Edit concept Create issue ticket

Dengue Fever

Dengue fever is common arthropod-borne viral disease caused by the dengue virus, a single-stranded RNA virus.


Presentation

Individuals with dengue generally have a history of either living in or travelling recently to areas that have been denoted as endemic [5]. The incubation period for the condition is 3-14 days.

Symptoms that occur two weeks after departure of the individual from an endemic area may not be due to the dengue virus.

Most patients experience erythematous mottling of the skin, chills and facial flushing. Facial flushing can be regarded as one of the most specific indicators of dengue fever. The chills may last for 2-3 days. Maculopapular rash and nonspecific febrile syndrome is often seen in children that are younger than 15 years of age.

Standard cases of dengue begin with onset of fever, chills, aching of the back, head, extremities and other symptoms [6]. The fever generally lasts for 2-7 days and so fever longer than 10 days may not be due to dengue.

Other findings may include injected conjunctivae, inflamed pharynx, Lymphadenopathy, nausea and vomiting, dry or non-productive cough, tachychardia and brachychardia.

Fever
  • This is a pattern that is known as saddleback fever. The saddleback fever is more commonly seen in dengue hemorrhagic fever cases. Thrombocytopenia, lymphopenia and leukopenia are equally common with dengue fever.[symptoma.com]
  • A 5-year-old girl who presented with fever that was confirmed to be dengue fever, and subsequently improved, except that the fever persisted. She fulfilled diagnostic criteria for Kawasaki disease on day 7 of fever.[ncbi.nlm.nih.gov]
  • These findings led to a dengue fever diagnosis.[ncbi.nlm.nih.gov]
  • The relationship between dengue fever cases and climatic factors such as relative humidity and temperature was investigated during 2006-2009 to determine whether there is any relationship between dengue fever cases and climatic parameters in Jeddah City[ncbi.nlm.nih.gov]
  • In rare cases, dengue fever can cause visual impairment, which usually occurs within 1 month after contracting dengue fever and ranges from mild blurring of vision to severe blindness.[ncbi.nlm.nih.gov]
High Fever
  • He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6 C), arthralgia, myalgia, and skin rash a few days before.[ncbi.nlm.nih.gov]
  • An exploratory laparotomy was performed after 24 h because of the persisting strong abdominal pain and high fever. Intraoperatively, enlarged mesenteric lymph nodes were found, with no symptoms of gallbladder pathology.[ncbi.nlm.nih.gov]
  • The acute phase of the illness causes extreme muscle pains and high fevers. These may last up to two weeks. A particular syndrome of the illness called Dengue hemorrhagic fever (DHF) usually affects children younger than 10 years.[indianexpress.com]
  • It begins with a sudden onset of high fever that usually lasts between 3-5 days, and is accompanied by the following symptoms: High fever, possibly as high as 106 F (41 C) Severe headache Possible bleeding from the mouth and nose Retro-orbital pain (pain[pacificmedicalacls.com]
  • Dengue fever begins with a sudden high fever, often as high as 105 F (40.5 C), 4 to 7 days after the infection. A flat, red rash may appear over most of the body 2 to 5 days after the fever starts.[nlm.nih.gov]
Chills
  • He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6 C), arthralgia, myalgia, and skin rash a few days before.[ncbi.nlm.nih.gov]
  • Most patients experience erythematous mottling of the skin, chills and facial flushing. Facial flushing can be regarded as one of the most specific indicators of dengue fever. The chills may last for 2-3 days.[symptoma.com]
  • My symptoms included pounding headaches that lasted all day, cold chills in 90 degree weather, and severe muscle pain all over my body. I was a mess![expertvagabond.com]
  • The disease manifests as a sudden onset of severe headache, chills, pain upon moving the eyes, and low backache.[denguevirusnet.com]
  • The patient has chills or chilly sensations, a fever, exhaustion, diarrhea, and/or vomiting. Pain behind the eyeballs (postorbital) occurs on moving the head. The head, lower back, legs and joints ache. The patient feels very weak.[rarediseases.org]
Infectious Mononucleosis
  • Infectious mononucleosis . Coxsackievirus and other enteroviruses. Rickettsial infections. Measles . Rubella . Parvovirus B19 . Weil's disease (leptospirosis) . Influenza . Chikungunya viral infection . Kawasaki disease . Yellow fever . Hantavirus .[patient.info]
  • mononucleosis , an acute illness that can spread through saliva mitten hand a birth defect involving the fusion of several fingers, with a single fingernail vagabond ’ s disease discoloration of the skin in people who are exposed to lice bites over a[encyclopedia.com]
Malaise
  • A 60-year-old Sri Lankan man presented with a history of fever, arthralgia, and generalized malaise of 2 days duration.[ncbi.nlm.nih.gov]
  • In August 2013, a child aged 2 years and from the Tremembé ethnic group, who was previously healthy with no complaints, suddenly presented intense crying, precordial pain, and general malaise.[ncbi.nlm.nih.gov]
  • A 58-year-old woman came to the University Centre of Tropical Medicine in Gdynia after returning from a tourist journey to Brazil because of fever up to 39 C and malaise.[ncbi.nlm.nih.gov]
  • Signs and symptoms [ edit ] About 80% of people infected with the virus have no symptoms, or only a mild fever and general malaise . Mild cases without rash may be easily misdiagnosed as flu.[en.wikivoyage.org]
Hypotension
  • On admission physical examination revealed fever, dry mucosa, moderate hypotension and tachycardia. In the laboratory test results, leukopoenia, thrombocytopoenia and elevated transaminases were observed.[ncbi.nlm.nih.gov]
  • Five independent mortality predictors were identified: elderly age ( 65 years), hypotension (systolic blood pressure 90 mmHg), hemoptysis, diabetes mellitus, and chronic bedridden.[ncbi.nlm.nih.gov]
