Dengue Fever

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Presentation :

Dengue fever is the most prevalent arthropod-borne viral infection in the world and the most frequent cause of acute febrile illness among returning travelers from endemic areas, including Southeast Asia, the South Pacific, South and Central America, and the Caribbean.
Incubation period is 4 to 7 days followed by an acute febrile illness associated with frontal headache, retro-orbital pain, and myalgia; severe lumbosacral pain is characteristic.
- Symptoms give it one of it's common names: "Breakbone Fever"
Fever resolves after 5 to 7 days; however, some patients experience a second febrile period (saddleback pattern).
As the fever abates, a scarlatiniform rash, which spares the palms and soles, may evolve into areas of petechiae on extensor surfaces.
- Petechial rash may occur after application of tourniquet or blood pressure cuff (a positive “tourniquet test”) resulting from microvascular fragility
In patients with severe infection (sometimes termed Dengue Hemorrhagic Fever or Dengue Shock Syndrome), life-threatening hemorrhage and shock may ensue, with liver failure, encephalopathy, and myocardial damage. This syndrome appears to be related to previous infection of a different serotype and is unlikely in travelers who have not had dengue fever previously.
Laboratory findings include leukopenia, thrombocytopenia, and elevated serum aminotransferase levels.

Diagnosis is clinical, but should attempt to rule out alternative diagnoses (such as malaria, zika, chikungunya and leptospirosis).
Diagnosis is confirmed by acute/convalescent serology (IgM and IgG) or reverse transcriptase PCR.

Supportive care
- NSAIDs should be avoided 2/2 risk of bleeding
A live attenuated dengue vaccine is approved for use only for ages 9-16 who have history of lab confirmed dengue infection prior and are at risk of reinfection (typically living in endemic areas, or travel).
- Vaccinating children who have never had dengue appears to result in risk of more severe disease if the children become infected with dengue later.