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- Dengue virus (DENV) is an arthropod-borne virus (arbovirus) that causes a febrile illness characterized by intense headache (classically retro-orbital), rash, abdominal pain, nausea, and joint pain.
- The majority of DENV infections is subclinical or asymptomatic, but some people with DENV infection develop severe dengue disease, which:
- Manifests when the fever from the initial illness subsides
- Is characterized by plasma leak leading to hypovolemic shock and death
- Can be anticipated based on the presence of warning signs
- Identification of severe dengue-associated warning signs is important for determining need for additional monitoring and hydration.
DENV has been reemerging over the last 50 years as a significant cause of febrile illness in tropical and subtropical areas of the world.
- Approximately 50 to 60 million symptomatic infections per year worldwide
- Estimated 300 million infections per year worldwide, including subclinical or asymptomatic infections
- Travel to or residing in an area that is experiencing an outbreak of or is endemic for DENV.
- Exposure to Aedes spp. mosquitoes
- Previous DENV infection of a serotype that is different than the circulating serotype
- Mosquito avoidance
- Wear clothing that maximizes skin coverage.
- Use insect repellants such as N,N-diethyl-meta-toluamide (DEET).
- Empty open containers of standing water.
- DENV has a tropism for monocytes, macrophages, and dendritic cells.
- After invading a cell, it hijacks the cellular machinery to produce more infectious virus.
- Massive activation of the host inflammatory response is thought to lead to severe dengue disease.
- DENV nonstructural protein 1 (NS1) also directly affects vascular endothelium leading to plasma leakage.
- DENV is transmitted by Aedes aegypti and Aedes albopictus mosquitoes.
- Aedes mosquitoes are
- Endemic in many tropical and subtropical areas of the world
- Highly adapted to thrive in peri-urban settings, often entering homes and laying eggs in man-made containers
- Able to lay eggs in as little as a tablespoon of water
- Expanding their habitat range due to global warming
- DENV is endemic in many parts of South and Southeast Asia, Central and South America, and Australia.
- Humans are only known reservoir for DENV.
- DENV can be categorized into four serotypes.
- One or more serotypes may be circulating in an area.
- Infection from one serotype is thought to protect against reinfection from the same (homologous) serotype but does not provide durable protection against the other (heterologous) serotypes.
- Antibodies produced against one serotype (during primary infection) can cross-react with a heterologous serotype (during secondary infection) and increase the risk for developing severe dengue disease via a mechanism called antibody-dependent enhancement of infection.
- Single-stranded RNA virus
- DENV is a member of the Flaviviridae family of viruses that includes yellow fever virus, Japanese encephalitis virus, Zika virus, hepatitis C virus.
Commonly Associated Conditions
Other tropical and subtropical infections, including other mosquito-borne infections such as malaria or other arboviruses