. J Neurol Sci 2006;249(1):19–24.

Sharma N, Mahi S, Bhalla A, Singh V, Varma S, Ratho RK. Dengue fever related acalculous cholecystitis in a North Indian tertiary care hospital. J Gastroenterol Hepatol 2006;21(4):664–7.

Fink K, Ng C, Nkenfou C, Vasudevan SG, van Rooijen N, Schul W. Depletion of macrophages in mice results in higher dengue virus titers and highlights the role of macrophages for virus control. Eur J Immunol 2009;39(10):2809–21.

Schwartz E, Mileguir F, Grossman Z, Mendelson E. Evaluation of ELISA-based sero-diagnosis of dengue fever in travelers. J Clin Virol 2000;19(3):169–73.

Butt N, Abbassi A, Munir SM, Ahmad SM, Sheikh QH. Haematological and biochemical indicators for the early diagnosis of dengue viral infection. J Coll Physicians Surg Pak 2008;18(5):282–5.

Clark DV, Mammen MP Jr, Nisalak A, Puthimethee V, Endy TP. Economic impact of dengue fever/dengue hemorrhagic fever in Thailand at the family and population levels. Am J Trop Med Hyg 2005;72(6):786–91.

Whitehorn J, Farrar J. Dengue. Br Med Bull 2010;95:161–73.

WHO Guidelines Approved by the Guidelines Review Committee. Dengue: Guidelines for diagnosis, treatment, prevention and control: New Edition. Geneva: World Health Organization; 2009.

Webster DP, Farrar J, Rowland-Jones S. Progress towards a dengue vaccine. Lancet Infect Dis 2009;9(11):678–7.

Shah I, Deshpande GC, Tardeja PN. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J Trop Pediatr 2004;50(5):301–5.

Kulkarni MJ, Sarathi V, Bhalla V, Shirpuri D, Acharay U. Clinico-Epidemiological Profile of Children Hospitalized with Dengue. Indian J Pediatr 2010;77(10):1103–7.

Dhooria GS, Bhat D, Bais HS. Clinical Profile and Outcome in Children of Dengue fever in North India. Iran J Pediatr. 2008;18(03):222–28.

Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN. Epigastric pain and sonographic assessment of the pancreas in Dengue hemorrhagic fever. J Clin Ultrasound. 1998;26(5):257–9.

Solomon T, Dung MN, Vaughn DW, Kneen R, Thao LT, Raengsakularach B, et al. Neurological manifestations of dengue infection. Lancet 2000;355(9209):1053–9.

Diaz-Quijano FA, Villar-Centeno LA, Martinez-Vega RA. [Complications associated to severe thrombocytopenia in patients with dengue]. Rev Med Chil 2006;134(2):167–73.

La Russa VF, Innis BL. Mechanisms of dengue virus induced bone marrow suppression. Baillieres Clin Haematol 1995;8(1):249–70.

Mohammad H, Sarkar DN, Amin MR, Basher A, Ahmed T. Clinical Profile and Outcome of Patients with Dengue Syndrome in Hospital Care. J Medicine 2011;12(2):131–8.

Wu KL, Changchien CS, Kuo CH, Chiu KW, Lu SN, Kuo CM, et al. Early abdominal sonographic findings in patients with dengue fever. J Clin Ultrasound. 2004;32:386–8.

Akram DS, Igarashi A, Takasu T. Dengue virus infection among children with undifferentiated fever in Karachi. Indian J Pediatr 1998;65(5):735–40.

Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta AK. An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi. Indian Pediatr 1998;35(8):727–32.

Rategeri VH, Shepur TA, Wari PK, Chavan SC, Mujahid IB, Yergolkar PN. Clinical profile and outcome of dengue fever cases. Indian J Pediatr 2005;72(8):705–6.

Chandrakanta, Kumar R, Garima, Agarwal J, Jain A, Nagar R, et al. Changing clinical manifestations of dengue infection in north India. Dengue Bull. 2008;32:118–25.

Venkata Sai PM, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol 2005;78(929):416–8.