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Dengue

Last updated: June 2, 2021

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Dengue is a viral disease transmitted by mosquitoes (especially Aedes aegypti) and is widely distributed throughout the tropics and subtropics. Dengue classically presents with high fever, headache, body aches, exanthem, and generalized lymphadenopathy. Symptoms usually subside within one week. Some cases progress to the more severe dengue hemorrhagic fever (DHF) with thrombocytopenia, spontaneous bleeding, and potentially shock (dengue shock syndrome). Treatment is supportive. A vaccination is available for use in children, living in endemic areas, with confirmed prior dengue virus infection.

  • Distribution: tropical regions; worldwide, particularly Asia (e.g., Thailand)
  • Incidence
    • Most common viral disease affecting tourists in tropical regions
    • ∼ 400 million infections per year worldwide

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

References:[3]

Clinical featues of Dengue fever
Course Clinical features
Dengue fever Dengue without warning signs [3][4]
  • Incubation period: 4–10 days after mosquito bite
  • Duration of febrile phase of dengue fever: usually 2–7 days
Dengue with warning signs [3][4]
  • Critical phase: increased risk of clinical deterioration that occurs 3–7 days after symptom onset (coincides with fever abatement)
  • At risk population
    • Individuals with a history of previous dengue infection
    • Infants < 1 year of age
    • Patients with severe comorbidities
Severe dengue (Formally called dengue hemorrhagic fever or DHF) [3][4]
  • DHF typically occurs as a result of an antibody-dependent reaction in patients who are reinfected with a different serotype
  • Generally develops as the initial fever subsides (∼ 1 week after onset)
  • Severe dengue occurs in 1–2% of cases.
Dengue shock syndrome (DSS)
  • Presence of both symptoms of severe dengue and circulatory collapse and shock due to plasma leakage


If symptoms appear more than 2 weeks after returning from a dengue-endemic region, it is very unlikely that dengue is the cause.

Severe dengue is more frequent in individuals who experience a repeat infection with a second serotype, especially serotype 2.

Laboratory tests

Confirmation of diagnosis [6]

Acute phase (≤ 7 days after symptom onset)

Convalescent phase (i.e., > 7 days after symptom onset)

Severe hemorrhagic manifestations with shock and death as well as decreased neutrophil and platelet counts are more indicative of Dengue fever than Chikungunya fever.

The differential diagnoses listed here are not exhaustive.

References:[8][9][10][11][12]

  1. Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature. 2013; 496 (7446): p.504-507. doi: 10.1038/nature12060 . | Open in Read by QxMD
  2. Lee C, Lee H. Probable female to male sexual transmission of dengue virus infection. Infect Dis. 2018; 51 (2): p.150-152. doi: 10.1080/23744235.2018.1521004 . | Open in Read by QxMD
  3. Dengue: Clinical Guidance. https://www.cdc.gov/dengue/clinicallab/clinical.html. Updated: September 6, 2014. Accessed: February 21, 2017.
  4. Dengue and Severe Dengue. http://www.who.int/mediacentre/factsheets/fs117/en/. Updated: July 1, 2016. Accessed: March 20, 2017.
  5. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. http://apps.who.int/iris/bitstream/10665/44188/1/9789241547871_eng.pdf. Updated: January 1, 2009. Accessed: March 24, 2017.
  6. Dengue: Laboratory Guidance and Diagnostic Testing. https://www.cdc.gov/dengue/clinicalLab/laboratory.html. Updated: January 20, 2016. Accessed: March 24, 2017.
  7. Dengue Virus Antigen Detection. https://www.cdc.gov/dengue/healthcare-providers/testing/antigen-detection.html. Updated: May 3, 2019. Accessed: December 17, 2020.
  8. Safety of CYD-TDV dengue vaccine.
  9. Gubler DJ. Aedes aegypti and Aedes aegypti-borne disease control in the 1990s: top down or bottom up: Charles Franklin Craig Lecture. Am J Trop Med Hyg. 1989; 40 (6): p.571-578. doi: 10.4269/ajtmh.1989.40.571 . | Open in Read by QxMD
  10. Halstead SB. Selective primary health care: strategies for control of disease in the developing world: XI-Dengue. Rev Infect Dis. 1984; 6 (2): p.251-264.
  11. Rothman AL, Durbin AP, Whitehead SS. Current Topics in Microbiology and Immunology: Dengue Virus. Springer ; 2010
  12. López-Gatell H, Alpuche-Aranda CM, Santos-Preciado JI, Hernández-Ávila M. Dengue vaccine: local decisions, global consequences. Bull World Health Organ. 2016; 94 (11): p.850-855. doi: 10.2471/blt.15.168765 . | Open in Read by QxMD
  13. Focus On: Dengue Fever. https://www.acep.org/Clinical---Practice-Management/Focus-On--Dengue-Fever/. Updated: June 1, 2008. Accessed: March 24, 2017.