Dengue - Revision history

Rossdonaldson1: /* Work-up */

2025-04-16T20:02:54Z

Work-up

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	**[[West Nile virus]] testing (see testing cross-reactivity concerns below)		**[[West Nile virus]] testing (see testing cross-reactivity concerns below)
	**See [[Fever in traveler]]		**See [[Fever in traveler]]
	*Definitive ~~Dengue~~ testing (all are serum tests)		*Definitive dengue testing (all are serum tests)
	**Acute phase (0-7 days post symptom onset)<ref>https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html</ref>		**Acute phase (0-7 days post symptom onset)<ref>https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html</ref>
	***Nucleic acid amplification test (NAAT) (e.g., RT-PCR) '''OR''' NS1 ELISA test, '''AND'''		***Nucleic acid amplification test (NAAT) (e.g., RT-PCR) '''OR''' NS1 ELISA test, '''AND'''

Rossdonaldson1: /* Disposition */

2025-04-16T20:01:53Z

Disposition

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	*Advise to:		*Advise to:
	**Say well hydrated		**Say well hydrated
	**Avoid [[aspirin and other [[NSAIDs]]. Fever should be controlled with acetaminophen and tepid sponge baths.		**Avoid [[aspirin]] and other [[NSAIDs]]. Fever should be controlled with acetaminophen and tepid sponge baths.
	*For at least one week, avoid mosquitoes and use insect repellent to prevent additional spread.		*For at least one week, avoid mosquitoes and use insect repellent to prevent additional spread.

Rossdonaldson1: /* Dengue */

2025-04-16T20:01:14Z

Dengue

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	**[[Acetaminophen]] for pain/fever		**[[Acetaminophen]] for pain/fever
	***DO NOT use [[aspirin]] or [[ibuprofen]] due to increased risk of hemorrhage		***DO NOT use [[aspirin]] or [[ibuprofen]] due to increased risk of hemorrhage
			**PO hydration

	===Severe Dengue===		===Severe Dengue===

Rossdonaldson1: /* Dengue */

2025-04-16T20:00:16Z

Dengue

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	===Dengue===		===Dengue===
	*Typically outpatient, if well hydrated and non-toxic appearing		*Typically outpatient, if well hydrated and non-toxic appearing
	*May consider admitting certain high-risk patients (e.g., pregnant, extremes of age, concerning concomitant chronic disease)		**May consider admitting certain high-risk patients (e.g., pregnant, extremes of age, concerning concomitant chronic disease)
			*Advise to:
			**Say well hydrated
			**Avoid [[aspirin and other [[NSAIDs]]. Fever should be controlled with acetaminophen and tepid sponge baths.
			*For at least one week, avoid mosquitoes and use insect repellent to prevent additional spread.

	===Severe Dengue===		===Severe Dengue===

Rossdonaldson1: /* Management */

2025-04-16T19:58:23Z

Management

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	==Management==		==Management==
			''No specific antiviral treatment for dengue is available.''
	===Dengue===		===Dengue===
	*Supportive Care		*Supportive Care
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	===Severe Dengue===		===Severe Dengue===
	Above plus:		Above plus:
	*Monitor for shock and reduce the risk of complications resulting from increased vascular permeability, plasma leakage, and organ damage.		*Treatment is supportive and requires careful volume management
	*[[IVFs]]		**Monitor for shock and reduce the risk of complications resulting from increased vascular permeability, plasma leakage, and organ damage.
	*~~Blood~~ [[~~Transfusion~~]] ~~- consider in~~ hemorrhagic shock		*[[IVFs]] (mainstay of supportive care)
			*Consider blood [[transfusion]] if hemorrhagic shock
			*Prophylactic platelet transfusions and steroids are ''not'' recommended

	==Disposition==		==Disposition==

Rossdonaldson1: /* Prevention */

2025-04-16T19:35:00Z

Prevention

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	==Prevention==		==Prevention==
	*The vaccine Dengvaxia was approved by the Food and Drug Administration in 2021 and was recommended for children and adolescents aged 9 – 16 years who had a laboratory confirmed previous dengue virus infection AND live in areas where dengue is common. However, production ~~of this product~~ was discontinued due to low demand and currently, no vaccines are available.<ref>Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1</ref><ref>http://publichealth.lacounty.gov/acd/VectorDengue.htm</ref><ref>Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1</ref>.		*The vaccine Dengvaxia was approved by the Food and Drug Administration in 2021 and was recommended for children and adolescents aged 9 – 16 years who had a laboratory confirmed previous dengue virus infection AND live in areas where dengue is common. However, production was discontinued due to low demand and currently, no vaccines are available.<ref>Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1</ref><ref>http://publichealth.lacounty.gov/acd/VectorDengue.htm</ref><ref>Paz-Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70(No. RR-6):1–16. DOI: http://dx.doi.org/10.15585/mmwr.rr7006a1</ref>.

