Expanded Dengue Syndrome
Unusual manifestations of patients with severe organ involvement such as liver, kidneys, brain or heart associated with dengue infection have been increasingly reported in dengue hemorrhagic fever (DHF) and also in dengue patients who do not have evidence of plasma leakage. These unusual manifestations may be associated with co-infections, co-morbidities or complications of prolonged shock and can be clubbed under the expanded dengue syndrome
The World Health Organization (WHO) has coined the term expanded dengue to describe cases that do not fall into either dengue shock syndrome or dengue hemorrhagic fever. This has incorporated several atypical findings of dengue.
The atypical manifestations noted in dengue can be multisystemic and multifaceted.
| System | Unusual or atypical manifestations |
| CNS involvement | Encephalopathy, encephalitis, febrile seizures, I/C bleed |
| GI involvement | Acute hepatitis/fulminant hepatic failure, cholecystitis, cholangitis and acute pancreatitis |
| Renal involvement | Acute renal failure, hemolytic uremic syndrome, acute tubular necosis |
| Cardiac involvement | Cardiac arrhythmia, cardiomyopathy, myocarditis, pericardial effusion |
| Respiratory involvement | Pulmonary edema, ARDS, pulmonary hemorrhage, Pleural effusion |
| EYE | Conjunctival bleed, macular hemorrhage, visual impairment, optic neuritis |
In clinical practice, the occurrence of the atypical presentation should prompt us to investigate dengue. Knowledge of expanded dengue helps to clinch the diagnosis of dengue early, especially during ongoing epidemics, avoiding further battery of investigations.
