Dengue Literature Review

India

2 min read

India

Overview

India and the broader Indian subcontinent are among the highest-burden regions for dengue globally. DENV is endemic across much of the country, particularly in urban centres, with cyclical epidemic peaks. Unlike Taiwan (non-endemic, periodic epidemic importation), dengue circulates year-round in many Indian cities, creating a background of population immunity that shapes clinical presentation and research findings.

Key Points from Literature

Kolkata as a Research Setting

  • A 2021–2024 cross-sectional study at ICMR-National Institute of Cholera and Enteric Diseases (NICED), Kolkata, characterised ANA profiles in 135 lab-confirmed dengue patients presenting at fever clinics of multiple medical colleges and hospitals (see Chatterjee2024 - ANA Detection in Dengue Kolkata).
  • The study population was recruited from urban Kolkata fever clinics, meaning it skews toward presentations severe enough to seek hospital care — likely an enriched sample for moderate-to-severe dengue rather than representative of all community infections.
  • Dengue classification used the 1997 WHO guidelines (dengue fever, DHF, DSS) rather than the updated 2009 WHO criteria, which affects comparability with more recent studies (see Dengue Clinical Classification).

Dengue ANA Profile Findings

  • ANA-IIFA positivity was 54.8% in dengue-confirmed patients vs. 10.3% in dengue-negative controls — the highest dengue-associated ANA rate documented in this wiki (see Chatterjee2024 - ANA Detection in Dengue Kolkata, Antinuclear Antibodies).
  • LIA confirmation rate was 18.5% in dengue-positive patients, indicating most IIFA-positive dengue ANAs are non-specific.
  • MCTD and autoimmune myositis were the two autoimmune disease categories significantly associated with dengue in multivariate analysis (see Autoimmunity in Dengue).

Endemic vs. Non-Endemic Context

Findings from endemic India may not directly generalise to epidemic settings in non-endemic countries (Taiwan, Cuba). In endemic areas: (a) a higher proportion of dengue patients will be secondary infections (prior immunity); (b) dengue-like febrile illnesses from other pathogens are more frequent, complicating clinical diagnosis; (c) healthcare-seeking behaviour and illness severity threshold differ. The Kolkata study’s predominantly IgM-based confirmation (94%) may include patients at varying phases of infection including convalescence.

Contradictions & Debates

  • The MCTD/myositis findings from the Kolkata hospital-based cohort diverge from Shih2023’s population-based Taiwan cohort, which found no rheumatic disease associations. The different settings (endemic/hospital vs. non-endemic/population) and methods may explain this, but direct reconciliation is not possible from available evidence.

Sources

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