Dengue is the most rapidly spreading mosquito-borne viral disease in the world. in the last 50 years, the incidence has increased 30-fold with increasing geographical expansion to new countries and in the present decade, from urban to rural settings. More than 70% of the population at risk for dengue worldwide, live in member states of the WHO South East Asia Region and West Pacific Region which bear nearly 75% of the current global disease burden due to dengue [1]. The relationship of this country with dengue has been long and intense. After the first virologically proved epidemic of dengue fever along the east coast of India in 1963-1964, it spread all over the country [2]. There are currently no vaccines nor antiviral drugs available for dengue virus; the only effective way to prevent epidemic DF/DHF is to control the mosquito vector, Aedes aegypti [3]. Dengue remains a puzzling disease in many aspects, such as the virus –vector and host-virus relationship, and clinical expression variability [4]. WHO has given the case definition of dengue fever in its comprehensive guidelines. Accordingly, a probable cause is defined as an acute febrile illness with two or more of any findings viz. headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, leucopenia and supportive serology [5]. Dengue hemorrhagic fever (DHF) is characterized by fever; hemorrhagic manifestations; thrombocytopenia; increased capillary permeability; pleural effusion or hypoalbuminemia. Dengue shock syndrome (DSS) shows features of DHF with hypotension [6]. In 2009, the WHO proposed a new classification, dengue, and serious dengue, in which dengue is subdivided according to the presence or absence of the following warning signs: abdominal pain, persistent vomiting, edema, mucosal bleeding, lethargy, irritability, hepatomegaly (>2cm), and increased hematocrit concurrent with decreased platelet count[7]. Early diagnosis of dengue virus infection is important for treatment and aversion of complications like DSS and DHF. Dengue virus-specific IgM antibodies appear as early as three days of dengue viral fever and can persist for 30-60 days, whereas IgG antibodies appear at about seventh day, peak at 2-3 weeks, and persist for life [8]. Dengue fever is not easily diagnosed before the presentation of the classic symptoms. Combinations of the symptoms and dynamic ordinary laboratory tests are helpful to physicians for accurate diagnosis of dengue fever [9].

showed that only 16 cases (21.3%) were reported to be dengue serology positive. The remaining 59 (78.6%) were dengue serology negative. A total of about 33 children that fulfilled the inclusion criteria were studied and the results were analyzed as given below.

Table-1: Distribution of children according to gender.

In Table-1, it was seen that out 33 cases studied, male children 23 ( 69.6%), female 10 (30.3%).

Table 2: Distribution of children according to age group.

Table 2 shows that the maximum numbers of seronegative dengue cases were seen among 11-15 years of age cases 17 (51.5%), followed by 12 cases (36.3%) in 6 to 10 years of age and 4 (12.1%) in 1-5 years of age.

Table 3: Distribution of children according to clinical profile.

Which showed that serology negative outnumbered serology positive cases. In a study done by Ho-Chen et al, it was seen that out of 317 pediatric cases clinically suspected of dengue, 205 were serology positive and 112 were serology negative [9].

A total of about 33 children that fulfilled the inclusion criteria were studied and the results were analyzed. In the present study, it was seen that, there was a preponderance of male children 23 ( 69.6%), than females 10 (30.3%). Maximum numbers of cases were seen among 11-15 years of age cases 17(%), followed by 12 cases (36.3%) in 6 to 10 years of age and 4 (12.1%) in 1- 5 years of age. Similar findings were also observed in a study conducted by Ho-Chen et al in seronegative dengue fever in children as well as in studies done in Malaysia and Pondicherry [9,13,14].

The most common symptom was fever seen in 33 (100%) of cases, followed by anorexia 27cases (81.8%), generalised myalgia 21cases (63.6%) , headache 14 cases (42.4% ), pain abdomen in 10 cases( 30.3%), vomiting 6 cases (18.1%), loose stools 5 cases (15.1%), cough 3 cases (9%),rashes in 2 case (6%). Similarly, fever was the most common symptom noted in a study conducted in Mumbai during the dengue epidemic [15]. But in a study done by Ho-Chen et al, in seronegative dengue cases, it was seen that cough was the most common clinical symptom [9]. In the current study, the most common atypical findings noted were loose stools and cough. But a study done in Puducherry, lymphadenopathy was the most common atypical finding observed [16].

The most common sign was hepatomegaly 30 cases (90.9%), splenomegaly 12 cases (36.3%), pedal edema 9 (27.2%), pleural effusion 5 (15.1%), ascites 4 (12.1%) and hypotension, altered sensorium and bleeding in 1 case (3%). Similar findings were seen in a study conducted in Delhi, hepatomegaly being the most common sign [17]. Altered sensorium was noted in (3%) of cases in the current study in severe dengue patients, which is a well-recognized symptom of dengue encephalitis/increased dengue viral neurotropism [18].

It was seen that 21 (63.6%) of patients were discharged in <5 days. Most of them belong to DF without warning signs. About 12 (36.3%) were discharged after 5 days of admission, most of them had DF with warning signs. In a study done by Mittal et al, the mean duration of hospital stay was