Dengue fever A90.x

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. The CLDN1 protein acts as a receptor for the virus to enter the cell.

Endemic in tropics and subtropics (also in highly urbanized areas!) outside Europe (Southeast Asia, South Pacific, Africa, Central and South America, Caribbean).About 2-3 billion people live in endemic areas worldwide. Incidence (worldwide): Approximately 50 million infections/year, including approximately 500,000 cases of dengue hemorrhagic fever (DHF) and 20,000 deaths (primarily children). The significant global spread trend is due to the worldwide decline in vector control for decades, the increase in urban breeding sites combined with increasing littering in poor areas of the tropics, and due to increased international migration and travel.

About 2,000 cases/year are reported nationwide, especially among vacation travelers (Thailand!) or migrants.

Recently, dengue fever infections also occurred at Lake Garda/Italy (Federal Foreign Office Notices 2023).

Infection with dengue viruses by biting the vector (Aedes species, esp. Aedes aegypti; diurnal; bites mainly at dusk!).

The yellow fever mosquito is a small (3-4 mm), dark-colored mosquito with white stripes on the legs and a white marking on the neck shield (scutum) resembling a lyre. Hence the name of the mosquito, the proboscis is black. Females and males are equally marked, usually the females are slightly larger. Only the female mosquitoes suck blood after fertilization to meet their protein needs for the production of offspring. The male mosquitoes feed mainly on nectar and other sweet plant juices. The females can also meet their energy needs from these.

All 4 serotypes cause identical disease symptoms. Classic dengue fever begins after an incubation period of 5-8 days with high fever, severe headache, bone pain ("bone breaking fever") joint swelling.

Before the convalescent phase, a morbilliform or scarlatiniform exanthema develops; often eye involvement, lymph node swelling. Afterwards, the patient has a peculiar gait for a long time (dengue = ornamentation).

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

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.

Remember! Notification obligation in case of pathogen detection or hemorrhagic course of disease!

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