Dengue in the Western Hemisphere

Dengue is an important insect-borne viral disease, transmitted in the Western hemisphere by the A. aegypti mosquito. It is endemic in the Caribbean with sporadic outbreaks in different regions. Cases in the United States are mostly imported cases but can be seen in the Gulf states as well as the Southeast. Dengue is most frequently a self-limiting illness characterized by sudden onset of fever, chills, headache, retroocular pain, general malaise, myalgias, arthralgias, and a skin rash. In a small group of patients, the same viruses may cause dengue hemorrhagic fever and dengue shock syndrome. In the Western hemisphere, dengue with hemorrhagic manifestations and dengue with shock syndrome have been documented frequently in adults. There are four serotypes of dengue viruses and all have been documented to be present in the Western hemisphere. The clinical illness is similar for any of the four serotypes; after infection there is lifelong homotypic immunity and heterotypic immunity for several months. The diagnosis of dengue is based on clinical findings and can be confirmed by serologic tests or virus isolation. There is no specific treatment for dengue; hydration is important as well as aggressive fluid management if hypotension develops. It is important to avoid aspirin and salicylates. The best treatment is prevention through mosquito control and public education to eradicate the breeding grounds for the mosquito.