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Last Updated: 9/12/2013  

Dengue

Dengue is a rapidly spreading mosquito-borne viral infection endemic to parts of Africa, Asia, and Central and South America. The illness includes an incubation period of 4 to 10 days, an acute febrile phase lasting 2 to 7 days, a critical phase beginning around the time of defervescence and lasting 1 to 2 days, and a recovery phase lasting 2 to 3 days.

Prevention
  • Recommend mosquito avoidance to prevent dengue, including covering skin, the use of screens, and applying mosquito repellants containing DEET.

Diagnosis
  • Ask patients with suspected dengue about typical symptoms including fever, headache, myalgias, rash, and GI symptoms.

  • Look for physical exam findings that suggest a diagnosis of dengue, including rash, abdominal tenderness, signs of hemorrhagic manifestations, and signs of circulatory compromise.

  • Obtain a CBC in patients with suspected dengue.

  • Use PCR, serology, or viral culture to confirm the diagnosis. Note that cell culture and PCR are useful early in the illness during the acute febrile phase.

  • Grade the severity of dengue to offer optimal management; look for warning signs and criteria for severe dengue and hospitalize patients with warning signs or severe disease.

Therapy
  • Provide fluid replacement for all patients with dengue and monitor them closely.

  • Use blood transfusions in patients with significant hemorrhagic manifestations.

  • Use appropriate drugs to provide supportive care to patients with dengue. Consider treatment with acetaminophen, diazepam for seizures, and PPIs or H2-blockers for patients with gastrointestinal bleeding.

DOI: 10.7326/d068
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Suranjith L. Seneviratne, MD, DPhil, FRCP, FRCPath, FCCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Panduka Karunanayake, MD, MRCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Suranjith L. Seneviratne, MD, DPhil, FRCP, FRCPath, FCCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Panduka Karunanayake, MD, MRCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Mitrakrishnan C. Shivanthan, MBBS, MD National Hospital of Sri Lanka
Colombo, Sri Lanka
has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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