eMedicine Specialties > Emergency Medicine > Infectious Diseases

Dengue Fever: Follow-up

Author: Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Coauthor(s): Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Further Inpatient Care

  • Admit to ICU if hypotensive or in DIC, otherwise admit to medicine ward.
    • Patient may require a central line.
    • Patient may require an arterial line.
    • Patient may require blood components.

Deterrence/Prevention

  • Reduce A aegypti vector populations.3
  • Reduce exposure to A aegypti.
    • Use insect repellent.
    • Sleep under a mosquito net in affected areas.
    • Wear protective clothing.
  • Vaccines against all 4 serotypes are currently under development. While this is challenging due to the complex immune response, vaccines may ultimately be the most effective control strategy, since vector control programs have been largely unsuccessful and of only short-term local benefit.4,5

Complications

  • Complications are rare but may include the following:
    • Brain damage from prolonged shock or intracranial hemorrhage
    • Myocarditis
    • Encephalopathy
    • Liver failure

Prognosis

  • Morens states that the rapid clinical response to aggressive fluids and electrolytes in even moribund children with DHF/DSS "is among the most dramatic events in clinical medicine." Treated promptly, children in shock and coma can wake up and return to near normalcy within hours.6
  • Convalescence may be prolonged, with weakness and mental depression.
  • Continued bone pain, bradycardia, and premature ventricular contractions (PVCs) are common.
  • Survival is related directly to early hospitalization and aggressive supportive care.
  • Dengue fever is not contagious through person-to-person contact.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to admit patients for aggressive supportive therapy
  • Failure to rule out other possible illnesses and specific therapies

Special Concerns

  • Pediatric deaths associated with dengue viral infection most commonly occur in infants younger than 1 year.
 


More on Dengue Fever

Overview: Dengue Fever
Differential Diagnoses & Workup: Dengue Fever
Treatment & Medication: Dengue Fever
Follow-up: Dengue Fever
Multimedia: Dengue Fever
References
Further Reading
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References

  1. Malavige GN, Fernando S, Fernando DJ, et al. Dengue viral infections. Postgrad Med J. Oct 2004;80(948):588-601. [Medline].

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

  3. Gurtler RE, Garelli FM, Coto HD. Effects of a Five-Year Citywide Intervention Program To Control Aedes aegypti and Prevent Dengue Outbreaks in Northern Argentina. PLoS Negl Trop Dis. 2009;3(4):e427. [Medline].

  4. 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].

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

  6. Morens DM. Antibody-dependent enhancement of infection and the pathogenesis of viral disease. Clin Infect Dis. Sep 1994;19(3):500-12. [Medline].

  7. Guzman MG, Kouri G. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J Clin Virol. May 2003;27(1):1-13. [Medline].

  8. Guzman MG, Kouri G. Dengue: an update. Lancet Infect Dis. Jan 2002;2(1):33-42. [Medline].

  9. Halstead SB. Pathogenesis of dengue: challenges to molecular biology. Science. Jan 29 1988;239(4839):476-81. [Medline].

  10. Hoeprich PD, Jordan MC, Ronald AR, eds; Halstead SB. Infectious Diseases: A Treatise of Infectious Processes. 1994:919-923.

  11. Kao CL, King CC, Chao DY, et al. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. J Microbiol Immunol Infect. Feb 2005;38(1):5-16. [Medline].

  12. Kuno G. Review of the factors modulating dengue transmission. Epidemiol Rev. 1995;(2):321-35. [Medline].

  13. Mandell GL, Douglas RG Jr, Bennett JE, eds; Monath TP. Principles and Practice of Infectious Disease. 3rd ed. Churchill Livingstone Inc; 1990:1248-1251.

  14. Monath TP. Yellow fever and dengue: The interactions of virus, vector, and host in the re-emergence of epidemic disease. Semin Virol. 1994;5:133-145.

  15. Ray CG, Ryan KJ, ed. Sherris Medical Microbiology: An Introduction to Infectious Diseases. McGraw-Hill Professional Publishing; 1994:525-535.

  16. 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].

  17. World Health Organization. Dengue Haemorrhagic Fever: Diagnosis, Treatment and Control. World Health Org; 1986:1-2.

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Further Reading

Clinical guidelines

Epidemic/epizootic West Nile virus in the United States: guidelines for surveillance, prevention, and control.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Department of Health and Human Services (U.S.) - Federal Government Agency [U.S.]
Division of Vector-Borne Infectious Diseases (Fort Collins, Colorado) - Federal Government Agency [U.S.]
National Center for Infectious Diseases - Federal Government Agency [U.S.]
Public Health Service (U.S.) - Federal Government Agency [U.S.]. 2001 Apr (revised 2003). 75 pages. NGC:003165

The practice of travel medicine: guidelines by the Infectious Diseases Society of America.
Infectious Diseases Society of America - Medical Specialty Society. 2006. 96 pages. NGC:005086

Clinical trials

Study of Sanofi Pasteur's CYD Dengue Vaccine in Healthy Subjects in Singapore

Study of ChimeriVax Tetravalent Dengue Vaccine in Healthy Subjects

Efficacy and Safety of Dengue Vaccine in Healthy Children

Safety of and Immune Response to Two Different Dengue Virus Vaccines in Individuals Previously Immunized Against Dengue Virus

A Study of Two Doses of WRAIR Dengue Vaccine Administered Six Months Apart to Healthy Adults and Children

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Keywords

breakbone fever, ki denga pepo, mosquito-transmitted viral disease, febrile syndrome, bleeding diathesis, disseminated intravascular coagulation, DIC, dengue hemorrhagic fever, DHF, dengue shock syndrome, DSS, dengue viral infections, dengue fever

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Contributor Information and Disclosures

Author

Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Daniel D Price, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Sharon R Wilson, MD is a member of the following medical societies: American Association of University Women, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William K Chiang, MD, Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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