  • The temperature rises quickly as high as 40 C, with relative low heart rate (bradycardia) and low blood pressure (hypotension).[denguevirusnet.com]
  • The most serious complications, although infrequent, are as follows: Dehydration Bleeding (hemorrhage) Low platelets Low blood pressure ( hypotension ) Slow heart rate (bradycardia) Liver damage Neurological damage ( seizures , encephalitis ) Death What[emedicinehealth.com]
Tachycardia
  • On admission physical examination revealed fever, dry mucosa, moderate hypotension and tachycardia. In the laboratory test results, leukopoenia, thrombocytopoenia and elevated transaminases were observed.[ncbi.nlm.nih.gov]
  • On admission, he had a tachycardia of 120 beats per minute, and blood pressure of 110/70 millimetres of mercury, with no bleeding manifestations.[ncbi.nlm.nih.gov]
  • […] epigastralgia (pain in the upper abdomen) Bleeding of the nose, mouth or gums Bleeding or bruising under the skin Hematemesis (vomiting blood) and vomiting without blood Dry skin and mucous membranes Excessive thirst Dehydration Insomnia and restlessness Tachycardia[pacificmedicalacls.com]
Red Eye
  • Dengue fever virus patients found to have red eyes need to be carefully followed and treated, as these eyes might develop thinning of the sclera that could lead to rupture of the globe, thereby resulting in blindness.[ncbi.nlm.nih.gov]
  • Symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints.[encyclopedia.com]
Flushing
  • Dengue is an arboviral infection that classically presents with fever, joint pain, headaches, skin flush and morbilliform rashes.[ncbi.nlm.nih.gov]
  • Most patients experience erythematous mottling of the skin, chills and facial flushing. Facial flushing can be regarded as one of the most specific indicators of dengue fever. The chills may last for 2-3 days.[symptoma.com]
  • The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41 C, possibly with convulsions and other complications.[denguevirusnet.com]
  • Initially, the features include high fever, which lasts for 2 – 7 days and can be as high as 40 – 41 C, facial flush and other non-specific constitutional symptoms of dengue fever.[chp.gov.hk]
Myalgia
  • An 8-year-old girl was admitted with fever, myalgia and petechiae. Dengue virus IgM antibodies were positive. She recovered completely, but her thrombocytopenia persisted. Six weeks later she became pancytopenic.[ncbi.nlm.nih.gov]
  • All patients had myalgia and headache. All of them, except one, had fever. Positive dengue serology (IgM) was found in all patients. No patient died.[ncbi.nlm.nih.gov]
  • He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6 C), arthralgia, myalgia, and skin rash a few days before.[ncbi.nlm.nih.gov]
  • A 34 year old male presented with low grade fever, headache, myalgia and breathlessness. Echocardiography revealed large pericardial effusion with right ventricular diagnostic collapse requiring urgent drainage. Subsequently patient improved.[ncbi.nlm.nih.gov]
  • While visiting Malaysia, a 22-year-old previously healthy Japanese man developed myalgia, headache, and fever, leading to a diagnosis of classical dengue fever.[ncbi.nlm.nih.gov]
Arthralgia
  • A 60-year-old Sri Lankan man presented with a history of fever, arthralgia, and generalized malaise of 2 days duration.[ncbi.nlm.nih.gov]
  • He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6 C), arthralgia, myalgia, and skin rash a few days before.[ncbi.nlm.nih.gov]
  • The patient had no history of travel off the island, and other family members reported having similar signs and symptoms, which consisted of fever, headache, myalgias and arthralgias, and a generalized erythematous rash.[ncbi.nlm.nih.gov]
  • Fever, myalgia, arthralgia and headache was significantly lower than normal population, while pleural effusions and ascites were observed more.[ncbi.nlm.nih.gov]
  • The diagnosis and notification criteria should not only include common symptoms of fever, myalgia, headache, skin rash and arthralgia, but should also be adjusted to include the most frequent symptoms of loss of appetite and feeling thirsty to shorten[ncbi.nlm.nih.gov]
Back Pain
  • The back pain is characteristic of the infection. Diagnosis A doctor may be able to diagnose dengue fever based on symptoms and any history a patient provides about travel and exposure to mosquitoes.[news-medical.net]
  • Some individuals may develop a sore throat , vomiting , nausea , abdominal and/or back pain , and loss of appetite.[emedicinehealth.com]
  • Symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints.[encyclopedia.com]
Headache
  • Dengue is an arboviral infection that classically presents with fever, joint pain, headaches, skin flush and morbilliform rashes.[ncbi.nlm.nih.gov]
  • A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital.[ncbi.nlm.nih.gov]
  • All patients had myalgia and headache. All of them, except one, had fever. Positive dengue serology (IgM) was found in all patients. No patient died.[ncbi.nlm.nih.gov]
  • A 34 year old male presented with low grade fever, headache, myalgia and breathlessness. Echocardiography revealed large pericardial effusion with right ventricular diagnostic collapse requiring urgent drainage. Subsequently patient improved.[ncbi.nlm.nih.gov]
  • While visiting Malaysia, a 22-year-old previously healthy Japanese man developed myalgia, headache, and fever, leading to a diagnosis of classical dengue fever.[ncbi.nlm.nih.gov]
Dysarthria
  • Clinical examination revealed a scanning dysarthria and marked horizontal nystagmus with bilateral dysmetria, dysdiadokokinesia and incordination more prominent on the right.[ncbi.nlm.nih.gov]
Dysmetria
  • Clinical examination revealed a scanning dysarthria and marked horizontal nystagmus with bilateral dysmetria, dysdiadokokinesia and incordination more prominent on the right.[ncbi.nlm.nih.gov]
Flaccid Paralysis
  • In regions where dengue is hyperendemic, screening for dengue illness may be important in patients presenting with acute flaccid paralysis.[ncbi.nlm.nih.gov]

