Dengue Clinical Presentation

  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Feb 3, 2012
 

History

Patients with dengue will have a history of living in, or recent travel to, a region where the disease is endemic. The incubation period is 3-14 days (average, 4-7 days); symptoms that begin more than 2 weeks after a person departs from an endemic area are probably not due to dengue.

Many patients experience a prodrome of chills, erythematous mottling of the skin, and facial flushing (a sensitive and specific indicator of dengue fever). The prodrome may last for 2-3 days. Children younger than 15 years usually have a nonspecific febrile syndrome, which may be accompanied by a maculopapular rash. Classic dengue fever begins with sudden onset of fever, chills, and severe (termed breakbone) aching of the head, back, and extremities, as well as other symptoms. The fever lasts 2-7 days and may reach 41°C. Fever that lasts longer than 10 days is probably not due to dengue.

Pain and other accompanying symptoms may include any of the following:

  • Headache
  • Retro-orbital pain
  • General body pain (arthralgias, myalgias)
  • Nausea and vomiting (however, diarrhea is rare)
  • Rash
  • Weakness
  • Altered taste sensation
  • Anorexia
  • Sore throat
  • Mild hemorrhagic manifestations (eg, petechiae, bleeding gums, epistaxis, menorrhagia, hematuria)
  • Lymphadenopathy

Rash in dengue fever is a maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands of skin sparing. The rash typically begins on day 3 and persists 2-3 days.

Fever typically abates with the cessation of viremia. Occasionally, and more commonly in children, the fever abates for a day and then returns, a pattern that has been called saddleback fever. A second rash may occur within 1-2 days of defervescence, lasting 1-5 days; it is morbilliform, is maculopapular, spares the palms and soles, and occasionally desquamates.

Recovery is complete but slow, with fatigue and exhaustion often persisting after the fever has subsided. The convalescent phase may last for 2 weeks.

Patients are at risk for development of dengue hemorrhagic fever or dengue shock syndrome at approximately the time of defervescence. Abdominal pain in conjunction with restlessness, change in mental status, hypothermia, and a drop in the platelet count presages the development of dengue hemorrhagic fever.

Of patients with dengue hemorrhagic fever, 90% are younger than 15 years. The initial phase of dengue hemorrhagic fever is similar to that of dengue fever and other febrile viral illnesses. Shortly after the fever breaks (or sometimes within 24 hours before), signs of plasma leakage appear, along with the development of hemorrhagic symptoms such as bleeding from sites of trauma, gastrointestinal bleeding, and hematuria. Patients may also present with abdominal pain, vomiting, febrile seizures (in children), and a decreased level of consciousness.

If left untreated, dengue hemorrhagic fever most likely progresses to dengue shock syndrome. Common symptoms in impending shock include abdominal pain, vomiting, and restlessness. Patients also may have symptoms related to circulatory failure.

Next

Physical Examination

Dengue fever presents in a nonspecific manner and may not be distinguishable from other viral or bacterial illness. According to the Pan American Health Organization (PAHO), the clinical description of dengue fever is an acute febrile illness of 2-7 days duration associated with 2 or more of the following:

  • Severe and generalized headache
  • Retro-orbital pain
  • Severe myalgias, especially of the lower back, arms, and legs
  • Arthralgias, usually of the knees and shoulders
  • Characteristic rash
  • Hemorrhagic manifestations
  • Leukopenia

Additional findings may include the following:

  • Injected conjunctivae
  • Facial flushing, a sensitive and specific predictor of dengue infection
  • Inflamed pharynx
  • Lymphadenopathy
  • Nausea and vomiting
  • Nonproductive cough
  • Tachycardia, bradycardia, and conduction defects

Up to half of patients with dengue fever develop a characteristic rash. The rash is variable and may be maculopapular or macular. Petechiae and purpura may develop as hemorrhagic manifestations. Hemorrhagic manifestations most commonly include petechiae and bleeding at venipuncture sites.

A tourniquet test is often positive. This test is performed by inflating a blood pressure cuff on the upper arm to midway between diastolic and systolic blood pressures for 5 minutes. The results are considered to be positive if more than 20 petechiae per square inch are observed on the skin in the area that was under pressure. Other hemorrhagic manifestations include nasal or gingival bleeding, melena, hematemesis, and menorrhagia.

Neurologic manifestations such as seizures and encephalitis/encephalopathy have been reported in rare cases of dengue infection. Some of these cases did not display other typical features of dengue infection. Other neurologic complications associated with dengue infection include neuropathies, Guillain-Barré syndrome, and transverse myelitis.

