Overview
What is severe dengue (dengue hemorrhagic fever)?
What is the mortality rate for dengue?
What is the typical presentation of dengue?
What are the signs and symptoms of dengue?
What are the clinical characteristics of severe dengue (dengue hemorrhagic fever)?
What are the lab criteria for the diagnosis of dengue?
How is dengue detected in early phase of disease?
Which lab tests should be performed in the workup of possible dengue?
What are the characteristic lab findings in dengue?
What are the characteristic lab findings in severe dengue (dengue hemorrhagic fever)?
What is the role of guaiac testing in suspected dengue?
Which imaging studies are used in the evaluation of suspected dengue?
When is oral rehydration indicated for the management of dengue?
When is inpatient care indicated for dengue?
When is a transfusion of fresh frozen plasma (FFP) indicated in the treatment of dengue?
What is the global incidence of dengue?
What is severe dengue (dengue hemorrhagic fever)?
What is characteristic of hyperendemic dengue?
Which lab techniques are used to confirm dengue infection?
What are treatment options used for dengue?
What is the earliest known documentation of dengue?
When was the first reported dengue epidemic?
How frequently do outbreaks of severe dengue (dengue hemorrhagic fever) occur?
How has dengue spread in Southeast Asia?
How was dengue prevented in the Americas in the late 20th century?
What is the global incidence of dengue outbreaks in 2014?
What are the differences between serotype 1 dengue (DENV-1) and serotype 2 dengue (DENV-2)?
Where was the first clearly identified local transmission of dengue in the US?
What is characteristic of the dengue outbreaks in Hawaii in the 21st century?
Which vectors for dengue are present in the US and what is their geographic range?
What is the mortality rate of dengue in the US?
What is the prevalence of dengue in Europe?
Which factors are responsible for the increased spread of dengue?
What are the benefits of travel surveillance for dengue?
What is the pathophysiology for dengue?
How are dengue viruses transmitted?
What are characteristics of the Aedes mosquito species that transmit dengue?
What are the primary hosts for the transmission of dengue?
How does the transmission of dengue occur?
What is the duration of classic dengue fever?
What is the disease progression of dengue?
Which age group is at highest risk for dengue (dengue hemorrhagic fever)?
What is the disease progression of severe dengue (dengue hemorrhagic fever)?
What is the immunopathology of severe dengue (dengue hemorrhagic fever)?
Which strain of dengue is most virulent?
What are the causes of thrombocytopenia in dengue?
What are the serotypes of dengue?
What are risk factors for dengue infection?
What is the largest known epidemic of dengue?
What is the incidence of dengue in the US?
What is the principal mosquito vector for dengue in the US?
Where in the US do most dengue cases occur?
What is the global incidence of dengue?
In the 21st century, which countries previously without dengue have reported outbreaks?
What are the morbidity and mortality of severe dengue (dengue hemorrhagic fever) in Southeast Asia?
What is the economic burden of dengue infection in Southeast Asia?
How does the incidence and mortality of dengue vary by age in in Southeast Asia?
What is the epidemiology of dengue in Africa?
Which areas of South America are at highest risk for dengue?
How does the incidence of dengue vary by race?
How does the incidence of dengue vary by sex?
How does the incidence of dengue vary by age?
What is the prognosis of dengue fever?
What are the risk factors for death by dengue fever?
Which factors affect the severity of dengue?
What are the complications and sequelae of dengue virus infections?
What is dengue shock syndrome?
What is the economic impact of dengue?
What information about dengue should patients be given?
Where can information about reducing the risks of contracting dengue fever during travel be found?
Presentation
What should be the focus of medical history in suspected dengue?
What are the typical symptoms of dengue?
What are the signs and symptoms of dengue?
How is rash characterized in dengue?
How long is the recovery process for patients with dengue?
What are the signs and symptoms of severe dengue (dengue hemorrhagic fever)?
What happens if severe dengue (dengue hemorrhagic fever) is left untreated?
What are the Pan American Health Organization (PAHO) diagnostic criteria for dengue?
Which physical findings are characteristic of dengue fever?
What is the prevalence of rash due to dengue infection and how is it characterized?
How is a tourniquet test performed in the evaluation of dengue?
What are neurologic manifestations of dengue?
Which physical findings are characteristic of severe dengue?
What are the WHO criteria for the diagnosis of severe dengue (dengue hemorrhagic fever)?
