Infectious Disease Compendium

Dengue

Microbiology

A flavivirus

Diagnosis

Review

Incubation of three to fourteen days, then a high fever, headache (right behind the eyes), vomiting, muscle and joint pains (aka breakbone fever), and a characteristic skin rash.

Serology. It can cross react with zika, yellow fever and chikungunya. There are also PCR and viral antigen detection such as for NS1.

Can be a mild illness to dengue hemorrhagic fever or severe dengue: plasma leak with shock, ARDS, or both; severe bleeding and severe organ impairment.

Epidemiologic Risks

Mosquito bites. It is curious that severe disease is more likely to occur with sequential infections by different types.

A disease of world wide tropical distribution. 4 types, cleverly called 1,2,3,4. The virus is moving north with global warming and has been found in theFlorida Keys and Texas. It was wandering back and forth over the border from Arizona and Mexico. Now if only a wall could prevent dengue spread...

It is endemic in a park in Tokyo, Japan as of 2014 (PubMed). It is just matter of time before it is endemic the US South.

Empiric Therapy

Supportive. Maybe prochlorperazine (PubMed).

Pearls

There is a vaccine coming that reduces symptomatic disease and the trials have also shown that immunity from natural infection is not lifelong (Pubmed). The vaccine makes interpreting serology problematic (PubMed)

And in Central America it may actually be Punta Toro (Spanish for kick a bull on 4th down I think) virus as a dengue mimic (PubMed).

People with DHF have an increased risk of stroke in the first two months following the illness (PubMed)(PubMed).

Rants

Last Update: 04/16/18.