Dengue fever (DF) is a viral infection (one of four serotypes) transmitted by mosquitos in endemic regions of the world. Classic DF is an acute febrile illness associated with HA, retro-orbital pain and muscle/joint pains. Differential diagnoses include malaria, leptospirosis, and typhoid fever. Treatment is supportive with adequate hydration and acetaminophen for HA, myalgia, and fever. Avoid NSAIDs and aspirin for potential bleeding complications.
The most feared manifestation of DF is dengue hemorrhagic fever (DHF) which is hypothesized to be immune-mediated. To make this diagnosis, the World Health Organization has delineated 4 cardinal features:
- increased vascular permeability (Hct > 20% of baseline), ascites or pleural effusion
- marked thrombocytopenia ( < 100,000 cells/mm3)
- fever lasting 2-7 days
- spontaneous bleeding (petechiae, ecchymosis, GI bleeding, epistaxis, menorrhagia)
Rare cases of associated liver failure, CNS dysfunction (ie encephalopathy, seizures) and myocardial dysfunction (ie myocarditis) have been reported. Early recognition is imperative. No vaccine available. Treatment is supportive with airway management, blood products, IV colloids and/or crystalloids.
Rothman AL, Srikiatkhachom A, Kalayanarooj S. Clinical Manifestations and Diagnosis of Dengue Virus Infections. UpToDate 2014.
Rothman AL, Srikiatkhachom A, Kalayanarooj S. Prevention and Treatment of Dengue Virus Infection. UpToDate 2013.