Prevalence and Variability of Clinical Manifestations of Dengue in Peru: A Systematic Review and Meta-Analysis of Observational Studies

Dengue remains a major public health challenge in Peru, where recurrent outbreaks show marked variation in clinical presentation. This systematic review and meta-analysis synthesized available evidence to quantify the frequency and variability of dengue manifestations in Peruvian patients and to identify clinically relevant patterns for early recognition. We systematically searched PubMed, Scopus, Embase, Web of Science, ScienceDirect, Google Scholar, Virtual Health Library, and Scielo for observational studies published between 1993 and January 2025. Two reviewers independently selected studies, extracted data, and assessed methodological quality. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using random-effects models. Twenty-eight studies including 4418 patients were analyzed. The most frequent manifestations were fever (95%; 95% CI: 90–98%), headache (86%; 95% CI: 80–91%), malaise (82%; 95% CI: 71–91%), myalgia (69%; 95% CI: 58–79%), arthralgia (64%; 95% CI: 56–73%), and retro-orbital pain (56%; 95% CI: 47–66%). Gastrointestinal symptoms were also common, including nausea/vomiting (40%; 95% CI: 33–48%) and abdominal pain (33%; 95% CI: 21–45%), whereas hemorrhagic and severe manifestations were less frequent, such as hematemesis (6%; 95% CI: 2–10%), petechiae (6%; 95% CI: 2–10%), jaundice (3%; 95% CI: 1–7%), and melena (1%; 95% CI: 0–6%). Heterogeneity was high across most outcomes (I2 generally >90%), suggesting substantial between-study variability. This heterogeneity is likely related to differences in geographic region, outbreak period, circulating serotypes, diagnostic methods, and case severity definitions across studies. These findings highlight a consistent core symptom profile of dengue in Peru while also demonstrating important clinical variability. This information may support earlier clinical suspicion, triage, and surveillance in endemic settings. However, pooled estimates should be interpreted cautiously given the high heterogeneity, moderate methodological rigor of included studies, and lack of individual-level data. Future analyses stratified by region, study period, and diagnostic method are needed to generate more clinically precise estimates.