Dengue fever is a notifiable disease. In dengue-endemic regions, suspected, probable, and confirmed cases of dengue infection should be reported to the relevant authorities as soon as possible.
Endemic in more than 100 countries, including countries in the Southeast Asian and Western Pacific regions, the Americas, Africa, and the Eastern Mediterranean. Asia represents approximately 70% of the global burden of disease.
Severe dengue fever is characterised by marked thrombocytopenia, severe haemorrhage, plasma leakage leading to shock or fluid accumulation with respiratory distress, and severe organ impairment.
Confirmatory tests include viral antigen or nucleic acid detection and serology. Difficult to distinguish clinically from Zika and chikungunya virus infections without diagnostic testing.
No specific antiviral agent has been developed. Meticulous fluid therapy and the identification of the critical phase are the most important aspects of management.
A tetravalent vaccine is available in approximately 20 countries. Multiple vaccine candidates are currently in clinical development.
A globally important arboviral infection transmitted by the Aedes genus of mosquito (primarily Aedes aegypti, but also A albopticus), an insect found in tropical and subtropical regions of the world. There are 4 antigenically distinct dengue virus serotypes: DENV-1, DENV-2, DENV-3, and DENV-4. They are RNA viruses that belong to the Flavivirus genus/Flaviviridae family, which also includes yellow fever virus, West Nile virus, Japanese encephalitis virus, Zika virus, and the St Louis encephalitis virus. Dengue virus infection causes a wide range of severe and non-severe clinical manifestations.
History and exam
Key diagnostic factors
- presence of risk factors
- skin flushing/rash
- haemorrhagic signs
- abdominal distension
- pleuritic chest pain, dyspnoea, cough
- signs of circulatory collapse
Other diagnostic factors
- gastrointestinal symptoms
- upper respiratory tract symptoms
- residence in/travel from dengue-endemic region within the past 2 weeks
- children aged 1 to 5 years
- older age
- presence of comorbidities
- exposure to infected blood products
- living with uncovered water container
- female sex
- blood group O
1st investigations to order
- liver function tests (LFTs)
- serum albumin level
- reverse transcription-polymerase chain reaction (RT-PCR)
- non-structural protein 1 (NS1) detection
Investigations to consider
- coagulation studies
- chest x-ray
- abdominal ultrasound
- reverse transcription-insulated isothermal polymerase chain reaction (RT-iiPCR)
WHO group C (established warning signs)
WHO group B (developing warning signs)
WHO group A (no warning signs)
S.A.M. Kularatne, MBBS, MD, MRCP (UK), FRCP (London), FCCP (SL)
Chair of Medicine
Department of Medicine
Faculty of Medicine
University of Peradeniya
SAMK is an author of several references cited in this monograph.
John McBride, PhD, MBBS, DTM&H, FRACP, FRCPA
Professor of Medicine
James Cook University
Cairns Base Hospital Clinical School
JM declares that he has no competing interests.
Michael Jacobs, MA, PhD, MBBS, FRCP, DTM&H
Royal Free Hampstead NHS Trust
MJ declares that he has no competing interests.
Stephen Gluckman, MD
Professor of Medicine
Penn Global Medicine
Penn Center for Primary Care
SG declares that he has no competing interests.
- Zika virus infection
- Chikungunya virus infection
- Rickettsial diseases
- Laboratory testing for Zika virus and dengue virus infections
- Guidelines for the diagnosis and treatment of Dengue in China
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