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Published on: November 1, 2018
Hepatic dysfunction in childhood dengue infection
B Mohan1, A K Patwari, V K Anand
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
Insights
Childhood dengue infection (DI) can cause temporary liver function abnormalities, particularly in severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) cases, with or without hepatomegaly.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hepatology
Background:
- Dengue infection (DI) is a significant pediatric health concern.
- Hepatic involvement is a common complication in childhood DI.
- Understanding the pattern of liver function derangement is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate hepatic functions in children with DI during the acute phase.
- To compare liver enzyme levels across different dengue severity classifications (DF, DHF, DSS).
- To assess the impact of hepatomegaly on liver function tests in pediatric DI.
Main Methods:
- Prospective study of 61 children (2 months-12 years) with DI.
- Categorization into dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS).
- Monitoring of liver function tests including AST, ALT, AP, and bilirubin levels during acute illness and hospitalization.
Main Results:
- Elevated AST, ALT, and AP levels were observed in 80-87% of children on admission, irrespective of hepatomegaly.
- Increased proportion and significantly higher mean levels of liver enzymes and bilirubin were noted in the second week of hospitalization (p < 0.05).
- DHF and DSS cases exhibited significantly higher mean AST, ALT, and AP levels compared to DF (p < 0.05).
Conclusions:
- Childhood dengue infection leads to transient liver function derangements.
- The severity of liver involvement correlates with dengue severity, being more pronounced in DHF and DSS.
- Liver function abnormalities in DI can occur with or without clinical hepatomegaly.
Abstract:
Hepatic functions of 61 children, diagnosed to have dengue infection (DI), aged 2 months to 12 years comprising 37 cases of dengue fever (DF), 16 with dengue hemorrhagic fever (DHF), and eight with dengue shock syndrome (DSS) were prospectively studied during the acute attack. Hepatomegaly (74 per cent), epistaxis (26 per cent), jaundice (25 per cent), and petechial rashes (18 per cent) were the common clinical manifestations of DI. On admission, levels of serum aspartate transaminase (AST), serum alanine transaminase (ALT) and serum alkaline phosphatase (AP) were raised in 80-87 per cent of children with hepatomegaly (group I) and 81 per cent of cases without hepatomegaly (group II). During the second week of hospitalization the proportion of cases with raised levels of AST, ALT, AP and serum bilirubin increased and the mean levels were significantly higher (p < 0.05) in both the groups. These levels gradually declined over the next 2-3 weeks. All the cases with DSS and DHF had raised AST, ALT and AP levels and the mean levels of these enzymes were significantly higher (p < 0.05) as compared to DF. Our results suggest a transient derangement of liver functions in childhood DI, more so in DSS and DHF, with or without hepatomegaly.
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