DENGUE FEVER

Dengue fever is endemic in many tropical and subtropical countries. The vector is the day-biting Aedes mosquito. Dengue is the most common arboviral cause of fever in the returned traveler, and its area of endemicity has expanded considerably, particularly stretching into Mexico, the Caribbean, and Central and South America. Infection may be caused by any of the four dengue virus serotypes (DEN 1, 2, 3, 4). Subsequent infection with a different serotype may be more severe, resulting in dengue hemorrhagic fever or dengue shock syndrome.
After an incubation period of 3 to 10 days (range, 3-14 days), dengue fever typically manifests with the abrupt onset of fevers, frontal headaches, and severe myalgias. Retro-orbital pain, exacerbated with movement of the eyes, is a usual complaint. The typical rash associated with dengue fever is a macular or maculopapular erythroderma that blanches under light pressure. A secondary centrifugal maculopapular rash may appear on the third or fourth day of illness. Leukopenia and mild thrombocytopenia are frequent but nonspecific findings. Rarely, travelers may develop dengue hemorrhagic fever, characterized by thrombocytopenia (platelet count <100,000/mm) and hemorrhagic manifestations (petechiae, purpura, gastrointestinal bleeding) or dengue shock syndrome, the hallmark of which is circulatory failure. The diagnosis is made clinically and can be confirmed by noting a fourfold rise in antibody titer between acute and convalescent serum samples sent at least 4 weeks apart. Treatment is supportive.
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DENGUE FEVERDengue fever is endemic in many tropical and subtropical countries. The vector is the day-biting Aedes mosquito. Dengue is the most common arboviral cause of fever in the returned traveler, and its area of endemicity has expanded considerably, particularly stretching into Mexico, the Caribbean, and Central and South America. Infection may be caused by any of the four dengue virus serotypes (DEN 1, 2, 3, 4). Subsequent infection with a different serotype may be more severe, resulting in dengue hemorrhagic fever or dengue shock syndrome.After an incubation period of 3 to 10 days (range, 3-14 days), dengue fever typically manifests with the abrupt onset of fevers, frontal headaches, and severe myalgias. Retro-orbital pain, exacerbated with movement of the eyes, is a usual complaint. The typical rash associated with dengue fever is a macular or maculopapular erythroderma that blanches under light pressure. A secondary centrifugal maculopapular rash may appear on the third or fourth day of illness. Leukopenia and mild thrombocytopenia are frequent but nonspecific findings. Rarely, travelers may develop dengue hemorrhagic fever, characterized by thrombocytopenia (platelet count <100,000/mm) and hemorrhagic manifestations (petechiae, purpura, gastrointestinal bleeding) or dengue shock syndrome, the hallmark of which is circulatory failure.

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The diagnosis is made clinically and can be confirmed by noting a fourfold rise in antibody titer between acute and convalescent serum samples sent at least 4 weeks apart. Treatment is supportive.*203/348/5*

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