	==See Also==		==See Also==

Rossdonaldson1: /* Diagnosis */

2025-04-16T19:34:05Z

Diagnosis

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	***A positive IgM antibody test		***A positive IgM antibody test
	****Diagnosed by a 4x increase in acute vs convalescent titers		****Diagnosed by a 4x increase in acute vs convalescent titers
	****~~Limited~~ by possible cross reactivity against other flaviviruses (e.g., [[Zika]], [[Japanese encephalitis]], St. Louis encephalitis, [[West Nile]], [[yellow fever]]) viruses		****Is limited by possible cross reactivity against other flaviviruses (e.g., [[Zika]], [[Japanese encephalitis]], St. Louis encephalitis, [[West Nile]], [[yellow fever]]) viruses
	**Negative		**Negative
	***A negative result from a RT-PCR or NS1 ELISA test does ''not'' rule out infection.		***A negative result from a RT-PCR or NS1 ELISA test does ''not'' rule out infection.

Rossdonaldson1: /* Diagnosis */

2025-04-16T18:19:53Z

Diagnosis

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	****Limited by possible cross reactivity against other flaviviruses (e.g., [[Zika]], [[Japanese encephalitis]], St. Louis encephalitis, [[West Nile]], [[yellow fever]]) viruses		****Limited by possible cross reactivity against other flaviviruses (e.g., [[Zika]], [[Japanese encephalitis]], St. Louis encephalitis, [[West Nile]], [[yellow fever]]) viruses
	**Negative		**Negative
	**A negative result from a RT-PCR or NS1 ELISA test does ''not'' rule out infection.		***A negative result from a RT-PCR or NS1 ELISA test does ''not'' rule out infection.
			**IgG detection should not be used to diagnose acute dengue because it does not distinguish between current and previous infection.
	*Other possible lab findings:		*Other possible lab findings:
	**CBC: [[Leukopenia]], [[thrombocytopenia]], and hemoconcentration		**CBC: [[Leukopenia]], [[thrombocytopenia]], and hemoconcentration

Rossdonaldson1: /* Diagnosis */

2025-04-16T18:18:06Z

Diagnosis

← Older revision		Revision as of 18:18, 16 April 2025
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	===Diagnosis===		===Diagnosis===
	[[File:Dengue testing.png\|thumb\|When laboratory tests become positive. Day zero is symptom start. 1st = primary infection; 2nd = secondary infection.<ref>Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue" (PDF). The New England Journal of Medicine. 366 (15): 1423–32. doi:10.1056/NEJMra1110265. hdl:11343/191104. PMID 22494122. Archived from the original on 28 August 2021. Retrieved 24 September 2019.</ref>]]		[[File:Dengue testing.png\|thumb\|When laboratory tests become positive. Day zero is symptom start. 1st = primary infection; 2nd = secondary infection.<ref>Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue" (PDF). The New England Journal of Medicine. 366 (15): 1423–32. doi:10.1056/NEJMra1110265. hdl:11343/191104. PMID 22494122. Archived from the original on 28 August 2021. Retrieved 24 September 2019.</ref>]]
			''In the US, dengue is a nationally notifiable disease and all suspected cases should be reported to the local health department.''
	*Typically a clinical diagnosis in the ED		*Typically a clinical diagnosis in the ED
	**All patients with clinically suspected dengue should receive appropriate management without waiting for diagnostic test results.		**All patients with clinically suspected dengue should receive appropriate management without waiting for diagnostic test results.

Rossdonaldson1: /* Work-up */

2025-04-16T18:16:47Z

Work-up

← Older revision		Revision as of 18:16, 16 April 2025
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	*Consider tests to rule out other possible processes:		*Consider tests to rule out other possible processes:
	**CBC, chemistry, LFTs, viral panels		**CBC, chemistry, LFTs, viral panels
			**[[West Nile virus]] testing (see testing cross-reactivity concerns below)
	**See [[Fever in traveler]]		**See [[Fever in traveler]]
	*Definitive Dengue testing (all are serum tests)		*Definitive Dengue testing (all are serum tests)