Saturday Night Dengue Fever & Staying Alive

The only thing worse than terrible Bee Gees jokes, would be to miss Dengue Fever in a returned febrile traveller who presents to the ED (or to be that traveller..ed). Below is my simplified take on Dengue Fever.

What is it?

Viral infection (DENV), with 4 subtypes.

How do you get it?

- Bite from infected Aedes aegypti mosquito

- Exposure to DENV infected blood products

- Vertical transmission to fetus from infected mum, in utero, or childbirth

Clinical Presentation

- Consider in all febrile patients who return from tropics / subtropics within 2 weeks of   symptom onset.

- incubation 4-7 days

- Fever with 2 or more of the following

- headache

- retro-orbital pain

- muscle aches

- joint pain

- rash (usually after fever subsides) - macular/maculopapular, scaly, pruritic

- haemorrhagic manifestation 

- leucopenia

- 1 % develop Dengue Haemorrhagic Fever (DHF) as fever passes.

- DF and DHF differentited by increased vascular permeability in DHF, low platelet count (<100), increased haematocrit (>20% of baseline after fluid replacement)

- Dengue Shock Syndrome (DSS) - DHF criteria plus hypotension, or frank shock. 

Diagnosis

- Dengue Serology / PCR

Management

- No specific therapy

- Essentially supportive care

- Fever control

- Avoid NSAID and Aspirin

- IV fluids, moitor haematocrit and platelets.

Dengue Endemic Areas

Dengue Fever - CDC Yellow Book For Travellers