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Rationale for review
Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue....
Contexts in source publication
Context 1
... be familiar with the clinical management of increased vascular permeability leading to intravascular volume depletion is the hallmark of severe dengue, which may progress to life-threatening DSS. Three phases can be observed: the febrile phase with rapid decrease of platelets and increase of haematocrit, the critical phase and the recovery phase (Fig. 1). Warning signs often occur at the time of defervescence and usually include irritability, abdominal pain and vomiting. Clinical detection of vascular permeability is based on a range of symptoms, signs and laboratory parameters, and as the progression to severe dengue can occur rapidly, such clinical assessments need to be done ...
Context 2
... Fluid overload is a mistake of inexperienced clinicians that may result in pulmonary oedema and death. Figure 1 displays the consequences of too little or too much fluid. Causes of death are often related to either of the the following three delays: delay in admitting a patient with warning signs, delay in initiating fluid therapy during the critical phase or delay in discontinuing fluid resuscitation in the recovery phase. ...
Similar publications
Flaviviruses cause a spectrum of potentially severe diseases. Most flaviviruses are transmitted by mosquitoes or ticks and are widely distributed all over the world. Among them, several mosquito-borne flaviviruses are co-epidemic, and the similarity of their antigenicity creates abundant cross-reactive immune responses which complicate their preven...
Citations
... These include fulminant hepatitis, myocarditis, arrhythmias, rhabdomyolysis, optic neuritis, retinal vasculopathy, hemophagocytic syndrome, and so on. 3 Neurological complications of dengue fever have a wide spectrum and can be fatal if not identified and treated at the right time. DENV is a neurotropic virus and can infect the supporting cells of the central nervous system. ...
A 38-year-old gentleman, following an uncomplicated dengue fever 2 weeks back, developed acute onset bilateral lower limb weakness and numbness for 5 days, associated with bladder and bowel incontinence and a band-like sensation in T4 dermatome. On examination, he had paraparesis with normal cranial nerves except for left upper motor neuron-type 7th cranial nerve palsy and normal higher mental function. Magnetic resonance imaging (MRI) of the brain and spine detected multiple demyelinating lesions. A diagnosis of postdengue acute disseminated encephalomyelitis (ADEM) was made as part of postinfective inflammatory process after the fever had subsided. Cerebrospinal fluid study ruled out active infection. He was treated with intravenous steroids and is currently recovering. An interesting point in our case was that the patient had significant imaging findings in MRI of the brain with no symptoms or signs suggestive of intracranial involvement-ADEM without evidence of encephalitis.
... Dengue is endemic in most tropical and subtropical countries, which are popular tourist destinations, and thus is a frequent cause of febrile illness among travellers (Halstead and Wilder-Smith, 2019). It has overtaken malaria as the leading cause of febrile illness for those travelling to Southeast Asia (Wilder-Smith, 2012; Halstead and Wilder-Smith, 2019). ...
... Dengue is particularly prevalent in tropical and sub-tropical countries but now it has emerged as pandemic being endemic in tropical and sub-tropical regions 5 . Dengue cases have become higher in travelers from southeast Asian region have higher infectivity and rate of hospitalization 6,7 . Dengue is ende-mic in Pakistan; after two massive outbreaks in 1995 and 2005, outbreaks of dengue tend to afflict different cities on annual basis 1, 8 . ...
Objective: To assess correlation of Aspartate Aminotransferase (AST) to platelet ratio index with other biochemical markers such as white cell count, platelet count, hemoglobin, hematocrit and liver function tests in patients of dengue fever for disease severity. Methods: Data was collected from 223 dengue fever patients admitted to a hospital setting in an out- break of 2022. Binary logistic regressions analysis was employed. AST to Platelet Ratio Index (APRI) was calculated and all parameters were studied to assess their association with the disease sever- ity. Severity of dengue was based on development of complications like bleeding, shock, end organ damage and duration of stay in the hospital. Results: The analysis done by software SPSS version 26.0 showed that 3.6% of the patients were se- verely ill while 96.4% were non severe with mean duration of stay in the hospital of 4.95 days. Univariate analysis showed ALT and age have positive correlation with disease severity with CI 95% and APRI significant positive correlation was at CI 90%. Multivariate analysis showed age and APRI to have association with disease severity with OR 1.06 and OR 1.16 respectively (p <0.05). Area under the Receiver Operating Characteristic (ROC) curve for APRI was 0.59. Conclusion: In addition to other biochemical parameters APRI can be used as an independent marker of predicting severity of disease in dengue patients thus it can add value in timely management of the dengue patients.
