Written by Megan Hilbert
Spoon Feed
The incidence of dengue in non-endemic regions is increasing, making it extremely important for us to keep on the differential for patients with recent travel (or not!).
My achy-breaky… joints
Remember from medical school:
- Dengue is a vector-borne illness (Aedes aegypti and Aedes albopictus mosquitoes).
- There are 4 different viruses; infection with one does not confer resistance to others.
- Most (75%) patients are asymptomatic.
- If symptomatic, patient’s tend to have myalgias, arthralgias, nausea, vomiting, headache, macular/maculopapular rash (“break-bone” fever).
- There are 3 phases: 1.) febrile (last 2-7 days), 2.) critical, and 3.) recovery.
- Severe dengue (previously known as dengue hemorrhagic fever or dengue shock syndrome) is characterized by plasma leak with hypovolemic shock. Be careful with the recovery phase where the leak is reversed and the patient may become volume overloaded!
- A second infection with dengue (regardless of which strain) results in increased likelihood of developing severe dengue (OR 2.26, 95%CI 1.63-3.09) due to antibody dependent enhancement (old antibodies facilitate entry and replication in host cells – yikes!).
- Treatment is appropriate prevention and supportive care.
Why are we reviewing this? Because new concerns exist; lately, some patients have locally acquired cases. This has already occurred in Florida, Hawaii, Arizona, and California. In addition, a quick reminder that it can also be spread via blood exposure (although this is far less likely). Finally, while there is a vaccine, it is no longer made in the U.S. due to lack of demand.
How does this change my practice?
I appreciate good spaced repetition for knowledge retention. This was a well-done review of dengue fever and highlights the importance of keeping this on my differential even if a patient hasn’t traveled recently.
Source
Dengue. JAMA. 2024 Nov 27. doi: 10.1001/jama.2024.21094. Epub ahead of print. PMID: 39602174
