Dengue Fever

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild.  Dengue affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean.  This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific.  With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler.  The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

SYMPTOMS

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self limiting febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, join pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia.  Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. 

Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence.  A small proportion of patients develop DHF, which is caracterized by presence of resolving fever or a recent history of fever, lasting 2-7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count≤100,000/mm³), and increased vascular permeability, evidenced by hemoconcentration, hyposlbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock.  Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids.  There is no antiviral drug or vaccine against the dengue virus.

Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

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