... El DENV se disemina con frecuencia de un lugar a otro por viajeros infectados virémicos, y cuando el vector está presente existe la posibilidad que se establezca o incremente la transmisión local (17). ...
... Las formas graves son eventos infrecuentes y se observan con mayor frecuencia en personas que visitan a amigos y familiares en áreas endémicas (17). El riesgo de progresar a dengue grave depende de determinantes virales, edad del individuo, condiciones predisponentes del huésped, infecciones previas por otro serotipo y la experiencia en el abordaje de estos pacientes de los diversos sistemas de salud. ...
Desarrollado en conjunto por SADI y SLAMVI
... Die Zahl der an die Weltgesundheitsorganisation (WHO) gemeldeten Dengue-Fälle hat sich in den letzten 2 Dekaden mehr als verzehnfacht (2). Dabei (15,16). ...
... Dritt-und Viertinfektionen sind hingegen in der Regel mit einem leichten oder asymptomatischen Verlauf assoziiert (16,17). Neben der oben beschriebenen Symptomatik sind im Verlauf der akuten Erkrankung eine Thrombozytopenie, eine Leukopenie und bei Kapillarleck ein erhöhter oder ansteigender Hämatokrit charakteristisch. ...
Dengue, Chikungunya und Zika - Prävention exotischer Infektionskrankheiten. Soeben hat die STIKO eine Empfehlung zur Dengue-Impfung mit Qdenga veröffentlicht, in den USA wurde erstmals eine Vakzine gegen Chikungunya zugelassen. Die Entwicklung weiterer Impfstoffe gegen vektorübertragene Viruserkrankungen stellt nach wie vor eine Herausforderung dar.
... Dengue is the most common arboviral disease globally and is caused by infection with one of four immunologically distinct dengue viruses serotypes (DENV1-4). 1 Most dengue infections are asymptomatic or associated with a benign febrile illness and only a minority of infections progress to severe disease. Immune responses to dengue play a crucial role in determining the likelihood of clinical disease and its severity. ...
... 2 In primary dengue infection, individuals typically gain lifelong protection against the infecting serotype (homotypic protection) and temporary cross-protection against the others (heterotypic protection). 1 Modelling studies based on data from endemic settings suggest that ∼18% (95% CI: 16-20%) of primary dengue infections are symptomatic. 3 For secondary infections, the proportion of cases that are symptomatic varies with the time since primary infection. ...
... 1,2 A recent meta-analysis estimated that secondary infections are more than twice as likely to cause severe disease than primary infections [OR 2.26 (95% CI 1.65-3.09)]. 2 Severe dengue is estimated to occur in ∼2-4% of secondary cases. 1 Dengue is now the leading cause of febrile illness in returned travellers from all continents except Africa. 4,5 A recent publication estimates an incidence rate of 6 symptomatic dengue infections per 1000 unvaccinated travellers to endemic areas per month. ...
... Dengue virus is a mosquito-borne flavivirus that is most common in tropical and subtropical areas [144]. Dengue causes headaches, fever, abdominal pain, bleeding, myalgias, and loss of capillary integrity and increased mortality by up to 12.5% in SCD patients [145][146][147], due to their compromised immune systems, which make them more susceptible to hypovolemia and endothelial cell activation. ...
Sickle cell disease (SCD) is a complex genetic disorder associated with multiple clinical manifestations, including increased susceptibility to bacterial and viral infections. This review article presents a comprehensive analysis of the current literature obtained from various online databases focusing on the relationship between SCD and infections caused by specific pathogens, such as pneumonia- and influenza-causing pathogens, Escherichia coli, Staphylococcus aureus, parvovirus, and hepatitis viruses. We discuss the underlying mechanisms that contribute to the increased susceptibility of individuals with SCD to these infections, primarily related to the pathophysiology of variant hemoglobin (HbSS) and its impact on vascular occlusion, hemolysis, functional asplenia, and immune deficiency. Moreover, we highlight the significant burden of infections on SCD patients, particularly children under five years of age, where they are the leading cause of morbidity and mortality. Additionally, we address the challenges faced in attempts for reducing the global mortality rate associated with SCD, particularly in low-income countries, where factors such as increased pathogen exposure, co-morbidities like malnutrition, lower vaccination rates, and limited healthcare facilities contribute to the high disease burden. This review emphasizes the need for targeted interventions, improved healthcare access, vaccination programs, and infection prevention strategies to alleviate the impact of infections on individuals with SCD and reduce the global mortality rates associated with the disease.
