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Half of dengue fever cases do not present typically: 'breakbone fever'.

NEW YORK -- Its nickname may be "breakbone fever," but dengue fever doesn't always live up to its reputation.

Only about 45% of patients with dengue fever experience the classic severe myalgias and bone pain, so the absence of this Finding does not rule it out, Dr. Jay S. Keystone said at a meeting on infectious diseases sponsored by the Center for Bio-Medical Communication.

The infection is endemic throughout the tropics, and is increasingly being seen in Southeast Asia. Transmission of dengue fever occurs via the bite of the Aedes aegypti mosquito.

Any fever in a traveler returning from an endemic area can be dengue. The fever typically follows a "saddle-back" temperature course, peaking twice with a period of defervescence intervening. Other symptoms can include headache, striking retroorbital pain, and a maculopapular rash with diffuse erythema, said Dr. Keystone of the Centre for Travel and Tropical Medicine, Toronto General Hospital.

The incubation period of dengue is short, with symptom onset typically between 2 and 7 days. "It usually comes on in a week and is gone in a week," he said.

Between 1977 and 1994, a total of 2,248 suspected cases of dengue fever were reported in the United States; most of the patients were travelers returning from the tropics. But there is a "small but significant" risk for dengue in the continental United States, according to the Centers for Disease Control and Prevention. In south Texas, for example, there have been three sporadic outbreaks during the last 25 years.

In the absence of hemorrhagic complications, dengue fever is considered relatively benign, but serologic diagnosis is important nonetheless. "Patients need to know. They will need to take extra precautions when traveling in the tropics again. A second bout can be much worse than the first."

The specific diagnosis can be made by viral culture, polymerase chain reaction, or detection of IgM or IgG antibodies.

Management of the acute illness includes maintenance of fluid and electrolyte balance and antipyretics. "Avoid salicylates and NSAIDs, however, because the pathogenesis of dengue involves capillary leakage, and the last thing you want to do is increase capillary leakage," he advised.

A warning sign that hemorrhagic fever may be developing is an increase in the hematocrit to 10% above standard, he said. Hemorrhagic dengue is potentially lethal, particularly in children, with a case fatality rate of about 5%.

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Title Annotation:Clinical Rounds
Publication:Family Practice News
Geographic Code:1USA
Date:May 15, 2004
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