Dengue hemorrhagic fever

Findings for dengue hemorrhagic fever are similar to those for dengue fever and include the following:

  • Biphasic fever curve
  • Hemorrhagic findings more pronounced than in dengue fever
  • Signs of peritoneal effusion, pleural effusion, or both

Minimal criteria for the diagnosis of dengue hemorrhagic fever, according to the World Health Organization (WHO), are as follows[43] :

  • Fever
  • Hemorrhagic manifestations (eg, hemoconcentration, thrombocytopenia, positive tourniquet test)
  • Circulatory failure, such as signs of vascular permeability (eg, hypoproteinemia, effusions)
  • Hepatomegaly

In addition, conjunctival injection develops in approximately one third of patients with dengue hemorrhagic fever. Optic neuropathy has been reported and occasionally results in permanent and significant visual impairment.[44] Pharyngeal injection develops in almost 97% of patients with dengue hemorrhagic fever. Generalized lymphadenopathy is observed.

Hepatomegaly is present more often in dengue shock syndrome than in milder cases. Hepatic transaminase levels may be mildly to moderately elevated. Encephalopathy is a rare complication that may result from a combination of cerebral edema, intracranial hemorrhage, anoxia, hyponatremia, and hepatic injury.

Dengue shock syndrome

Findings of dengue shock syndrome include the following:

  • Hypotension
  • Bradycardia (paradoxical) or tachycardia associated with hypovolemic shock
  • Hepatomegaly
  • Hypothermia
  • Narrow pulse pressure (< 20 mm Hg)
  • Signs of decreased peripheral perfusion
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick B Hinfey, MD  Research Director and Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Hagop A Isnar, MD, FACEP Department of Emergency Medicine, Crouse Hospital

Hagop A Isnar, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Deborah Sentochnik, MD Consulting Staff, Department of Internal Medicine, Division of Infectious Disease, The Mary Imogene Bassett Hospital

Deborah Sentochnik, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol. 2008;62:71-92. [Medline].

  2. 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. [Medline].

  3. Gubler DJ. Cities spawn epidemic dengue viruses. Nat Med. Feb 2004;10(2):129-30. [Medline].

  4. 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. [Medline].

  5. Halstead SB. Dengue. Lancet. Nov 10 2007;370(9599):1644-52. [Medline].

  6. 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. [Medline].

  7. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. Jan 12 2006;354(2):119-30. [Medline].

  8. CDC. Imported dengue--United States, 1997 and 1998. MMWR Morb Mortal Wkly Rep. Mar 31 2000;49(12):248-53. [Medline]. [Full Text].

  9. Engelthaler DM, Fink TM, Levy CE, Leslie MJ. The reemergence of Aedes aegypti in Arizona. Emerg Infect Dis. Apr-Jun 1997;3(2):241-2. [Medline]. [Full Text].

  10. Chye JK, Lim CT, Ng KB, et al. Vertical transmission of dengue. Clin Infect Dis. Dec 1997;25(6):1374-7. [Medline].

  11. Wagner D, de With K, Huzly D, Hufert F, Weidmann M, Breisinger S, et al. Nosocomial acquisition of dengue. Emerg Infect Dis. Oct 2004;10(10):1872-3. [Medline].

  12. Dejnirattisai W, Duangchinda T, Lin CL, Vasanawathana S, Jones M, Jacobs M, et al. A complex interplay among virus, dendritic cells, T cells, and cytokines in dengue virus infections. J Immunol. Nov 1 2008;181(9):5865-74. [Medline].

  13. Halstead SB, Heinz FX, Barrett AD, Roehrig JT. Dengue virus: molecular basis of cell entry and pathogenesis, 25-27 June 2003, Vienna, Austria. Vaccine. Jan 4 2005;23(7):849-56. [Medline].

  14. Limjindaporn T, Wongwiwat W, Noisakran S, Srisawat C, Netsawang J, Puttikhunt C, et al. Interaction of dengue virus envelope protein with endoplasmic reticulum-resident chaperones facilitates dengue virus production. Biochem Biophys Res Commun. Feb 6 2009;379(2):196-200. [Medline].

  15. Zhang JL, Wang JL, Gao N, Chen ZT, Tian YP, An J. Up-regulated expression of beta3 integrin induced by dengue virus serotype 2 infection associated with virus entry into human dermal microvascular endothelial cells. Biochem Biophys Res Commun. May 11 2007;356(3):763-8. [Medline].

