Clinical Background
Dengue is the most prevalent mosquito-borne viral disease in humans.
Epidemiology
- Incidence - 50-100 million cases worldwide each year
- Transmission
- Dengue fever virus is transmitted by mosquito vectors
- Aedes aegypti in the sub-tropical and tropical Americas
- Aedes albopictus in Asia
- Infection with any strain results in lifelong homologous immunity
- Reinfection with a heterologous serotype of dengue virus enhances the infection, resulting in the most severe clinical manifestations of dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS)
- Epidemics of dengue fever are common throughout the world
Organism
- Dengue fever is caused by 1 of 4 dengue virus serotypes (dengue 1-4)
- Dengue virus belongs to the family Flaviviridae
- The virus consists of a single strand of RNA surrounded by an icosahedral nucleocapsid
- Cross reactions between members of Flaviviridae are common (eg, Banzi virus; Japanese, St. Louis, and Murray Valley encephalitis viruses; Rocio virus; West Nile virus and yellow fever virus)
Clinical Presentation
- Incubation is 4-7 days
- Constitutional
- Fever typically lasts 5-7 days
- Headache and retroorbital pain
- Myalgia and arthralgia
- Prostration (incubation period of 2-6 days)
- Severe myalgias (Breakbone fever)
- Rash - petechial, diffuse erythematous or morbilliform
- Hemorrhagic manifestations - epistaxis, petechiae, gum bleeding
- Hematologic - leukopenia, thrombocytopenia
- Lymphadenopathy
- Infection can lead to DHF, resulting in renal failure and DSS
- Majority of cases occur in children <15 years
- Death occurs primarily in children between the ages of 5 and 15 years
Treatment
- No vaccine available, treatment is supportive
See Also
Diagnosis
Diagnosis
- Laboratory testing
- Laboratory diagnosis of dengue fever depends on 1 or more of the following 4 criteria
- Isolation of the virus from clinical specimens using cultured mosquito cells
- Detection of a fourfold or greater change in reciprocal IgG or IgM antibodies by ELISA in paired serum samples
- Demonstration of dengue virus antigen in autopsy tissue by immunohistochemistry or immunofluorescence or in serum samples by EIA
- Detection of viral genomic sequences in autopsy tissue, serum, or CSF samples using PCR
Differential Diagnosis
- Malaria
- Typhoid fever
- Leptospirosis
- Other viral hemorrhagic fevers
- Epstein-Barr viral infection
- Cytomegaloviral infection
- HIV - initial infection
- Measles
- Rubella
- Meningococcal disease
- Sepsis
- Brucellosis
Tests generally appear in the order most useful for common clinical situations
| Test name: Dengue Fever Virus Antibodies, IgG & IgM
|
| ARUP #: 0093096 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Use: Diagnose infectious agent in hemorrhagic febrile illness |
| Limitations: May require paired convalescent samples |
| Follow-up:
For equivocal results, repeat testing in 10-14 days
|
Additional Tests Available
| Test name: Dengue Fever Virus Antibody, IgG
|
| ARUP #: 0093097 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Comments: |
| Test name: Dengue Fever Virus Antibody, IgM
|
| ARUP #: 0093098 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Comments: |
References
Guidelines
Epidemic/epizootic West Nile virus in the United States: guidelines for surveillance, prevention, and control. Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Department of Health and Human Services (U.S.) - Federal Government Agency [U.S.]
Division of Vector-Borne Infectious Diseases (Fort Collins, Colorado) - Federal Government Agency [U.S.] National Center for Infectious Diseases - Federal Government Agency [U.S.]
Public Health Service (U.S.) - Federal Government Agency [U.S.]. 2001 Apr (revised 2003). 75 pages. NGC:003165 General References
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Medical Reviewers
Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah
Comprehensive Review: July 2008
Last Update: July 2008
