Dengue Fever 3

7/29/2019 Dengue Fever 3

1/16

Dengue feverFrom Wikipedia, the free encyclopedia

For other uses, seeDengue fever (disambiguation).

Dengue fever

Classification and external resources

The typical rash seen in dengue fever

ICD-10 A90

ICD-9 061

DiseasesDB 3564

MedlinePlus 001374

eMedicine med/528

MeSH C02.782.417.214

Dengue fever(UK/de/orUS/di/), also known as breakbone fever, is an infectioustropical

diseasecaused by thedengue virus. Symptoms includefever,headache,muscleandjoint pains, and a

characteristicskin rashthat issimilar to measles. In a small proportion of cases the disease develops into the
http://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=061http://en.wikipedia.org/wiki/Diseases_Databasehttp://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb3564.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/001374.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/med/topic528.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2013/MB_cgi?mode=&term=Dengue&field=entry#TreeC02.782.417.214http://www.nlm.nih.gov/cgi/mesh/2013/MB_cgi?mode=&term=Dengue&field=entry#TreeC02.782.417.214http://en.wikipedia.org/wiki/British_Englishhttp://en.wikipedia.org/wiki/British_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/American_Englishhttp://en.wikipedia.org/wiki/American_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/File:Denguerash.JPGhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Skin_rashhttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Tropical_diseasehttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/American_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_English#Keyhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/Help:IPA_for_Englishhttp://en.wikipedia.org/wiki/British_Englishhttp://www.nlm.nih.gov/cgi/mesh/2013/MB_cgi?mode=&term=Dengue&field=entry#TreeC02.782.417.214http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.emedicine.com/med/topic528.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.nlm.nih.gov/medlineplus/ency/article/001374.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.diseasesdatabase.com/ddb3564.htmhttp://en.wikipedia.org/wiki/Diseases_Databasehttp://www.icd9data.com/getICD9Code.ashx?icd9=061http://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://en.wikipedia.org/wiki/ICD-10_Chapter_Ahttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/Dengue_fever_(disambiguation)


2/16

life-threatening dengue hemorrhagic fever, resulting inbleeding,low levels of blood plateletsand blood

plasma leakage, or into dengue shock syndrome, wheredangerously low blood pressureoccurs.

Dengue is transmitted by several species ofmosquitowithin thegenusAedes, principallyA. aegypti. The virus

has four different types; infection with one type usually gives lifelongimmunityto that type, but only short-term

immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As

there is no commercially availablevaccine, prevention is sought by reducing the habitat and the number of

mosquitoes and limiting exposure to bites.

Treatment of acute dengue is supportive, using either oral or intravenousrehydrationfor mild or moderate

disease, andintravenous fluidsandblood transfusionfor more severe cases. Theincidenceof dengue fever

has increased dramatically since the 1960s, with around 50100 million people infected yearly. Early

descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the

early 20th century. Dengue has become a global problem since theSecond World Warand isendemicin more

than 110 countries. Apart from eliminating the mosquitoes, work is ongoing on a vaccine, as well as medication

targeted directly at the virus.

Contents

[hide]

