Abstract
Background: Dengue is a serious public health threat with a variable clinical course ranging from self-limited illness to fatal complications. Atypical manifestations and uncommon clinical pattern of presentations have been observed during the recent past.
Methodology A retrospective study was conducted for all pediatric patients admitted to Mukalla and university hospital from December 2015 to March 2016 with a suspicion of dengue infection after the attack of Chapala cyclone in November 2015 to determine the common clinical presentations and recognize any atypical manifestations of dengue infection. Data collected included age, gender, monthly distribution, duration of symptoms on admission, common presentations, associated co-morbidities, complications and outcome.
Results: The sample consisted of 123 patients (32 cases confirmed, 91 cases probable) including 59 males and 64 females. The most common age group of presentation was between 9-12 years. Classic dengue fever (DF) was present in 120 cases (97.6%) and only one case (0.81%) had dengue shock syndrome (DSS). The most common manifestations included fever (100%), vomiting (64.2%), anorexia (52%), abdominal pain (48 %) and general weakness (42.3%). Hemorrhagic manifestations were present in (17%) of cases. Unusual presentation included upper respiratory manifestations (20.3%), pleural effusion (3.2%), hypotension (22%), tachycardia (16.3%), bradycardia (13.6%) and hematuria (1.6%). Seizures (4.1 %) were the commonest neurological presentation. Two patients had coma and one patient died.
Conclusion: High index of suspicion, especially among the healthcare personnel at primary health centers, is needed to ensure prompt recognition, early management, avoid fatal complications and improve the outcome of dengue infection.

Key words: Atypical manifestation, Chapala cyclone, dengue; dengue virus, Yemen