Dengue fever A90.x

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

breakbone fever; dandy fever; dengue fever

History
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Rush, 1789

Definition
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Mosquito-borne viral disease characterized by the triad fever, exanthema, joint, muscle, headache. Complicated haemorrhagic courses are called haemorrhagic Dengue fever or dengue shock syndrome.

Pathogen
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Dengue viruses (DEN1-DEN4). In the genus Flavivirus of the family Flaviviridae, whose prototype is the yellow fever virus, dengue viruses form a separate group.

Occurrence/Epidemiology
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Endemic in tropics and subtropics (even in highly urbanised areas!) outside Europe (South East Asia, South Pacific, Africa, Central and South America, Caribbean).

About 2-3 billion people worldwide live in endemic areas. Incidence (worldwide): Approx. 50 million infections per year, of which approx. 500,000 cases of dengue haemorrhagic fever (DHF) and 20,000 deaths (mainly children). The considerable global tendency to spread is based on the worldwide decline in vector control for decades, the increase in urban breeding grounds in conjunction with increasing littering in the poor quarters of the tropics, and increased international migration and travel.

Nationwide about 2,000 illnesses/year are reported, especially among holiday travellers (Thailand!) or migrants.

Etiopathogenesis
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Infection with dengue viruses by sting of the vector (Aedes species, especially Aedes aegypti; diurnal; sting mainly at dusk!)

Manifestation
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Mainly in children and adolescents in endemic areas, especially fair-skinned children of the male sex.

Clinical features
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All 4 serotypes cause identical disease symptoms. Classical dengue fever begins after an incubation period of 5-8 days with high fever, severe headache, bone pain ("bone-breaking fever"), swelling of joints. Prior to the convalescence phase, a morbilli- or scarlatiniform exanthema develops; often eye involvement, lymph node swelling. Afterwards, the patient walks for a long time in a peculiar way (dengue = ornamental).

Dengue haemorrhagic fever (DHF) (see haemorrhagic fever below) has a two-phase course: dengue fever followed by brief remission (phase 1), followed by sudden deterioration with bleeding in the skin and mucous membranes (phase 2).

Laboratory
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Leukopenia, thrombocytopenia, relative lymphocytosis, slightly elevated transaminases.

Diagnosis
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Medical history and clinic. Virus detection (difficult); detection of virus-specific antibodies (only after the 4th day of illness) by means of CFT, HHT, NT; detection of IgM antibodies (Elisa).

Differential diagnosis
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Yellow fever; Ebola; other infections that cause hemorrhagic fever

Complication(s)
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In case of unfavourable course dengue shock and lethal outcome.

Therapy
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Symptomatic, according to WHO guidelines. Cave! Aspirin in hemorrhagic diathesis should be avoided.

Monitoring of vital functions, sufficient fluid intake, in case of disseminated coagulopathy possibly heparin therapy.

Skin changes symptomatic with cooling lotions.

Haemorrhagic forms require immediate intensive medical treatment.

Progression/forecast
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Without therapy, exitus lethalis in about 20% of patients (especially small children!). With intensive medical care the mortality rate is about 1%.

Prophylaxis
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Exposure prophylaxis (in contrast to malaria also during the day) with repellents (DEET, Bayrepel), as well as with permethrin-impregnated mosquito nets at night. A vaccine is not yet available. Live vaccine is being tested.

Note(s)
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Remember! Notification obligation in case of pathogen detection or hemorrhagic course of disease!

Literature
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  1. Aviles G et al (2003) Complete coding sequences of dengue-1 viruses from Paraguay and Argentina. Virus Res 98: 75-82
  2. Hlastead SB, Deen JL (2002) The future if dendue vaccine. Lancet 360: 1100-1101
  3. de Oliveira Poersch C et al (2005) Dengue virus infections: comparison of methods for diagnosing the acute disease. J Clin Virol 32: 272-277
  4. DeRoeck D et al (2003) Policymakers' views on dengue fever/dengue haemorrhagic fever and the need for dengue vaccines in four southeast Asian countries. Vaccines 22: 121-129
  5. Kay B, Vu SN (2005) New strategy against Aedes aegypti in Vietnam. Lancet. 365: 613-617
  6. Rush B (1789) An account of the bilious remitting fever, as it appeared in Philadelphia in the summer and autumn in the year 1780. in: Rush B (ed) Medical inquiries and observations. Pritchard & Hall, Philadelphia, S. 89-100
  7. Sideridis K et al (2003) Dengue fever: diagnostic importance of a camelback fever pattern. Heart Lung 32: 414-418
  8. Wichmann O et al (2005) Dengue antibody prevalence in German travelers. Emerg Infect Dis 11: 762-765

Outgoing links (1)

Fever, hemorrhagic;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020