1 Signs and symptoms

o 1.1 Clinical course

o 1.2 Associated problems

2 Cause

o 2.1 Virology

o 2.2 Transmission

o 2.3 Predisposition

3 Mechanism

o 3.1 Viral replication

o 3.2 Severe disease

4 Diagnosis

o 4.1 Classification

o 4.2 Laboratory tests

5 Prevention

6 Management

7 Epidemiology
http://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Genushttp://en.wikipedia.org/wiki/Genushttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Dengue_feverhttp://en.wikipedia.org/wiki/Dengue_feverhttp://en.wikipedia.org/wiki/Dengue_feverhttp://en.wikipedia.org/wiki/Dengue_fever#Signs_and_symptomshttp://en.wikipedia.org/wiki/Dengue_fever#Signs_and_symptomshttp://en.wikipedia.org/wiki/Dengue_fever#Clinical_coursehttp://en.wikipedia.org/wiki/Dengue_fever#Clinical_coursehttp://en.wikipedia.org/wiki/Dengue_fever#Associated_problemshttp://en.wikipedia.org/wiki/Dengue_fever#Associated_problemshttp://en.wikipedia.org/wiki/Dengue_fever#Causehttp://en.wikipedia.org/wiki/Dengue_fever#Causehttp://en.wikipedia.org/wiki/Dengue_fever#Virologyhttp://en.wikipedia.org/wiki/Dengue_fever#Virologyhttp://en.wikipedia.org/wiki/Dengue_fever#Transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#Transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#Predispositionhttp://en.wikipedia.org/wiki/Dengue_fever#Predispositionhttp://en.wikipedia.org/wiki/Dengue_fever#Mechanismhttp://en.wikipedia.org/wiki/Dengue_fever#Mechanismhttp://en.wikipedia.org/wiki/Dengue_fever#Viral_replicationhttp://en.wikipedia.org/wiki/Dengue_fever#Viral_replicationhttp://en.wikipedia.org/wiki/Dengue_fever#Severe_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#Severe_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#Diagnosishttp://en.wikipedia.org/wiki/Dengue_fever#Diagnosishttp://en.wikipedia.org/wiki/Dengue_fever#Classificationhttp://en.wikipedia.org/wiki/Dengue_fever#Classificationhttp://en.wikipedia.org/wiki/Dengue_fever#Laboratory_testshttp://en.wikipedia.org/wiki/Dengue_fever#Laboratory_testshttp://en.wikipedia.org/wiki/Dengue_fever#Preventionhttp://en.wikipedia.org/wiki/Dengue_fever#Preventionhttp://en.wikipedia.org/wiki/Dengue_fever#Managementhttp://en.wikipedia.org/wiki/Dengue_fever#Managementhttp://en.wikipedia.org/wiki/Dengue_fever#Epidemiologyhttp://en.wikipedia.org/wiki/Dengue_fever#Epidemiologyhttp://en.wikipedia.org/wiki/Dengue_fever#Epidemiologyhttp://en.wikipedia.org/wiki/Dengue_fever#Managementhttp://en.wikipedia.org/wiki/Dengue_fever#Preventionhttp://en.wikipedia.org/wiki/Dengue_fever#Laboratory_testshttp://en.wikipedia.org/wiki/Dengue_fever#Classificationhttp://en.wikipedia.org/wiki/Dengue_fever#Diagnosishttp://en.wikipedia.org/wiki/Dengue_fever#Severe_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#Viral_replicationhttp://en.wikipedia.org/wiki/Dengue_fever#Mechanismhttp://en.wikipedia.org/wiki/Dengue_fever#Predispositionhttp://en.wikipedia.org/wiki/Dengue_fever#Transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#Virologyhttp://en.wikipedia.org/wiki/Dengue_fever#Causehttp://en.wikipedia.org/wiki/Dengue_fever#Associated_problemshttp://en.wikipedia.org/wiki/Dengue_fever#Clinical_coursehttp://en.wikipedia.org/wiki/Dengue_fever#Signs_and_symptomshttp://en.wikipedia.org/wiki/Dengue_feverhttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/World_War_IIhttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Immunity_(medical)http://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Genushttp://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Bleeding


3/16

8 History

o 8.1 Etymology

9 Research

10 Notes

11 References

12 External links

Signs and symptoms

Schematic depiction of the symptoms of dengue fever

Typically, people infected with dengue virus areasymptomatic(80%) or only have mild symptoms such as an

uncomplicated fever.[1][2][3]

Others have more severe illness (5%), and in a small proportion it is life-

threatening.[1][3]

Theincubation period(time between exposure and onset of symptoms) ranges from 314

days, but most often it is 47 days.[4]

Therefore, travelers returning from endemic areas are unlikely to have

dengue if fever or other symptoms start more than 14 days after arriving home.[5]

Children often experience

symptoms similar to those of thecommon coldandgastroenteritis(vomiting and diarrhea)[6]

and have a greater

risk of severe complications,[5][7]

though initial symptoms are generally mild but include high fever.[7]

Clinical course
http://en.wikipedia.org/wiki/Dengue_fever#Historyhttp://en.wikipedia.org/wiki/Dengue_fever#Historyhttp://en.wikipedia.org/wiki/Dengue_fever#Etymologyhttp://en.wikipedia.org/wiki/Dengue_fever#Etymologyhttp://en.wikipedia.org/wiki/Dengue_fever#Researchhttp://en.wikipedia.org/wiki/Dengue_fever#Researchhttp://en.wikipedia.org/wiki/Dengue_fever#Noteshttp://en.wikipedia.org/wiki/Dengue_fever#Noteshttp://en.wikipedia.org/wiki/Dengue_fever#Referenceshttp://en.wikipedia.org/wiki/Dengue_fever#Referenceshttp://en.wikipedia.org/wiki/Dengue_fever#External_linkshttp://en.wikipedia.org/wiki/Dengue_fever#External_linkshttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-3http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-3http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/File:Dengue_fever_symptoms.svghttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Common_coldhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gubler379-4http://en.wikipedia.org/wiki/Incubation_periodhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Euro10-3http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Dengue_fever#External_linkshttp://en.wikipedia.org/wiki/Dengue_fever#Referenceshttp://en.wikipedia.org/wiki/Dengue_fever#Noteshttp://en.wikipedia.org/wiki/Dengue_fever#Researchhttp://en.wikipedia.org/wiki/Dengue_fever#Etymologyhttp://en.wikipedia.org/wiki/Dengue_fever#History


