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Severe dengue virus infection in travelers: risk factors and laboratory indicators.
J Infect Dis. 2007 Apr 15; 195(8):1089-96.JI

Abstract

BACKGROUND

Dengue fever is the most common arboviral disease in travelers. In countries where dengue virus is endemic, sequential (secondary) infections with different dengue virus serotypes are associated with disease severity. Data on severity and secondary infection rates in a population of travelers are lacking.

METHODS

Intensified surveillance of dengue fever in travelers was performed within the European Network on Surveillance of Imported Infectious Diseases. Data were collected at 14 European clinical referral centers between 2003 and 2005.

RESULTS

A total of 219 dengue virus infections imported from various regions of endemicity were reported. Serological analysis revealed a secondary immune response in 17%. Spontaneous bleeding was observed in 17 (8%) patients and was associated with increased serum alanine and aspartate aminotransferase levels and lower median platelet counts. Two (0.9%) patients fulfilled the World Health Organization (WHO) case definition for dengue hemorrhagic fever. However, 23 (11%) travelers had severe clinical manifestations (internal hemorrhage, plasma leakage, shock, or marked thrombocytopenia). A secondary immune response was significantly associated with both spontaneous bleeding and other severe clinical manifestations.

CONCLUSIONS

In travelers, severe dengue virus infections are not uncommon but may be missed if the WHO classification is strictly applied. High liver enzyme levels and low platelet counts could serve as indicators of disease severity.

Authors+Show Affiliations

Institute of Tropical Medicine, Charité University Medicine, Berlin, Germany. WichmannO@rki.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17357044

Citation

Wichmann, Ole, et al. "Severe Dengue Virus Infection in Travelers: Risk Factors and Laboratory Indicators." The Journal of Infectious Diseases, vol. 195, no. 8, 2007, pp. 1089-96.
Wichmann O, Gascon J, Schunk M, et al. Severe dengue virus infection in travelers: risk factors and laboratory indicators. J Infect Dis. 2007;195(8):1089-96.
Wichmann, O., Gascon, J., Schunk, M., Puente, S., Siikamaki, H., Gjørup, I., Lopez-Velez, R., Clerinx, J., Peyerl-Hoffmann, G., Sundøy, A., Genton, B., Kern, P., Calleri, G., de Górgolas, M., Mühlberger, N., & Jelinek, T. (2007). Severe dengue virus infection in travelers: risk factors and laboratory indicators. The Journal of Infectious Diseases, 195(8), 1089-96.
Wichmann O, et al. Severe Dengue Virus Infection in Travelers: Risk Factors and Laboratory Indicators. J Infect Dis. 2007 Apr 15;195(8):1089-96. PubMed PMID: 17357044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe dengue virus infection in travelers: risk factors and laboratory indicators. AU - Wichmann,Ole, AU - Gascon,Joaquim, AU - Schunk,Mirjam, AU - Puente,Sabino, AU - Siikamaki,Heli, AU - Gjørup,Ida, AU - Lopez-Velez,Rogelio, AU - Clerinx,Joannes, AU - Peyerl-Hoffmann,Gabriele, AU - Sundøy,Anders, AU - Genton,Blaise, AU - Kern,Peter, AU - Calleri,Guido, AU - de Górgolas,Miguel, AU - Mühlberger,Nikolai, AU - Jelinek,Tomas, AU - ,, Y1 - 2007/03/02/ PY - 2006/06/30/received PY - 2006/09/26/accepted PY - 2007/3/16/pubmed PY - 2007/5/16/medline PY - 2007/3/16/entrez SP - 1089 EP - 96 JF - The Journal of infectious diseases JO - J Infect Dis VL - 195 IS - 8 N2 - BACKGROUND: Dengue fever is the most common arboviral disease in travelers. In countries where dengue virus is endemic, sequential (secondary) infections with different dengue virus serotypes are associated with disease severity. Data on severity and secondary infection rates in a population of travelers are lacking. METHODS: Intensified surveillance of dengue fever in travelers was performed within the European Network on Surveillance of Imported Infectious Diseases. Data were collected at 14 European clinical referral centers between 2003 and 2005. RESULTS: A total of 219 dengue virus infections imported from various regions of endemicity were reported. Serological analysis revealed a secondary immune response in 17%. Spontaneous bleeding was observed in 17 (8%) patients and was associated with increased serum alanine and aspartate aminotransferase levels and lower median platelet counts. Two (0.9%) patients fulfilled the World Health Organization (WHO) case definition for dengue hemorrhagic fever. However, 23 (11%) travelers had severe clinical manifestations (internal hemorrhage, plasma leakage, shock, or marked thrombocytopenia). A secondary immune response was significantly associated with both spontaneous bleeding and other severe clinical manifestations. CONCLUSIONS: In travelers, severe dengue virus infections are not uncommon but may be missed if the WHO classification is strictly applied. High liver enzyme levels and low platelet counts could serve as indicators of disease severity. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/17357044/Severe_dengue_virus_infection_in_travelers:_risk_factors_and_laboratory_indicators_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/512680 DB - PRIME DP - Unbound Medicine ER -