Category: International EM
Keywords: dengue, fever, international, mosquito, vector (PubMed Search)
Posted: 12/12/2012 by Andrea Tenner, MD
(Updated: 11/12/2024)
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Background:
Dengue is the most rapidly expanding mosquito-borne virus with an increasing incidence and geographical area. It is most commonly found in the tropics, but there are occasional outbreaks in other places, including Texas and Hawaii.
Clinical:
Three Phases:
1. The febrile phase lasts 2-7 dyas and is similar to other viral syndromes, often with high fever and nausea/vomiting. Petechiae may also be present which can be induced by the application of a tourniquet.
2. The critical phase occurs after defervescence and lasts only 24-48 hours. IT is marked by increased capillary permeability and can lead to severe pulmonary edema, shock, and multisystem organ failure.
3. The recovery phase is marked by hemodynamic improvement. Some patients have a rash described as "isles of white in a sea of red."
Some patients will develop bradycardia. Most patients have a self-limited form of the illness that is not severe, and consists of symptoms seen in the febrile phase. The patients that develop severe dengue can have markers in the febrile phase that are associated with organ dysfunction, GI bleeding, and increased capillary permeability. Other concerning symptoms early are abdominal tenderness and persistent vomiting.
Treatment:
Treatment is supportive, mostly consisting of IV fluids, which is very effective when started early in the patient's illness. For more information and maps of endemic areas check out the CDC or WHO websites: http://www.cdc.gov/travel/notices/in-the-news/dengue-tropical-sub-tropical.htm or http://www.who.int/denguecontrol/en/
University of Maryland Section for Global Emergency Health
Author: Jenny Saltzberg
Dengue: guidelines for diagnosis, treatment, prevention, and control -- New Edition. (2009) World Health Organization.
Chen LH, Wilson ME. Dengue and chikungunya in travelers: recent updates. Curr Opin Infect Dis. 2012 Oct;25(5):523-9.
