Dengue virus infection: Clinical manifestations and diagnosis
- Stephen J Thomas, MD
Stephen J Thomas, MD
- Professor and Chief, Division of Infectious Diseases
- State University of New York, Upstate Medical University
- Alan L Rothman, MD
Alan L Rothman, MD
- University of Rhode Island
- Anon Srikiatkhachorn, MD
Anon Srikiatkhachorn, MD
- Associate Professor
- University of Rhode Island
- Siripen Kalayanarooj, MD
Siripen Kalayanarooj, MD
- Professor of Pediatrics
- Rangsit University
- Consultant, WHO Collaborating Centre for Case Management of Dengue/DHF/DSS
- Queen Sirikit National Institute of Child Health (QSNICH)
Dengue is a febrile illness caused by infection with one of four dengue viruses (DENV) transmitted by Aedes aegypti or Aedes albopictus mosquitoes during the taking of a blood meal [1-3]. Infection may be asymptomatic or present with a broad range of clinical manifestations including a mild febrile illness to a life-threatening shock syndrome. Numerous viral, host, and vector factors are thought to impact risk of infection, disease, and disease severity.
There are four closely related but serologically distinct DENV types of the genus Flavivirus, called DENV-1, DENV-2, DENV-3, and DENV-4. There is transient cross-protection among the four types, which weakens and disappears over the months following infection; therefore, individuals living in a dengue-endemic area with all types co-circulating are at risk for infection with any and all DENV types.
Issues related to clinical manifestations and diagnosis of DENV infection will be reviewed here. Issues related to epidemiology, pathogenesis, prevention, and treatment are discussed separately. (See "Dengue virus infection: Pathogenesis" and "Dengue virus infection: Prevention and treatment" and "Dengue virus infection: Epidemiology".)
Overview — In 1997, the World Health Organization (WHO) published a classification scheme describing three categories of symptomatic dengue virus (DENV) infection: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) . (See 'WHO 1997 classification' below.)
The WHO 1997 classification scheme is data driven and evidence based but has been criticized . The term DHF suggests that hemorrhage is the cardinal manifestation of severe dengue; however, plasma leakage leading to intravascular volume depletion and potentially shock is the most specific feature of severe dengue and the focus of clinical management guidelines and algorithms [6,7]. In addition, some patients with severe illness requiring medical intervention do not meet all criteria for DHF. It is generally believed that use of the 1997 WHO definition for DHF underestimates the clinical burden of DENV infection .
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- CLASSIFICATION SCHEMES
- WHO 1997 classification
- - Dengue fever
- - Dengue hemorrhagic fever
- - Dengue shock syndrome
- WHO 2009 classification
- - Dengue without warning signs
- - Dengue with warning signs
- - Severe dengue
- CLINICAL MANIFESTATIONS
- Phases of infection
- - Febrile phase
- - Critical phase
- - Convalescent phase
- Additional manifestations
- Clinical approach
- Laboratory testing
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS