• Clinical science

Dengue

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

  • Pathogen
  • Transmission route
    • Vector-borne; : mosquitoes most commonly from the species Aedes aegypti

References:[3][4][5]

Clinical features

Classic dengue fever

  • Incubation period: 2–14 days
  • Children are usually asymptomatic
  • Starts with fever and malaise that lasts ∼ 1 week
  • Severe arthralgia and myalgia; (often referred to as “break-bone fever”)
  • Severe headache and retro-orbital pain
  • Maculopapular, measles-like exanthem (typically appears 2–5 days following fever)
  • Generalized lymphadenopathy

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)

  • Occurs in 1–2% of cases
  • Generally develops as the initial fever subsides (∼ 1 week after onset)
  • Clinical manifestations
    • Temperature change: ranges from hypothermia to a second spike in fever
    • Abdominal pain, vomiting
    • Changes in mental status (e.g., confusion)
    • Hemorrhagic manifestations; (e.g., petechiae, epistaxis, gingival bleeding)
    • Increased vascular permeability; → signs of pleural effusion; and/or ascites
  • Dengue shock syndrome (DSS): DHF + shock

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


References:[3][6][1][7]

Diagnostics

  • Laboratory tests
  • Best test for confirming infection: serology (IgM, IgG)
  • Alternatives
    • PCR
    • Molecular methods (ELISA): detection of viral antigen

References:[1][8][9][10]

Differential diagnoses

  • Malaria
  • Other viral hemorrhagic fevers
    • Especially Chikungunya; (exhibits similar symptoms with an emphasis on bilateral polyarthralgia)
  • Zika virus infection

The differential diagnoses listed here are not exhaustive.

Treatment

References:[11]

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:[12][13][14][15][16]