  16. Rothman AL, Ennis FA. Immunopathogenesis of Dengue hemorrhagic fever. Virology. Apr 25 1999;257(1):1-6. [Medline].

  17. Chen LC, Lei HY, Liu CC, Shiesh SC, Chen SH, Liu HS. Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients. Am J Trop Med Hyg. Jan 2006;74(1):142-7. [Medline].

  18. Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis. Oct 2006;19(5):429-36. [Medline].

  19. Guzman MG, Alvarez M, Rodriguez-Roche R, Bernardo L, Montes T, Vazquez S. Neutralizing antibodies after infection with dengue 1 virus. Emerg Infect Dis. Feb 2007;13(2):282-6. [Medline].

  20. Restrepo BN, Ramirez RE, Arboleda M, Alvarez G, Ospina M, Diaz FJ. Serum levels of cytokines in two ethnic groups with dengue virus infection. Am J Trop Med Hyg. Nov 2008;79(5):673-7. [Medline].

  21. Rothman AL. Dengue: defining protective versus pathologic immunity. J Clin Invest. Apr 2004;113(7):946-51. [Medline].

  22. de Macedo FC, Nicol AF, Cooper LD, Yearsley M, Pires AR, Nuovo GJ. Histologic, viral, and molecular correlates of dengue fever infection of the liver using highly sensitive immunohistochemistry. Diagn Mol Pathol. Dec 2006;15(4):223-8. [Medline].

  23. Shah I. Dengue and liver disease. Scand J Infect Dis. 2008;40(11-12):993-4. [Medline].

  24. Dejnirattisai W, Jumnainsong A, Onsirisakul N, et al. Cross-reacting antibodies enhance dengue virus infection in humans. Science. May 7 2010;328(5979):745-8. [Medline].

  25. Schmidt AC. Response to dengue fever--the good, the bad, and the ugly?. N Engl J Med. Jul 29 2010;363(5):484-7. [Medline].

  26. Kurane I, Innis BL, Nimmannitya S, Nisalak A, Meager A, Ennis FA. High levels of interferon alpha in the sera of children with dengue virus infection. Am J Trop Med Hyg. Feb 1993;48(2):222-9. [Medline].

  27. Wang E, Ni H, Xu R, Barrett AD, Watowich SJ, Gubler DJ. Evolutionary relationships of endemic/epidemic and sylvatic dengue viruses. J Virol. Apr 2000;74(7):3227-34. [Medline].

  28. Centers for Disease Control and Prevention Web site. CDC traveler's health page. Dengue. Available at http://www.cdc.gov/Dengue/travelOutbreaks/. Accessed October 20, 2011.

  29. Chen WS, Wong CH, Cillekens L. Dengue antibodies in a suburban community in Malaysia. Med J Malaysia. Mar 2003;58(1):142-3. [Medline].

  30. Istúriz RE, Gubler DJ, Brea del Castillo J. Dengue and dengue hemorrhagic fever in Latin America and the Caribbean. Infect Dis Clin North Am. Mar 2000;14(1):121-40, ix. [Medline].

  31. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis. Sep 24 2008;2(9):e300. [Medline]. [Full Text].

  32. Centers for Disease Control and Prevention (CDC). Travel-associated Dengue surveillance - United States, 2006-2008. MMWR Morb Mortal Wkly Rep. Jun 18 2010;59(23):715-9. [Medline]. [Full Text].

  33. Centers for Disease Control and Prevention (CDC). Locally acquired Dengue--Key West, Florida, 2009-2010. MMWR Morb Mortal Wkly Rep. May 21 2010;59(19):577-81. [Medline].

  34. Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgrad Med J. Oct 2004;80(948):588-601. [Medline]. [Full Text].

  35. Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ. Apr 2005;83(4):308-14. [Medline]. [Full Text].

  36. World Health Organization. Impact of Dengue. Available at http://www.who.int/csr/disease/dengue/impact/en/index.html. Accessed October 14, 2011.

  37. Lin CC, Huang YH, Shu PY, et al. Characteristic of dengue disease in Taiwan: 2002-2007. Am J Trop Med Hyg. Apr 2010;82(4):731-9. [Medline]. [Full Text].

  38. Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Libraty DH, Rothman AL. Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study. Lancet. Apr 28 2007;369(9571):1452-9. [Medline].