4/16

Clinical course of dengue fever[8]

The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes),

muscle and joint pains, and a rash. The alternative name for dengue, "breakbone fever", comes from the

associated muscle and joint pains.[1][9]

The course of infection is divided into three phases: febrile, critical, and

recovery.[8]

The febrile phase involves high fever, potentially over 40 C (104 F), and is associated with generalized pain

and a headache; this usually lasts two to seven days.[8][9]

Nausea and vomiting may also occur.[7]

A rash occurs

in 5080% of those with symptoms[9][10]

in the first or second day of symptoms asflushed skin, or later in the

course of illness (days 47), as ameasles-likerash.[10][11]Somepetechiae(small red spots that do not

disappear when the skin is pressed, which are caused by brokencapillaries) can appear at this point,

[8]

as may

some mild bleeding from themucous membranesof the mouth and nose.[5][9]

The fever itself is

classicallybiphasicin nature, breaking and then returning for one or two days, although there is wide variation

in how often this pattern actually happens.[11][12]

In some people, the disease proceeds to a critical phase around the time fever resolves[7]

and typically lasts

one to two days.[8]

During this phase there may be significant fluid accumulation in thechestandabdominal

cavitydue to increasedcapillary permeabilityand leakage. This leads todepletion of fluid from the

circulationanddecreased blood supply to vital organs.[8]

During this phase, organ dysfunction and

severebleeding, typically from thegastrointestinal tract, may occur.[5][8]

Shock(dengue shock syndrome) and

hemorrhage (dengue hemorrhagic fever) occur in less than 5% of all cases of dengue,[5]

however those who

have previously been infected with otherserotypesof dengue virus ("secondary infection") are at an increased

risk.[5][13]

This critical phase, while rare, occurs relatively more commonly in children and young adults.[7]

The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream.[8]

This usually lasts

two to three days.[5]

The improvement is often striking, and can be accompanied with severeitchingand aslow
http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-10http://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/File:Course_of_Dengue_illness.pnghttp://en.wikipedia.org/wiki/File:Course_of_Dengue_illness.pnghttp://en.wikipedia.org/wiki/File:Course_of_Dengue_illness.pnghttp://en.wikipedia.org/wiki/File:Course_of_Dengue_illness.pnghttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Itchhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Serotypehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Bleedinghttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Hypoperfusionhttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Vascular_permeabilityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Thoracic_cavityhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-11http://en.wikipedia.org/wiki/Dengue_fever#cite_note-ER2010-11http://en.wikipedia.org/wiki/Fever#Typeshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Petechiahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-10http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Fitz2009-10http://en.wikipedia.org/wiki/Morbilliformhttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8


5/16

heart rate.[5][8]

Another rash may occur with either amaculopapularor avasculiticappearance, which is

followed by peeling of the skin.[7]

During this stage, afluid overloadstate may occur; if itaffects the brain, it may

cause areduced level of consciousnessorseizures.[5]

A feeling offatiguemay last for weeks in adults.[7]

Associated problems

Dengue can occasionally affect several otherbody systems,[8]

either in isolation or along with the classic

dengue symptoms.[6]

A decreased level of consciousness occurs in 0.56% of severe cases, which is

attributable either toinflammation of the brain by the virusor indirectly as a result of impairment of vital organs,

for example, theliver.[6][12]

Other neurological disorders have been reported in the context of dengue, such astransverse

myelitisandGuillain-Barr syndrome.[6]

Infection of the heartandacute liver failureare among the rarer

complications.[5][8]

Cause

Virology

Main article:Dengue virus

ATEMmicrographshowing dengue virusvirions(the cluster of dark dots near the center)

