Microbiology
A flavivirus
Diagnosis
Incubation of three to fourteen days, then a high fever, headache (right behind the eyes), vomiting, muscle and joint pains (aka breakbone fever), and a characteristic skin rash.
Serology. It can cross-react with Zika, Yellow Fever, and Chikungunya. There are also PCR and viral antigen detection such as for NS1.
It can be a mild illness to dengue hemorrhagic fever or severe dengue: plasma leak with shock, ARDS, or both; severe bleeding and severe organ impairment.
Is it dengue or (Leptospirosis? A C-reactive protein > 50 means Leptospirosis is more likely (Pubmed)
Epidemiologic Risks
Mosquito bites. It is curious that severe disease is more likely to occur with sequential infections by different types.
A disease of worldwide tropical distribution. 4 types, cleverly called 1,2,3,4. The virus is moving north with global warming and has been found in the Florida Keys and Texas. It was wandering back and forth over the border from Arizona and Mexico. Now if only a wall could prevent dengue spread...
"During 2010–2017, a total of 5,387 dengue cases were reported from U.S. states; 93% were travel-associated. Locally acquired cases were reported from Hawaii (250 cases), Florida(103), Texas (24), and New York (one) (Pubmed)."
It is endemic in a park in Tokyo, Japan as of 2014 (PubMed). It is just a matter of time before it is endemic in the US South.
Empiric Therapy
Supportive. Maybe prochlorperazine (PubMed).
Pearls
There is a vaccine coming that reduces symptomatic disease and the trials have also shown that immunity from natural infection is not lifelong (Pubmed). The vaccine makes interpreting serology problematic (PubMed)
And in Central America, it may actually be Punta Toro (Spanish for kick a ball on 4th down I think) virus as a dengue mimic (PubMed).
People with DHF have an increased risk of stroke in the first two months following the illness (PubMed)(PubMed).
Rants
Last Update: 02/16/20.
Curious Cases
Relevant links to my Medscape blog