Dengue Fever
Dengue Fever
Dengue Fever
Introduction
● Dengue fever is one of the world’s major emerging infectious diseases. It is now
the most common cause of arboviral disease in the world. 2
● Most cases will be self-limiting with good recovery, however occasionally severe
disease can occur in the form of dengue hemorrhagic fever and/ or dengue shock
syndrome.
Pathology
Organism
Pathophysiology
Epidemiology
Dengue virus has been recognized since the latter part of the 18th century as causing
epidemics in tropical and subtropical parts throughout the world.
Global distribution of dengue fever, 2002, (CDC)
Transmission
Aedes aegypti is found worldwide in the tropics and subtropics, and is the
principal vector. It is an efficient vector because it is highly susceptible to dengue
virus, feeds preferentially on human blood, is a daytime feeder, has an almost
imperceptible bite, and is capable of biting several people in a short period for one
blood meal. The mosquito is well adapted to life in urban settings and typically
breeds in clean, stagnant water in containers that collect rainwater, such as tires,
tin cans, pots, and buckets.
Aedes albopictus, a mosquito common in South East Asia and Papua New
Guinea is also an important vector.
● Note that in countries where dengue currently is not endemic but where a capable
vector exists, new autochthonous cycles of infection may be established from
infected travelers or immigrants who are coming from areas where the disease is
endemic.
● There is no evidence of person to person transmission.
Incubation Period
● The incubation period is usually about three days but may be up to fourteen days.
Reservoir
● Humans are the only vertebrate hosts of the virus. There is a jungle cycle between
monkeys and mosquitoes, but this plays no role in human disease.
Period of Communicability
● Infection with one serotype confers long-term immunity only to that serotype, and
therefore persons may be infected up to four times. 2
Clinical Features
Two forms of dengue fever are described, classical dengue (also known as “break bone
fever”) and the more severe life threatening form, dengue hemorrhagic fever.
See appendix 1 below for a suggested algorithm for the clinical diagnosis of possible
dengue fever.
● Arthralgias
● Headache, frontal and retro-orbital pain is common.
● Lethargy/ malaise.
4. GIT upset
5. Rash
In its severest form it may result in shock (dengue shock syndrome), which has a
high fatality rate.
The rate of death from dengue haemorrhagic fever without dengue shock syndrome
is up to 5%, with the shock syndrome mortality is high without aggressive
supportive treatment.
● Arthralgias
● Lethargy/ malaise.
4. GIT upset
5. Haemorrhagic phenomena
The tourniquet test is performed by inflating a blood pressure cuff on the upper
arm to a point midway between systolic and diastolic blood pressures for five
minutes. A test is considered positive when there are 20 or more petechiae per
square inch (6.25 cm2) on the forearm.
Investigations
Biochemical
1. FBE
2. U&Es/ glucose
4. LFTs
Serology
● IgM indicates acute infection. May take up to 5 days after the onset of fever. IgM
levels will then remain detectable for 3-6 months.
● IgG merely indicates indeterminate past infection. A rise in titre will generally
begin after 7-10 days of the fever. A four fold rise in titre however is only useful
retrospectively. IgG will remain detectable for life.
● Note however that, either IgM or IgG positivity may result from cross-reactivity
with other flavivirus antibodies (such as West Nile, Yellow fever or Japanese
encephalitis) and so the possibility of exposure to other flaviviruses must be
considered. Levels may also be elevated due to previous vaccination against
flaviviruses.
PCR
Management
1. Supportive treatment:
There is no specific treatment for dengue fever.
2. Anti-pyretics:
● Paracetomol may be given. Aspirin and NSAIDs are best avoided due to
the potential to aggravate bleeding complications.
3. Monitoring:
Disposition
● Any patient with suspected dengue fever must be admitted to hospital. This will
usually be the case for fever in any returned traveller from regions of the world
where serious infectious disease is endemic
● Dengue fever will rarely be diagnosed in the ED and other serious infectious
diseases such as malaria or typhoid will also need to be considered in the first
instance.
Vaccine
● There is no vaccine currently available for dengue fever, but intensive research
continues.
Appendix 1