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Dengue 

Dengue

Chapter:
Dengue
Author(s):

Bridget Wills

and Jeremy Farrar

DOI:
10.1093/med/9780199204854.003.070515_update_001

February 27, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Epidemiology—expanding geographical range (Pacific Region, Americas, Africa, the Arabian Peninsula, and even the warmer parts of Europe).

Potential drug therapy—failure of chloroquine.

Vaccines—continuing trials of experimental ChimeriVax-Dengue vaccine.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Dengue is caused by a flavivirus and is the most important mosquito-borne viral infection of humans. Some 40 million symptomatic infections are estimated to occur annually. The disease is hyper-endemic in many large Asian cities, and is also a significant problem in the Pacific region and in the Americas. The primary mosquito vector is Aedes aegypti. Infection can be caused by any one of four closely related but serologically distinct dengue viral serotypes. Following infection with a single serotype there is life-long immunity to that serotype but the possibility of more severe disease during a subsequent infection with a different serotype.

Clinical features and diagnosis—symptomatic disease ranges from a nonspecific febrile illness through to a syndrome characterized by plasma leakage that may, if severe, result in the development of potentially fatal dengue shock syndrome. Thrombocytopenia and deranged haemostasis also occur, but clinically significant bleeding is unusual except it patients with profound shock. Severe hepatic and neurological complications are also seen in some patients. Diagnosis depends on viral isolation, detection of viral antigen or viral RNA, or serological testing.

Management and prevention—treatment is supportive, with particular emphasis on careful fluid management. Prompt volume resuscitation is essential for patients with shock, with regular monitoring of the pulse rate, blood pressure, and haematocrit to minimize the risk of fluid overload. No vaccine is available as yet but a number of candidates are entering clinical trials. Currently prevention relies on elimination of potential vector breeding sites, biological and chemical vector control strategies, and avoidance of mosquito bites.

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