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- Dengue fever or “breakbone fever” is caused by an arbovirus—dengue virus (DENV)—a Flavivirus, from the Flaviviridae family.
- Single-stranded positive RNA virus with four antigenically distinct serotypes (DENV1, DENV2, DENV3, DENV4)
- Endemic in tropical and subtropical regions of Africa, Asia, and America
Dengue fever is reportable to the CDC.
The World Health Organization (WHO) estimates 50 to 100 million cases annually worldwide (1).
- Dengue is present in over 100 countries.
- The virus is common in urban and residential areas.
- There have been multiple dengue fever outbreaks in the continental United States over the past decade.
Etiology and Pathophysiology
- Dengue is transmitted by the bite from an infected female Aedes mosquito.
- Symptoms begin after a 3- to 7-day incubation.
- The virus spreads from the inoculation site to the bloodstream via the reticuloendothelial system.
- The disease has three phases: febrile, critical (plasma leak), and spontaneous recovery (convalescent phase).
- Dengue hemorrhagic fever (DHF) is a complication of dengue fever thought to be due to antibody-dependent response related to prior exposure to a different serotype with subsequent endothelial dysfunction and vascular instability.
- Residing in or traveling to endemic areas
- Risk factors for the development of DHF include (2):
- Young age; female gender
- High body mass index
- Sequential infection by different DENV serotypes
- No vaccine or prophylaxis currently exists.
- Vector control is the most important preventive step.
- Vector control can be achieved through the use of chemical, biologic, and environmental means (e.g., removal of breeding sites—standing water).
- The Aedes mosquito is most active during the day and prefers to bite indoors. Patients should wear protective clothing and insect repellent to decrease bite exposures.