Dengue fever virus (DENV) is anRNA virusof the familyFlaviviridae; genusFlavivirus. Other members of the

same genus includeyellow fever virus,West Nile virus,St. Louis encephalitis virus,Japanese encephalitis

virus,tick-borne encephalitis virus,Kyasanur forest disease virus, andOmsk hemorrhagic fever virus.[12]

Most

are transmitted byarthropods(mosquitoes orticks), and are therefore also referred to

asarboviruses(arthropod-borne viruses).[12]

The dengue virusgenome(genetic material) contains about 11,000nucleotide bases, whichcodefor the three

different types of protein molecules (C, prM and E) that form thevirus particleand seven other types of protein
http://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Maculopapular_rashhttp://en.wikipedia.org/wiki/Maculopapular_rashhttp://en.wikipedia.org/wiki/Maculopapular_rashhttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Hepatic_encephalopathyhttp://en.wikipedia.org/wiki/Hepatic_encephalopathyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndromehttp://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndromehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Transmission_electron_microscopyhttp://en.wikipedia.org/wiki/Transmission_electron_microscopyhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/File:Dengue.jpghttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Nucleotide_basehttp://en.wikipedia.org/wiki/Genomehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Arbovirushttp://en.wikipedia.org/wiki/Tickhttp://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Gould-12http://en.wikipedia.org/wiki/Omsk_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Kyasanur_forest_diseasehttp://en.wikipedia.org/wiki/Tick-borne_encephalitis_virushttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/Japanese_encephalitishttp://en.wikipedia.org/wiki/St._Louis_encephalitishttp://en.wikipedia.org/wiki/West_Nile_virushttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Flavivirushttp://en.wikipedia.org/wiki/Flaviviridaehttp://en.wikipedia.org/wiki/RNA_virushttp://en.wikipedia.org/wiki/Virionhttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Transmission_electron_microscopyhttp://en.wikipedia.org/wiki/Dengue_virushttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Acute_liver_failurehttp://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndromehttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Transverse_myelitishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Hepatic_encephalopathyhttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Altered_level_of_consciousnesshttp://en.wikipedia.org/wiki/Cerebral_edemahttp://en.wikipedia.org/wiki/Fluid_overloadhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Maculopapular_rashhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Bradycardia


6/16

molecules (NS1, NS2a, NS2b, NS3, NS4a, NS4b, NS5) that are only found in infected host cells and are

required for replication of the virus.[13][14]

There are four strains of the virus, which are calledserotypes, and

these are referred to as DENV-1, DENV-2, DENV-3 and DENV-4.[2]

The distinctions between the serotypes is

based on the theirantigenicity.[15]

Transmission

The mosquitoAedes aegyptifeeding on a human host

Dengue virus is primarily transmitted byAedesmosquitoes, particularlyA. aegypti.[2]

These mosquitoes usually

live between thelatitudesof 35 North and 35 South below anelevationof 1,000 metres (3,300 ft).[2]

They

typically bite during the day, particularly in the early morning and in the evening,[16][17]

but they are able to bite

and thus spread infection at any time of day all during the year.[18]

OtherAedes species that transmit the

disease includeA. albopictus,A. polynesiensisandA. scutellaris.[2]

Humans are the primaryhostof the

virus,[2][12]

but it also circulates in nonhumanprimates.[19]

An infection can be acquired via a single bite.[20]

A

female mosquito that takes a blood meal from a person infected with dengue fever, during the initial 210 day

febrile period, becomes itself infected with the virus in the cells lining its gut.[21]

About 810 days later, the virus

spreads to other tissues including the mosquito'ssalivary glandsand is subsequently released into its saliva.

The virus seems to have no detrimental effect on the mosquito, which remains infected for life.Aedes

aegyptiprefers to lay its eggs in artificial water containers, to live in close proximity to humans, and to feed on

people rather than othervertebrates.[22]

Dengue can also be transmitted via infectedblood productsand throughorgan donation.[23][24]In countries such

asSingapore, where dengue is endemic, the risk is estimated to be between 1.6 and 6 per

10,000transfusions.[25]Vertical transmission(from mother to child) during pregnancy or at birth has been

reported.[26]

Other person-to-person modes of transmission have also been reported, but are very

unusual.[9]

The genetic variation in dengue viruses is region specific, suggestive that establishment into new

territories is relatively infrequent, despite dengue emerging in new regions in recent decades.[7]

