Dengue - Clinical and public health ramifications

Dengue virus infection is spread by the mosquito vector Aedes aegypti and causes significant morbidity and mortality worldwide. In Australia, it is an important cause of fever in the returned traveller and recent outbreaks have occurred in northern Queensland. A comprehensive understanding of the clinical and public health ramifications of dengue infection is essential for general practitioners.

The aim of this article is to review the pathophysiology, clinical manifestations, complications, laboratory investigations and public health consequences of dengue infection.

Dengue should be considered as a differential diagnosis of fever in a returned traveller, including in patients who have travelled to northern Queensland within 3 months of an outbreak. Clinical manifestations vary from asymptomatic infection to serious disease. Typical symptoms last 7 days and may include: fever, headache, myalgia, fatigue, abnormal taste sensation, arthralgia, maculopapular rash and anorexia. Around 1% of patients will get the more severe form of the illness, dengue haemorrhagic fever. Recommended diagnostic tests depend on the time since the onset of symptoms. Management involves symptomatic treatment and monitoring for complications. Dengue haemorrhagic fever requires hospitalisation. Prompt notification to public health authorities and advice to patients about prevention of spread are a key role of the GP.