  39. Lahiri M, Fisher D, Tambyah PA. Dengue mortality: reassessing the risks in transition countries. Trans R Soc Trop Med Hyg. Oct 2008;102(10):1011-6. [Medline].

  40. Beatty ME, Beutels P, Meltzer MI, et al. Health economics of dengue: a systematic literature review and expert panel's assessment. Am J Trop Med Hyg. Mar 2011;84(3):473-88. [Medline]. [Full Text].

  41. Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg. Feb 2011;84(2):200-7. [Medline]. [Full Text].

  42. Suaya JA, Shepard DS, Siqueira JB, et al. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg. May 2009;80(5):846-55. [Medline].

  43. WHO. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd ed. Geneva: World Health Organization; 1997. [Full Text].

  44. Sanjay S, Wagle AM, Au Eong KG. Dengue optic neuropathy. Ophthalmology. Jan 2009;116(1):170; author reply 170. [Medline].

  45. Teves Maria A. Wrong treatment most common cause of dengue fatality. ABS/CBN News. Available at http://www.abs-cbnnews.com/nation/09/03/09/wrong-treatment-most-common-cause-dengue-fatality. Accessed September 3, 2010.

  46. Bottieau E, Clerinx J, Van den Enden E, Van Esbroeck M, Colebunders R, Van Gompel A. Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions. Medicine (Baltimore). Jan 2007;86(1):18-25. [Medline].

  47. Malhotra N, Chanana C, Kumar S. Dengue infection in pregnancy. Int J Gynaecol Obstet. Aug 2006;94(2):131-2. [Medline].

  48. Singh N, Sharma KA, Dadhwal V, Mittal S, Selvi AS. A successful management of dengue fever in pregnancy: report of two cases. Indian J Med Microbiol. Oct-Dec 2008;26(4):377-80. [Medline].

  49. Warrilow D, Northill JA, Pyke A, Smith GA. Single rapid TaqMan fluorogenic probe based PCR assay that detects all four dengue serotypes. J Med Virol. Apr 2002;66(4):524-8. [Medline].

  50. Kong YY, Thay CH, Tin TC, Devi S. Rapid detection, serotyping and quantitation of dengue viruses by TaqMan real-time one-step RT-PCR. J Virol Methods. Dec 2006;138(1-2):123-30. [Medline].

  51. Trung DT, Thao le TT, Hien TT, et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg. Oct 2010;83(4):774-80. [Medline]. [Full Text].

  52. Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health. Nov 2008;13(11):1328-40. [Medline].

  53. Lima EQ, Nogueira ML. Viral hemorrhagic fever-induced acute kidney injury. Semin Nephrol. Jul 2008;28(4):409-15. [Medline].

  54. Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann EA. Epidemiology of acute kidney injury in Latin America. Semin Nephrol. Jul 2008;28(4):320-9. [Medline].

  55. Chaterji S, Allen JC Jr, Chow A, Leo YS, Ooi EE. Evaluation of the NS1 rapid test and the WHO dengue classification schemes for use as bedside diagnosis of acute dengue fever in adults. Am J Trop Med Hyg. Feb 2011;84(2):224-8. [Medline]. [Full Text].

  56. Wichmann O, Stark K, Shu PY, Niedrig M, Frank C, Huang JH. Clinical features and pitfalls in the laboratory diagnosis of dengue in travellers. BMC Infect Dis. 2006;6:120. [Medline].

  57. Domingo C, de Ory F, Sanz JC, Reyes N, Gascón J, Wichmann O, et al. Molecular and serologic markers of acute dengue infection in naive and flavivirus-vaccinated travelers. Diagn Microbiol Infect Dis. Sep 2009;65(1):42-8. [Medline].

  58. Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. Apr 2007;26(4):283-90; discussion 291-2. [Medline].

  59. Srikiatkhachorn A, Gibbons RV, Green S, et al. Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 1994-2005. Clin Infect Dis. Apr 15 2010;50(8):1135-43. [Medline]. [Full Text].

  60. Setiati TE, Mairuhu AT, Koraka P, Supriatna M, Mac Gillavry MR, Brandjes DP, et al. Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system. BMC Infect Dis. Mar 26 2007;7:22. [Medline]. [Full Text].

  61. Tassniyom S, Vasanawathana S, Chirawatkul A, Rojanasuphot S. Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study. Pediatrics. Jul 1993;92(1):111-5. [Medline].

  62. WHO. Dengue. Available at http://www.who.int/topics/dengue/en/. Accessed October 20, 2011.

  63. Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. Sep 1 2005;353(9):877-89. [Medline].