Predisposition
http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Antigenicityhttp://en.wikipedia.org/wiki/Antigenicityhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-15http://en.wikipedia.org/wiki/Dengue_fever#cite_note-15http://en.wikipedia.org/wiki/Dengue_fever#cite_note-15http://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-16http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-16http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-16http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18http://en.wikipedia.org/wiki/Dengue_fever#cite_note-18http://en.wikipedia.org/wiki/Aedes_albopictushttp://en.wikipedia.org/wiki/Aedes_albopictushttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-19http://en.wikipedia.org/wiki/Dengue_fever#cite_note-19http://en.wikipedia.org/wiki/Dengue_fever#cite_note-19http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-21http://en.wikipedia.org/wiki/Dengue_fever#cite_note-21http://en.wikipedia.org/wiki/Dengue_fever#cite_note-21http://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-22http://en.wikipedia.org/wiki/Dengue_fever#cite_note-22http://en.wikipedia.org/wiki/Dengue_fever#cite_note-22http://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-23http://en.wikipedia.org/wiki/Dengue_fever#cite_note-23http://en.wikipedia.org/wiki/Dengue_fever#cite_note-23http://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Blood_transfusionshttp://en.wikipedia.org/wiki/Blood_transfusionshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-25http://en.wikipedia.org/wiki/Dengue_fever#cite_note-25http://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-26http://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-26http://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-26http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/wiki/File:Aedes_aegypti_biting_human.jpghttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-pmid20130380-26http://en.wikipedia.org/wiki/Vertical_transmissionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-25http://en.wikipedia.org/wiki/Blood_transfusionshttp://en.wikipedia.org/wiki/Singaporehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-23http://en.wikipedia.org/wiki/Dengue_fever#cite_note-23http://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Blood_productshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-22http://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Salivary_glandhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-21http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Yellow10-20http://en.wikipedia.org/wiki/Dengue_fever#cite_note-19http://en.wikipedia.org/wiki/Primatehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Host_(biology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Aedes_scutellarishttp://en.wikipedia.org/wiki/Aedes_polynesiensishttp://en.wikipedia.org/wiki/Aedes_albopictushttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-18http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-16http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp59-16http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Elevationhttp://en.wikipedia.org/wiki/Latitudehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Aedeshttp://en.wikipedia.org/wiki/Aedes_aegyptihttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-15http://en.wikipedia.org/wiki/Antigenicityhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Serovarhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13


7/16

Severe disease is more common in babies and young children, and in contrast to many other infections it is

more common in children that are relatively well nourished.[5]

Otherrisk factorsfor severe disease include

female sex, highbody mass index,[7]

andviral load.[27]

While each serotype can cause the full spectrum of

disease,[13]

virus strain is a risk factor.[7]

Infection with one serotype is thought to produce lifelong immunity to

that type, but only short term protection against the other three.[2][9]The risk of severe disease from secondary

infection increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3,

or if someone previously exposed to DENV-3 acquires DENV-2.[14]

Dengue can be life-threatening in people

withchronic diseasessuch asdiabetesandasthma.[14]

Polymorphisms(normal variations) in particulargeneshave been linked with an increased risk of severe

dengue complications. Examples include the genes coding for the proteins known asTNF,mannan-binding

lectin,[1]

CTLA4,TGF,[13]

DC-SIGN,PLCE1, and particularformsofhuman leukocyte antigenfrom gene

variations ofHLA-B.[7][14]

A common genetic abnormality in Africans, known asglucose-6-phosphate

dehydrogenase deficiency, appears to increase the risk.[27]Polymorphisms in the genes for thevitamin D

receptorandFcRseem to offer protection against severe disease in secondary dengue infection.[14]

Mechanism

When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's

saliva. It binds to and enterswhite blood cells, and reproduces inside the cells while they move throughout the

body. The white blood cells respond by producing a number of signaling proteins, such

ascytokinesandinterferons, which are responsible for many of the symptoms, such as the fever, the flu-like

symptoms and the severe pains. In severe infection, the virus production inside the body is greatly increased,

and many more organs (such as theliverand thebone marrow) can be affected. Fluid from the bloodstream

leaks through the wall of small blood vessels into body cavities due to capillary permeability. As a result, less

blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient

blood to vital organs. Furthermore, dysfunction of the bone marrow due to infection of thestromal cellsleads to

reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of

bleeding, the other major complication of dengue fever.[27]

Viral replication

Once inside the skin, dengue virus binds toLangerhans cells(a population ofdendritic cellsin the skin that

identifies pathogens).[27]

The virusenters the cellsthrough binding between viral proteins andmembrane

proteinson the Langerhans cell, specifically theC-type lectinscalled DC-SIGN,mannose

receptorandCLEC5A.[13]

