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Clinical manifestations and diagnosis of dengue virus infection

Authors
Alan L Rothman, MD
Anon Srikiatkhachorn, MD
Siripen Kalayanarooj, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Dengue is the most prevalent mosquito-borne viral disease; it is estimated that over 390 million dengue virus infections occur each year throughout the world, including 96 million that produce illness [1]. Symptomatic dengue virus infections can present with a wide range of clinical manifestations, from mild febrile illness to a life-threatening shock syndrome or organ dysfunction [2,3]. Both viral and host factors are thought to contribute to the manifestations of disease in each infected individual.

The various clinical features and the available methods for the diagnosis of dengue virus infections will be reviewed here. The pathogenesis and measures to prevent and treat the disease are discussed separately. (See "Pathogenesis of dengue virus infection" and "Prevention and treatment of dengue virus infection" and "Epidemiology of dengue virus infections".)

VIROLOGY

There are four closely related but serologically distinct dengue viruses, called DENV-1, DENV-2, DENV-3, and DENV-4, of the genus Flavivirus. There is only transient and weak cross-protection among the four serotypes; therefore, individuals living in an area of endemic dengue can be infected with up to four dengue serotypes in a lifetime. Multiple virus serotypes often co-circulate within the same region (hyperendemicity), causing periodic epidemics.

CLINICAL MANIFESTATIONS

The typical clinical manifestations of dengue range from self-limited dengue fever (DF) to dengue hemorrhagic fever (DHF) with shock syndrome [4]. In cohort studies involving more than 3400 children in Southeast Asia and Latin America, virologically confirmed dengue was responsible for approximately 10 percent of episodes of acute febrile illness, with an incidence of 2.9 and 4.6 episodes per 100 person-years in Latin America and Asia, respectively; the incidence of DHF was less than 0.3 episodes per 100 person-years [5].

With wider availability of laboratory testing, there are increasing reports of unusual clinical manifestations, as discussed below [3]. The risk of severe disease is much higher in repeat infection than primary infection [6]. (See "Pathogenesis of dengue virus infection".)

                   

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