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FINDINGS: This illness begins with 3-7 days of fever and severe myalgias followed by a maculopapular rash. The rash may desquamate. Rarely, there is redness and swelling of the palms and soles. A biphasic fever pattern may occur, corresponding to 2 separate rashes about a week apart. Other findings include leukopenia, thrombocytopenia, lymphadenopathy, and petechiae. Also, bradycardia, epistaxis, gum bleeding, elevated liver enzymes and frank hepatitis may develop. Dengue hemorrhagic fever (DHF) is defined by the presence of acute onset of high fever and hemostatic abnormality (positive tourniquet test, thrombocytopenia, and a hematocrit increased by 20%). Dengue shock syndrome (DSS) includes the above plus hypotension or a pulse pressure of 20 mmHg or less. Early in the course of the disease, children with DHF-DSS are indistinguishable from children with ordinary dengue fever. Abdominal pain, hepatomegaly, hemorrhages, pneumonia, pleural effusions, cyanosis, and shock follow the initial febrile period. EPIDEMIOLOGY: The incidence of Dengue fever is highest in urban areas during the rainy season. Dengue hemorrhagic fever affects mainly children < 10 years of age living in endemic areas of S.E. Asia, China, and Cuba; it has a mortality rate of 6 to 30% (mainly infants < 1 year). Monkeys are reservoirs for dengue fever in Southeast Asia and West Africa. [CCDM, p. 146-52; Merck Manual, p. 1620; ID, p. 2113-8; eMedicine: Dengue Fever by Price DD] |
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