DC-SIGN, a non-specific receptor for foreign material on dendritic cells, seems to be

the main point of entry.[14]

The dendritic cell moves to the nearestlymph node. Meanwhile, the virus genome is

translated in membrane-bound vesicles on the cell'sendoplasmic reticulum, where the cell's protein synthesis

apparatus produces new viral proteins that replicate the viral RNA and begin to form viral particles. Immature
http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Risk_factorhttp://en.wikipedia.org/wiki/Risk_factorhttp://en.wikipedia.org/wiki/Risk_factorhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Viral_loadhttp://en.wikipedia.org/wiki/Viral_loadhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Polymorphism_(biology)http://en.wikipedia.org/wiki/Polymorphism_(biology)http://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/Transforming_growth_factor_betahttp://en.wikipedia.org/wiki/Transforming_growth_factor_betahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/PLCE1http://en.wikipedia.org/wiki/PLCE1http://en.wikipedia.org/wiki/PLCE1http://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/HLA-Bhttp://en.wikipedia.org/wiki/HLA-Bhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Interferonshttp://en.wikipedia.org/wiki/Interferonshttp://en.wikipedia.org/wiki/Interferonshttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Endoplasmic_reticulumhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/CLEC5Ahttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/Mannose_receptorhttp://en.wikipedia.org/wiki/C-type_lectinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Membrane_proteinhttp://en.wikipedia.org/wiki/Receptor-mediated_endocytosishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dendritic_cellhttp://en.wikipedia.org/wiki/Langerhans_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Interferonshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Fc_receptor#Fc-gamma_receptorshttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Calcitriol_receptorhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Glucose-6-phosphate_dehydrogenase_deficiencyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/HLA-Bhttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/PLCE1http://en.wikipedia.org/wiki/DC-SIGNhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Transforming_growth_factor_betahttp://en.wikipedia.org/wiki/CTLA4http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Mannan-binding_lectinhttp://en.wikipedia.org/wiki/Tumor_necrosis_factor-alphahttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Polymorphism_(biology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Chronic_diseasehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Guzman10-14http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp14-2http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Viral_loadhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Risk_factorhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5


8/16

virus particles are transported to theGolgi apparatus, the part of the cell where some of the proteins receive

necessary sugar chains (glycoproteins). The now mature new viruses bud on the surface of the infected cell

and are released byexocytosis. They are then able to enter other white blood cells, such

asmonocytesandmacrophages.[13]

The initial reaction of infected cells is to produce interferon, acytokinethat raises a number of defenses against

viral infection through theinnate immune systemby augmenting the production of a large group of proteins

mediated by theJAK-STAT pathway. Some serotypes of dengue virus appear to have mechanisms to slow

down this process. Interferon also activates theadaptive immune system, which leads to the generation

ofantibodiesagainst the virus as well asT cellsthat directly attack any cell infected with the virus.[13]

Various

antibodies are generated; some bind closely to the viral proteins and target them forphagocytosis(ingestion

byspecialized cellsand destruction), but some bind the virus less well and appear instead to deliver the virus

into a part of the phagocytes where it is not destroyed but is able to replicate further.[13]

Severe disease

It is not entirely clear why secondary infection with a different strain of dengue virus places people at risk of

dengue hemorrhagic fever and dengue shock syndrome. The most widely accepted hypothesis is that

ofantibody-dependent enhancement(ADE). The exact mechanism behind ADE is unclear. It may be caused

by poor binding of non-neutralizing antibodies and delivery into the wrong compartment of white blood cells that

have ingested the virus for destruction.[13][14]

There is a suspicion that ADE is not the only mechanism

underlying severe dengue-related complications,[1]

and various lines of research have implied a role for T cells

and soluble factors such as cytokines and thecomplement system.[27]

Severe disease is marked by the problems of capillary permeability (an allowance of fluid and protein normally

contained within blood to pass) and disorderedblood clotting.[6][7]

These changes appear associated with a

disordered state of the endothelialglycocalyx, which acts as amolecular filterof blood components.[7]

Leaky

capillaries (and the critical phase) are thought to be caused by an immune system response.[7]

Other processes

of interest include infected cells that becomenecroticwhich affect both coagulation andfibrinolysis(the

opposing systems of blood clotting and clot degradation)and low platelets in the blood, also a factor in normal

clotting.[27]

Diagnosis

Warning signs[7][28]