  64. Yadav SP, Sachdeva A, Gupta D, Sharma SD, Kharya G. Control of massive bleeding in dengue hemorrhagic fever with severe thrombocytopenia by use of intravenous anti-D globulin. Pediatr Blood Cancer. Dec 2008;51(6):812-3. [Medline].

  65. Waduge R, Malavige GN, Pradeepan M, Wijeyaratne CN, Fernando S, Seneviratne SL. Dengue infections during pregnancy: a case series from Sri Lanka and review of the literature. J Clin Virol. Sep 2006;37(1):27-33. [Medline].

  66. Ismail NA, Kampan N, Mahdy ZA, Jamil MA, Razi ZR. Dengue in pregnancy. Southeast Asian J Trop Med Public Health. Jul 2006;37(4):681-3. [Medline].

  67. Billingsley PF, Foy B, Rasgon JL. Mosquitocidal vaccines: a neglected addition to malaria and dengue control strategies. Trends Parasitol. Sep 2008;24(9):396-400. [Medline].

  68. Erlanger TE, Keiser J, Utzinger J. Effect of dengue vector control interventions on entomological parameters in developing countries: a systematic review and meta-analysis. Med Vet Entomol. Sep 2008;22(3):203-21. [Medline].

  69. Kay B, Vu SN. New strategy against Aedes aegypti in Vietnam. Lancet. Feb 12-18 2005;365(9459):613-7. [Medline].

  70. Hanh TT, Hill PS, Kay BH, Quy TM. Development of a framework for evaluating the sustainability of community-based dengue control projects. Am J Trop Med Hyg. Feb 2009;80(2):312-8. [Medline].

  71. Monath TP. Dengue and yellow fever--challenges for the development and use of vaccines. N Engl J Med. Nov 29 2007;357(22):2222-5. [Medline].

  72. McArthur JH, Durbin AP, Marron JA, Wanionek KA, Thumar B, Pierro DJ, et al. Phase I clinical evaluation of rDEN4Delta30-200,201: a live attenuated dengue 4 vaccine candidate designed for decreased hepatotoxicity. Am J Trop Med Hyg. Nov 2008;79(5):678-84. [Medline].

  73. O'Brien J. 12th Annual Conference on Vaccine Research. Expert Rev Vaccines. Sep 2009;8(9):1139-42. [Medline].

  74. Edelman R. Dengue vaccines approach the finish line. Clin Infect Dis. Jul 15 2007;45 Suppl 1:S56-60. [Medline].

  75. Blaney JE Jr, Durbin AP, Murphy BR, Whitehead SS. Development of a live attenuated dengue virus vaccine using reverse genetics. Viral Immunol. Spring 2006;19(1):10-32. [Medline].

  76. Sanofi Pasteur and International Vaccine Institute Partner Against Dengue. Available at http://www.dengue.info/front/index.jsp?siteCode=DENGUE. Accessed October 20, 2011.

  77. Lang J. Recent progress on sanofi pasteur's dengue vaccine candidate. J Clin Virol. Oct 2009;46 Suppl 2:S20-4. [Medline].

 
Previous
Next
 
Drawing of Aedes aegypti mosquito. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Aedes aegypti mosquito. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Aedes albopictus. From CDC Public Domain.
Worldwide distribution of dengue in 2000. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Worldwide distribution of dengue in 2003. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Worldwide distribution of dengue in 2005. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Increasing rates of dengue infection by regions of the world. Graphs from the World Health Organization (WHO) Web site.
Dengue transmission cycle. Illustration from the Centers for Disease Control and Prevention (CDC) Web site.
Distribution of Aedes aegypti mosquito vector in 1997. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Reinfestation by Aedes aegypti in the Americas after the 1970 (left) mosquito eradication program and most recent distribution as of 2002 (right). Picture from the Centers for Disease Control and Prevention (CDC) Web site.
A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation (DIC), as this severely ill pediatric ICU patient did. Crystalloid fluid resuscitation and standard DIC treatment are critical to the child's survival.(
Delayed capillary refill may be the first sign of intravascular volume depletion. Hypotension usually is a late sign in children. This child's capillary refill at 6 seconds was delayed well beyond a normal duration of 2 seconds.
Signs of early coagulopathy may be as subtle as a guaiac test that is positive for occult blood in the stool. This test should be performed on all patients in whom dengue virus infection is suspected.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.