Workup

The signs and symptoms of dengue fever are nonspecific [7]. Therefore attempting a laboratory confirmation of the dengue infection is vital. Criteria to be met in the laboratory for diagnosis to be confirmed include:

  • Detection of viral genomic sequences in autopsy tissue, serum, or cerebral spinal fluid (CSF) samples through polymerase chain reaction (PCR)
  • Demonstration of dengue virus antigen in autopsy tissue via immunohistochemistry or immunofluorescence or in serum samples via enzyme immunoassay (EIA)
  • Demonstration of a fourfold or greater change in reciprocal immunoglobulin G (IgG) or immunoglobulin M (IgM) antibody titers to one or more dengue virus antigens in paired serum samples
  • Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy samples

The following laboratory tests equally have to be performed:

  • Metabolic panel

Dengue fever characteristically shows thrombocytopenia with platelet count < 100 x 109/L. Leukopenia and mild or moderate increases in level of alanine aminotransferase values can also be found [8].

Staphylococcus Aureus
  • A sputum smear revealed leukocytes with phagocytized gram-positive cocci in clusters, and grew an isolate Staphylococcus aureus sensitive to semi-synthetic penicillin; he was treated successfully with ceftriaxone and cephalexin.[ncbi.nlm.nih.gov]

Treatment

Dengue fever is usually a self-limited illness. As there is presently no antiviral drug available, treatment is supportive, with analgesics, fluid replacement, and bed rest.

Prognosis

The dengue fever condition is a self-limiting one and the mortality rate is less than 1%. When adequately treated, dengue hemorrhagic fever has a mortality rate of 2-5%. If left untreated, dengue hemorrhagic fever has a mortality rate which is as high as 50% [9].

Etiology

Dengue fever is caused by the DENV (dengue virus). This virus is a single-stranded RNA virus of the family Flaviviridae and genus Flavivirus. The type specific virus is yellow fever [3]. The dengue virus has 4 stereotypes that are antigenically distinct. Each of the stereotypes have several different genotypes and disease severity is affected by the sequence of infection with different serotypes.

An important risk factor for infection is living in endemic areas of the tropics where the vector mosquito thrives. The explosive global population growth and poorly planned urbanization is what brings the human host and mosquito close to each other.