Worsening abdominal pain
http://en.wikipedia.org/wiki/Golgi_apparatushttp://en.wikipedia.org/wiki/Golgi_apparatushttp://en.wikipedia.org/wiki/Golgi_apparatushttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Complement_systemhttp://en.wikipedia.org/wiki/Complement_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Glycocalyxhttp://en.wikipedia.org/wiki/Glycocalyxhttp://en.wikipedia.org/wiki/Glycocalyxhttp://en.wikipedia.org/wiki/Molecular_sievehttp://en.wikipedia.org/wiki/Molecular_sievehttp://en.wikipedia.org/wiki/Molecular_sievehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Molecular_sievehttp://en.wikipedia.org/wiki/Glycocalyxhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Dengue_fever#cite_note-India10-6http://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Martina09-27http://en.wikipedia.org/wiki/Complement_systemhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Antibody-dependent_enhancementhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Phagocytehttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/Antibodyhttp://en.wikipedia.org/wiki/Adaptive_immune_systemhttp://en.wikipedia.org/wiki/JAK-STAT_signaling_pathwayhttp://en.wikipedia.org/wiki/Innate_immune_systemhttp://en.wikipedia.org/wiki/Cytokinehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Life10-13http://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Exocytosishttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Golgi_apparatus


9/16

Ongoing vomiting

Liver enlargement

Mucosal bleeding

Highhematocritwith lowplatelets

Lethargy or restlessness

Serosaleffusions

The diagnosis of dengue is typically made clinically, on the basis of reported symptoms andphysical

examination; this applies especially in endemic areas.[1]

However, early disease can be difficult to differentiate

from otherviral infections.[5]

A probable diagnosis is based on the findings of fever plus two of the

following:nauseaand vomiting, rash, generalized pains,low white blood cell count, positivetourniquet test, or

any warning sign (see table) in someone who lives in anendemicarea.[28]

Warning signs typically occur before

the onset of severe dengue.[8]

The tourniquet test, which is particularly useful in settings where no laboratory

investigations are readily available, involves the application of ablood pressure cuffat between

thediastolicand systolic pressure for five minutes, followed by the counting of anypetechialhemorrhages; a

higher number makes a diagnosis of dengue more likely with the cut off being more than 10 to 20 per

2.5 cm2

(1 inch2).

[8][29][30]

The diagnosis should be considered in anyone who develops a fever within two weeks of being in

thetropicsorsubtropics.[7]

It can be difficult to distinguish dengue fever andchikungunya, a similar viral

infection that shares many symptoms and occurs in similar parts of the world to dengue.[9]Often, investigations

are performed to exclude other conditions that cause similar symptoms, such asmalaria,leptospirosis,viral

hemorrhagic fever,typhoid fever,meningococcal disease,measles, andinfluenza.[5][31]

The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be

followed bylow plateletsandmetabolic acidosis.[5]

A moderately elevated level

ofaminotransferase(ASTandALT) from the liver is commonly associated with low platelets and white blood

cells.[7]

In severe disease, plasma leakage results inhemoconcentration(as indicated by a risinghematocrit)

andhypoalbuminemia.[5]Pleural effusionsorascitescan be detected by physical examination when large,[5]but

