ACEP News - June 2008 - (Page 17)

JUNE 2008 • ACEP NEWS CONTINUING MEDICAL EDUCATION Focus B Y J O S É G. C A B A Ñ A S, M . D. , A N D J O R G E FA L C Ó N C H E V E R E , M . D. On Dengue Fever engue fever is a common, worldwide, acute viral illness. The infection typically presents as a severe flu-like illness and may affect children and adults. It is usually a nonfatal disease, but it may progress to a severe form know as dengue hemorrhagic fever (DHF). It is well known that the disease is transmitted through the bite of infected mosquitoes of the genus Aedes. Dengue is common in, but not exclusive to, tropical areas. The disease may be seen in subtropical territories as well. The World Health Organization (WHO) considers dengue a major international health threat. The ongoing impact is staggering. It is estimated that there are more than 100 million cases of dengue worldwide every year.1 In recent decades, dengue has become a growing world pandemic. Currently, 2.5 billion people around the world live in areas at risk of the disease.2 There have been several reported epidemics of dengue fever in the Caribbean, Asia, and North and South America. Because the disease is present all over the world, it is possible that travelers may come to the United States from places where there is a dengue epidemic. Emergency physicians must be able to recognize dengue and understand the clinical strategies to treat it. What is Dengue? Dengue fever is an arboviral illness. The disease, also known as “breakbone” fever, is transmitted by infected mosquitoes and characterized by several major clinical manifestations: high fever, rash, retro-orbital headache, joint pain, and back pain. Dengue is among the most important globally re-emerging infectious diseases.3 The disease is caused by four virus serotypes (DEN-1, DEN-2, DEN-3, or DEN-4). Aedes aegypti is the traditional Criteria for Dengue Hemorrhagic Fever The following must all be present: Fever, or history of acute fever, lasting 2-7 days, occasionally biphasic. Hemorrhagic tendencies, evidenced by at least one of the following: – A positive tourniquet test. – Petechiae, ecchymoses, or purpura. – Bleeding from the mucosa, gastrointestinal tract, injection sites, or other locations. – Melena or hematemesis. Thrombocytopenia ( 20% above average for age, sex, of rashes, including a maculopapular monitored if dengue fever is suspected. and population. type. Patients may also have petechiae Monitoring should start after the third – A decrease in the hematocrit and conjunctival and pharyngeal infecday of illness and continue until the following volume replacement tion. Clinically, patients may be dehytreatment > 20% of baseline. drated and febrile. During initial evalu- second day after resolution of fever. If improvement is documented and no – Signs of plasma leakage such as ation, a complete blood count should complications are evident, monitoring pleural effusion, ascites, and be performed, with special attention can be done in an outpatient setting. hypoproteinemia. given to platelets, hematocrit, and When moderate to severe dehydrawhite blood cells. A hematocrit level eltion and hemoconcentration (defined evated more than 20% above normal Source: World Health Organization suggests hemoconcentration, especially Continued on following page Learning Objectives

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ACEP News - June 2008 Contents News - Time to Move Tricks of the Trade - Revealing Tips Focus On - Dengue Fever Practice Trends - EMTALA Results

ACEP News - June 2008

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