Increase in air travel also makes it easy for infectious diseases to be transported between different groups.

Epidemiology

United States

In the U.S dengue occurs principally in travellers who have just returned from areas marked as endemic. According to the CDC, 244 confirmed cases of travel related dengue were reported in the U.S within 2006 to 2008.

Over the past 20 years, there has been an increase in the cases of Dengue amongst returning U.S travellers. The condition is also responsible for majority of febrile illnesses in individuals returning from South America, Asia and the Caribbean [2].

International

500,000 cases of dengue hemorrhagic fever and 50-100 million cases of dengue fever occur worldwide each year with an approximated 22,000 deaths recorded yearly too. 40% of the world’s population are at risk of dengue infection (an estimated 2.5-3 billion people spread across 112 tropical and subtropical countries around the world).

The only continents where dengue transmission is not experienced are Antarctica and Europe. The WHO rates dengue as the most important viral disease transmitted by mosquito in the world. Dengue has continued to pose a challenge to world health as it has increased 30 fold over the past 30 years.

Sex distribution
Age distribution

Pathophysiology

As mentioned above, dengue fever is a mosquito-borne viral disease that is caused by one of four dengue virus types [4]. Homotypic immunity is conferred on an individual after infection by one type of this virus. There is also brief period of partial heterotypic immunity. It is possible for several serotypes to be in circulation in the event of an epidemic.

Dengue fever develops like majority of bacterial and viral illnesses. Fever sets in on the third day of illness and may last for 5-7 days. It abates with the end of viremia. In children, the fever is intermittent, abating for a day before recurring. This is a pattern that is known as saddleback fever. The saddleback fever is more commonly seen in dengue hemorrhagic fever cases.

Thrombocytopenia, lymphopenia and leukopenia are equally common with dengue fever. It is believed that this happens due to the direct destructive actions of the virus on bone marrow precursor cells.

Prevention

There are not yet any vaccines to prevent infection and the most effective protective measures are those that avoid mosquito bites.

Summary

Dengue fever is a mosquito-borne tropical disease that is caused by the dengue virus. It is also referred to as breakbone fever

Dengue fever is transmitted by the A. aegypti mosquito. The dengue virus is of 5 types. When an individual is infected with one type, he or she gets lifelong immunity to that type. Infection also brings immunity to the other virus forms, albeit temporary [1]. Infection by another type of the virus after an earlier case leads to an increased risk of severe complications.

There are no commercially available vaccines. Therefore prevention is achieved by reducing or destroying the mosquito habitat and also limiting the exposure of individuals to bites.

Dengue vascualopathy or Dengue hemorrahgic fever brings about vascular leakage in patients and this often results in serous effusions and hemoconcentration which may lead to a collapse of the circulatory system. This happens in conjuction with severe hemorrhagic complications leading to dengue shock syndrome, a condition with greater risk of fatality.

Patient Information

Individuals who have suffered dengue fever in the past should avoid mosquito bites through the use of repellants and other domestic vector control techniques especially when travelling to areas that are endemic [10]. This is because such individuals are at risk of developing the dengue shock syndrome or dengue hemorrhagic fever if they get infected with a different dengue strain in the future.

References

Article

  1. Normile D. Surprising new dengue virus throws a spanner in disease control efforts. Science 2013 342 (6157): 415.
  2. Whitehorn J, Farrar J. Dengue. Br. Med. Bull. 2010 95: 161–73.
  3. Bhatt S, Gething PW, Brady OJ, et al. (April 2013). "The global distribution and burden of dengue". Nature 496 (7446): 504–7.
  4. Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol. 2008;62:71-92.
  5. Statler J, Mammen M, Lyons A, Sun W. Sonographic findings of healthy volunteers infected with dengue virus. J Clin Ultrasound. Sep 2008;36(7):413-7.
  6. Gubler DJ. Cities spawn epidemic dengue viruses. Nat Med. Feb 2004;10(2):129-30.
  7. Wilder-Smith A, Gubler DJ. Geographic expansion of dengue: the impact of international travel. Med Clin North Am. Nov 2008;92(6):1377-90, x.
  8. Halstead SB. Dengue. Lancet. Nov 10 2007;370(9599):1644-52.
  9. Chowell G, Torre CA, Munayco-Escate C, Suárez-Ognio L, López-Cruz R, Hyman JM. Spatial and temporal dynamics of dengue fever in Peru: 1994-2006. Epidemiol Infect. Dec 2008;136(12):1667-77.
  10. Guzman MG, Halstead SB, Artsob H, et al. (December 2010). "Dengue: a continuing global threat". Nature Reviews Microbiology 8 (12 Suppl): S7–S16.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 17:26