the demonstration of fluid onultrasoundmay assist in the early identification of dengue shock
http://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Serosal_fluidhttp://en.wikipedia.org/wiki/Serosal_fluidhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Viral_infectionshttp://en.wikipedia.org/wiki/Viral_infectionshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Tourniquet_testhttp://en.wikipedia.org/wiki/Tourniquet_testhttp://en.wikipedia.org/wiki/Tourniquet_testhttp://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Petechialhttp://en.wikipedia.org/wiki/Petechialhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-30http://en.wikipedia.org/wiki/Dengue_fever#cite_note-30http://en.wikipedia.org/wiki/Tropicshttp://en.wikipedia.org/wiki/Tropicshttp://en.wikipedia.org/wiki/Tropicshttp://en.wikipedia.org/wiki/Subtropicshttp://en.wikipedia.org/wiki/Subtropicshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Chikungunyahttp://en.wikipedia.org/wiki/Chikungunyahttp://en.wikipedia.org/wiki/Chikungunyahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Meningococcal_diseasehttp://en.wikipedia.org/wiki/Meningococcal_diseasehttp://en.wikipedia.org/wiki/Meningococcal_diseasehttp://en.wikipedia.org/wiki/Measleshttp://en.wikipedia.org/wiki/Measleshttp://en.wikipedia.org/wiki/Measleshttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Aminotransferasehttp://en.wikipedia.org/wiki/Aminotransferasehttp://en.wikipedia.org/wiki/Aminotransferasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Alanine_transaminasehttp://en.wikipedia.org/wiki/Alanine_transaminasehttp://en.wikipedia.org/wiki/Alanine_transaminasehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Hemoconcentrationhttp://en.wikipedia.org/wiki/Hemoconcentrationhttp://en.wikipedia.org/wiki/Hemoconcentrationhttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hypoalbuminemiahttp://en.wikipedia.org/wiki/Hypoalbuminemiahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Asciteshttp://en.wikipedia.org/wiki/Asciteshttp://en.wikipedia.org/wiki/Asciteshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Asciteshttp://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Hypoalbuminemiahttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hemoconcentrationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Alanine_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aminotransferasehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Measleshttp://en.wikipedia.org/wiki/Meningococcal_diseasehttp://en.wikipedia.org/wiki/Typhoid_feverhttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Viral_hemorrhagic_feverhttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Malariahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Chen-9http://en.wikipedia.org/wiki/Chikungunyahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Subtropicshttp://en.wikipedia.org/wiki/Tropicshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-30http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Petechialhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Endemic_(epidemiology)http://en.wikipedia.org/wiki/Tourniquet_testhttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Viral_infectionshttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Serosal_fluidhttp://en.wikipedia.org/wiki/Plateletshttp://en.wikipedia.org/wiki/Hematocrit


10/16

syndrome.[1][5]

The use of ultrasound is limited by lack of availability in many settings.[1]

Dengue shock

syndrome is present ifpulse pressuredrops to 20 mm Hg along with peripheral vascular

collapse.[7]

Peripheral vascular collapse is determined in children via delayedcapillary refill, rapid heart rate, or

cold extremities.[8]

Classification

TheWorld Health Organization's 2009 classification divides dengue fever into two groups: uncomplicated and

severe.[1][28]This replaces the 1997 WHO classification, which needed to be simplified as it had been found to

be too restrictive, though the older classification is still widely used[28]

including by the World Health

Organization's Regional Office for South-East Asia as of 2011.[32]

Severe dengue is defined as that associated

with severe bleeding, severe organ dysfunction, or severe plasma leakage while all other cases are

uncomplicated.[28]

The 1997 classification divided dengue into undifferentiated fever, dengue fever, and dengue

hemorrhagic fever.[5][33]

Dengue hemorrhagic fever was subdivided further into grades IIV. Grade I is the

presence only of easy bruising or a positive tourniquet test in someone with fever, grade II is the presence of

spontaneous bleeding into the skin and elsewhere, grade III is the clinical evidence of shock, and grade IV is

shock so severe that blood pressure andpulsecannot be detected.[33]

Grades III and IV are referred to as

"dengue shock syndrome".[28][33]

Laboratory tests

When laboratory tests for dengue fever become positive where day zero is the start of symptoms, 1st refers to in those with

a primary infection, and 2nd refers to in those with a secondary infection.[7]

The diagnosis of dengue fever may be confirmed by microbiological laboratory testing.[28][34]

This can be done

by virus isolation incell cultures,nucleic acid detectionbyPCR, viralantigendetection (such as forNS1) or

specificantibodies(serology).[14][31]Virus isolation and nucleic acid detection are more accurate than antigen

detection, but these tests are not widely available due to their greater cost.[31]

Detection of NS1 during the

febrile phase of a primary infection may be greater than 90% however is only 6080% in subsequent

infections.[7]

All tests may be negative in the early stages of the disease.[5][14]

PCR and viral antigen detection

are more accurate in the first seven days.[7]

In 2012 a PCR test was introduced that can run on equipment used

to diagnose influenza; this is likely to improve access to PCR-based diagnosis.[35]
http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Pulse_pressurehttp://en.wikipedia.org/wiki/Pulse_pressurehttp://en.wikipedia.org/wiki/Pulse_pressurehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp25-8http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-White10-1http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-32http://en.wikipedia.org/wiki/Dengue_fever#cite_note-32http://en.wikipedia.org/wiki/Dengue_fever#cite_note-32http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Dengue_fever#cite_note-Peads10-5http://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHO97-33http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHO97-33http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHO97-33http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-NEJM2012-7http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikipedia.org/wiki/Dengue_fever#cite_note-WHOp10-28http://en.wikiped

Documents

Dengue Fever 3