Which physical findings are characteristic of severe dengue (dengue hemorrhagic fever)?
Which physical findings are characteristic of dengue shock syndrome?
DDX
How frequently is dengue misdiagnosed?
What are the main indicators of dengue infection?
How is dengue differentiated from preeclampsia?
What are the diagnostic considerations for vertical dengue transmission?
What are the differential diagnoses for Dengue?
Workup
What are the lab criteria for the diagnosis of dengue?
Which lab tests should be performed for the diagnosis of dengue?
What are the characteristic lab findings in dengue fever?
What is the role of hematocrit level measurement in the diagnosis of dengue?
Which lab findings suggest severe dengue (dengue hemorrhagic fever)?
When is guaiac testing indicated in the diagnosis of suspected dengue?
When is typing and crossmatching of blood indicated for the diagnosis of dengue?
What is the role of urinalysis in the diagnosis of dengue?
What is the role of arterial blood gas assessment in the diagnosis of dengue?
What is the role of electrocardiography in the diagnosis of dengue?
What are the primary histologic findings of dengue?
What is the role of chest radiography in the diagnosis of dengue?
What should be included in a public health report of dengue?
What is the significance of a finding of leukopenia in dengue?
What is the role of hematocrit level monitoring in the workup of suspected dengue?
What is the prevalence of thrombocytopenia in dengue?
What is the role of liver enzyme testing in the diagnosis of dengue?
What is the role of serum studies in the diagnosis of dengue?
Which serum tests are used for the diagnosis of dengue?
How is a serum study performed in the diagnosis of dengue?
What is the role of ultrasonography in the diagnose dengue?
What are the criteria used to classify a case as suspected or probable dengue?
What is required to confirm a case of dengue?
What are the criteria required to diagnose a case of severe dengue (dengue hemorrhagic fever)?
What are the manifestations of plasma leakage in dengue?
How is circulatory failure characterized in the diagnostic criteria for severe dengue shock?
How does the WHO classify dengue?
Treatment
What is the antiviral treatment for dengue?
What are the treatment approaches for dengue?
What is the role of steroids in the treatment of dengue?
What is the role of oral rehydration therapy in the treatment of dengue?
When is IV fluid administration indicated in the treatment of dengue?
What is required for the successful management of severe dengue (dengue hemorrhagic fever)?
How are fluid volume and blood pressure managed in severe dengue (dengue hemorrhagic fever)?
When are patients with severe dengue (dengue hemorrhagic fever) discharged from the hospital?
How is dengue diagnosed and treated during pregnancy?
Which dietary modifications are beneficial during the treatment of dengue?
Which activity modifications are beneficial during treatment of dengue?
What is the most widely used mosquito-control technique for the prevention of dengue?
How is the breeding of vector mosquitos reduced for the prevention of dengue?
What is a biological approach to reducing vector mosquitos and preventing dengue?
Which public health measures need to be taken to prevent dengue outbreaks?
What is the role of vaccination in the prevention of dengue?
What are the limitations of vaccine in the prevention of dengue?
Which specialists should be consulted for the management of dengue?
Medications
Which medications are used for the treatment of dengue?
Which medications in the drug class Volume Expanders are used in the treatment of Dengue?
Which medications in the drug class Analgesics are used in the treatment of Dengue?
Which medications in the drug class Vaccines, Live, Viral are used in the treatment of Dengue?
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Drawing of Aedes aegypti mosquito. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Aedes albopictus. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Worldwide distribution of dengue in 2000. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Worldwide distribution of dengue in 2003. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Worldwide distribution of dengue in 2005. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Increasing rates of dengue infection by regions of the world. Courtesy of the World Health Organization (WHO).
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Dengue transmission cycle. Courtesy of the Centers for Disease Control and Prevention (CDC).
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Reinfestation by Aedes aegypti in the Americas after the 1970 (left) mosquito eradication program and most recent distribution as of 2002 (right). Courtesy of the Centers for Disease Control and Prevention (CDC).
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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.
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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.
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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.
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Aedes aegypti mosquito. Courtesy of Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Aedes_aegypti.jpg; author Muhammad Mahdi Karim).
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Global map of dengue risk. Frequent or continuous risk = frequent outbreaks or ongoing transmission. Sporadic or uncertain risk = variable and unpredictable risk, country-level data are unavailable. Courtesy of the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html).