Dengue Literature Review

India

7 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).

Gwalior, Madhya Pradesh — ANA Seroconversion Study (Gawali2021)

Gawali2021 - ANA Prevalence in Seroconverted Dengue Patients was conducted at Gajra Raja Medical College (GRMC), Gwalior, Madhya Pradesh — a government medical college serving Central India. This is the third distinct Indian research setting in this wiki (alongside Kolkata/NICED and Manipal/Kasturba Medical College).

  • Study period: January 2019 – June 2020; 2,249 clinically suspected dengue patients screened, 765 (34%) seropositive
  • 163 patients followed up at 6 months; 120 (74%) had developed IgG; 22/120 (18.33%) were ANA-positive by HEp-2 IIFA at 1:100 dilution
  • Dominant ANA pattern: AC-1 (nuclear homogeneous, 81.81%) — associated with dsDNA, histone, and nucleosome targets
  • Key limitation: No control group tested for ANA in this setting; background ANA rate for Central India is unknown. The 18.33% rate is only modestly above the closest available baseline (Li2019 Chinese health-checkup at >1:100: 14.01%), limiting how much can be attributed to dengue exposure specifically.
  • IgG seroconversion was significantly associated with older age (mean 26.67 vs. 19.86 years, p = 0.004); ANA positivity showed no significant age or sex association.

Mumbai, Maharashtra — Dengue-Triggered SLE Case (Rajadhyaksha2012)

Rajadhyaksha2012 - Dengue Evolving into SLE and Lupus Nephritis originates from KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra — the fourth distinct Indian research setting in this wiki (alongside Kolkata/NICED, Gwalior/GRMC, and Manipal/KMC). This is a case report (n=1) rather than a cohort study; it provides no epidemiological data about dengue incidence or ANA prevalence in the Mumbai population.

  • Setting: tertiary academic hospital in Mumbai, the financial capital of Maharashtra state; published in Lupus (2012)
  • A 22-year-old woman with no prior autoimmune history developed primary DENV-1 infection (IgM+/IgG- ELISA; RT-PCR confirmed genotype 1) and was diagnosed with SLE and Class IV lupus nephritis 4 weeks later
  • The study adds Mumbai to the map of Indian dengue research settings and contributes to the autoimmunity thread; it does not report dengue serotype distribution, incidence, or population-level immunity data for Maharashtra
  • Maharashtra is a dengue-endemic state; Mumbai’s dense urban environment and monsoon flooding create conditions for sustained Aedes aegypti transmission. No serotype surveillance data from this setting is present in this wiki.

Manipal, Karnataka — Pathogenesis Research Setting (Bhatt2020)

Bhatt2020 - Dengue Pathogenesis Review originates from Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka — a different Indian research centre from Kolkata’s NICED. This is a narrative review article drawing on international literature; it does not report an original Indian patient cohort, but its authorship from a major Indian medical institution reflects the depth of dengue research infrastructure in Karnataka, a dengue-endemic state in southern India. The Southeast Asian epidemiological context — including the dominance of the virulent Asian genotype of DENV-2 in this region — shapes the paper’s framing of dengue pathogenesis. Karnataka is relevant to dengue epidemiology as part of India’s tropical dengue-endemic belt.

Lucknow, Uttar Pradesh + AIIMS New Delhi — 1996 DHF Epidemic (Chaturvedi2001)

Chaturvedi2001 - Cytotoxic Factor Autoantibodies DHF draws on serum samples collected from two sites during an extensive DHF epidemic in Northern India, August–November 1996:

  • Gandhi Memorial and Associated Hospitals, Lucknow, Uttar Pradesh
  • Pediatrics Department, All India Institute of Medical Sciences (AIIMS), New Delhi

This is the fifth Indian research setting in this wiki and the only one from Uttar Pradesh/Delhi. The 1996 epidemic was large: a companion paper (ref [9] of Chaturvedi2001) tested 333 patients and found hCF in 90% of them. Serum samples were transported to Kuwait University for analysis, reflecting the collaborative structure of the Chaturvedi group. The epidemic provides the backdrop for several related publications by the same group on hCF biology and CD4+ T cell responses.

The 1996 Northern India epidemic is the earliest dengue epidemic represented in this wiki’s primary sources (the next earliest is the 2001 Havana DENV-3 outbreak documented in Guzman2016). No serotype data are reported in Chaturvedi2001 for this epidemic.

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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