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Dengue

Last updated: July 24, 2020

Summary

Dengue is a viral disease transmitted by mosquitoes (especially Aedes aegypti) and is widely distributed throughout the tropics and subtropics. Dengue classically presents with high fever, headache, body aches, exanthem, and generalized lymphadenopathy. Symptoms usually subside within one week. Some cases progress to the more severe dengue hemorrhagic fever (DHF) with thrombocytopenia, spontaneous bleeding, and potentially shock (dengue shock syndrome). Treatment is supportive. A vaccination is available for use in children, living in endemic areas, with confirmed prior dengue virus infection.

Epidemiology

  • Distribution: tropical regions; worldwide, particularly Asia (e.g., Thailand)
  • Incidence
    • Most common viral disease affecting tourists in tropical regions
    • ∼ 400 million infections per year worldwide

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[4][5][6]

Clinical features

Classic dengue fever

If symptoms appear more than 2 weeks after returning from a dengue-endemic region, it is very unlikely that dengue is the cause!

Dengue hemorrhagic fever (DHF)

Dengue hemorrhagic fever is more frequent in individuals who experience a repeat infection with a second serotype, especially serotype 2!


References:[1][4][8][9]

Diagnostics

References:[1][7][10][11]

Differential diagnoses

Chikungunya fever [12][13]

Other

The differential diagnoses listed here are not exhaustive.

Treatment

References:[14]

Prevention

  • Avoid exposure, use of mosquito repellent (see also → mosquito bite prevention)
  • A tetravalent attenuated live vaccine (CYD-TDV) has been approved for use in children between 9–16 years of age who live in endemic areas and have a laboratory confirmed prior dengue virus infection.

References:[15][16][17][18][19]

References

  1. Thomas SJ, Rothman AL, Srikiatkhachorn A, Kalayanarooj S. Dengue Virus Infection: Clinical Manifestations and Diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/dengue-virus-infection-clinical-manifestations-and-diagnosis.Last updated: February 17, 2017. Accessed: March 24, 2017.
  2. Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature. 2013; 496 (7446): p.504-507. doi: 10.1038/nature12060 . | Open in Read by QxMD
  3. Lee C, Lee H. Probable female to male sexual transmission of dengue virus infection. Infect Dis. 2018; 51 (2): p.150-152. doi: 10.1080/23744235.2018.1521004 . | Open in Read by QxMD
  4. Dengue: Clinical Guidance. https://www.cdc.gov/dengue/clinicallab/clinical.html. Updated: September 6, 2014. Accessed: February 21, 2017.
  5. Rothman AL. Dengue Virus Infection: Epidemiology. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/dengue-virus-infection-epidemiology.Last updated: February 29, 2016. Accessed: March 25, 2017.
  6. LaBeaud AD. Zika Virus Infection: An Overview. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/zika-virus-infection-an-overview.Last updated: March 21, 2017. Accessed: March 27, 2017.
  7. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. http://apps.who.int/iris/bitstream/10665/44188/1/9789241547871_eng.pdf. Updated: January 1, 2009. Accessed: March 24, 2017.
  8. Dengue and Severe Dengue. http://www.who.int/mediacentre/factsheets/fs117/en/. Updated: July 1, 2016. Accessed: March 20, 2017.
  9. Dengue: Epidemiology. https://www.cdc.gov/Dengue/epidemiology/index.html. Updated: June 9, 2014. Accessed: March 24, 2017.
  10. World Health Organization. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. World Health Organization ; 1997
  11. Dengue: Laboratory Guidance and Diagnostic Testing. https://www.cdc.gov/dengue/clinicalLab/laboratory.html. Updated: January 20, 2016. Accessed: March 24, 2017.
  12. Chikungunya Virus. https://www.cdc.gov/chikungunya/symptoms/index.html. Updated: September 19, 2019. Accessed: July 22, 2020.
  13. Ojeda Rodriguez JA; Haftel A; Walker JR III.. Chikungunya Fever. StatPearls. 2020 .
  14. Thomas SJ, Rothman AL, Srikiatkhachorn A, Kalayanarooj S. Dengue Virus Infection: Prevention and Treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/dengue-virus-infection-prevention-and-treatment.Last updated: March 16, 2017. Accessed: March 24, 2017.
  15. Safety of CYD-TDV dengue vaccine.
  16. Gubler DJ. Aedes aegypti and Aedes aegypti-borne disease control in the 1990s: top down or bottom up: Charles Franklin Craig Lecture. Am J Trop Med Hyg. 1989; 40 (6): p.571-578. doi: 10.4269/ajtmh.1989.40.571 . | Open in Read by QxMD
  17. Halstead SB. Selective primary health care: strategies for control of disease in the developing world: XI-Dengue. Rev Infect Dis. 1984; 6 (2): p.251-264.
  18. Rothman AL, Durbin AP, Whitehead SS. Current Topics in Microbiology and Immunology: Dengue Virus. Springer ; 2010
  19. López-Gatell H, Alpuche-Aranda CM, Santos-Preciado JI, Hernández-Ávila M. Dengue vaccine: local decisions, global consequences. Bull World Health Organ. 2016; 94 (11): p.850-855. doi: 10.2471/blt.15.168765 . | Open in Read by QxMD
  20. Focus On: Dengue Fever. https://www.acep.org/Clinical---Practice-Management/Focus-On--Dengue-Fever/. Updated: June 1, 2008. Accessed: March 24, 2017.