... 37 It is known that the relative risk of severe dengue in secondary infection is increased by a factor of 2 to 7 as compared with primary infection. 41 Travellers with DENV infection were hospitalized in 10% 36 to 39% 42 ( Figure 2) of the majority upon return. Dengue haemorrhagic fever and dengue shock syndrome are rare in this population; few travellers died of dengue, most of them after a primary infection. ...
... Dengue haemorrhagic fever and dengue shock syndrome are rare in this population; few travellers died of dengue, most of them after a primary infection. 41,43,44 According to a recent study among 51 cases with dengue, the out-of-pocket costs were about USD 3700 and the loss of income USD 570. 42 Rabies-potential travel-related rabies exposures Some may disagree to find rabies in the 'frequent' category; however, it would be a mistake to report only rabies diagnosis and fatality. ...
Background:
Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPD) relevant for travellers have occurred.
Methods:
We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate (CFR). We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines.
Results:
COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to > 0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk.
Conclusion:
The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
... Dengue was recently identified as the leading cause of acute undifferentiated febrile illness among travelers returning to Europe from all continents except Africa (6). Attack rate estimates among travelers to endemic regions range from 10 to 30 per 1000 person-months but depend on travel destination, duration, and seasonality (7)(8)(9). The clinical course of dengue among travelers is most frequently uncomplicated (10)(11)(12)(13). ...
... The clinical course of dengue among travelers is most frequently uncomplicated (10)(11)(12)(13). Transmission intensity of DENV in the destination country; secondary dengue; time interval since the preceding dengue episode or other flavivirus exposure; seasonality; exposure during epidemic years; and host factors, such as older age and comorbidities, have been identified as risk factors for severe dengue in travelers (9). ...
Background:
Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.
Objective:
To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).
Design:
Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.
Setting:
20 of 71 international GeoSentinel sites.
Patients:
Returning travelers with complicated dengue.
Measurements:
Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.
Results:
Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.
Limitations:
Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.
Conclusion:
Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.
Primary funding source:
Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.
... 228outcomes16 ; physicians may overlook some infectious diseases by focusing on COVID-1917 ; 229 there may also have been changes in healthcare-seeking behavior and challenges in accessing230 healthcare. Therefore, considering the continued high risk among travelers despite the decline 231 in notified case counts, public health authorities should continue their efforts to ensure that 232 patients receive early diagnosis and treatment to prevent serious outcomes. ...
Background: Little is known about the trends of imported infectious diseases among travelers to non-endemic countries during the COVID-19 pandemic. This article aimed to describe those among travelers to Japan.
Methods: This is a descriptive study based on national surveillance data. Imported infectious disease cases were defined as those with a reported overseas source of infection among 15 diseases pre-selected based on the probability and impact of importation. The number of notified cases from April 2016 to March 2021 were described by disease and time of diagnosis. The relative ratio and absolute difference in case counts—both by number and per arrival—were calculated by disease comparing those from the pandemic period (April 2020–March 2021) to the pre-pandemic period (April 2016–March 2020).
Results: A total of 3524 imported infectious disease cases were diagnosed during the study period, including 3439 cases before and 85 cases during the pandemic. The proportionate distribution of diseases changed but notification counts of all 15 diseases decreased during the pandemic. Accounting for arrivals, however, seven diseases showed a two-fold or greater increase, with a notable absolute increase per million arrivals for amebiasis (60.1; 95%CI, 41.5–78.7), malaria (21.7; 10.5–33.0), and typhoid fever (9.3; 1.9–16.8).
Conclusion: The epidemiology of imported infectious diseases changed during the pandemic. While the number of imported infectious disease cases decreased, the number of cases per arrivals increased considerably both in relative and absolute terms for several diseases of public health and clinical importance.
