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Annelies Wilder Smith, Paul Ananth Tambyah, Severe Dengue Virus Infection in Travelers, The Journal of Infectious Diseases, Volume 195, Issue 8, 15 April 2007, Pages 1081–1083, https://doi.org/10.1086/512684
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Dengue has become one of the most important emerging disease problemsamong international travelers [1]. This comes as no surprise, because dengue is now the most common arboviral disease in the tropics and subtropics—areas that have become popular tourist destinations. In some case series, dengue is the second most frequent cause of hospitalization (after malaria) among travelers returning from the tropics [2]. GeoSentinel is a global provider-based surveillance network of travel medicine providers (available at: http://www.istm.org/geosentinel/main.html); in its most recent update, dengue was the most frequent cause of systemic febrile illness in travelers to Asia [3].
TheWorld Health Organization (WHO) classifies symptomatic dengue virus infections into 3 categories: undifferentiated fever, classic dengue fever, and dengue hemorrhagic fever (DHF) (figure 1) [4]. Dengue fever is defined clinically as an acute febrile illness with ⩾2 manifestations (headache, retroorbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, or leukopenia). DHF is defined by 4 criteria: (1) fever or history of fever lasting 2–7 days, (2) a hemorrhagic tendency shown by a positive tourniquet test or spontaneous bleeding, (3) thrombocytopenia (platelet count ⩽100 × 109 cells/L), and (4) evidence of plasma leakage shown either by hemoconcentration with substantial changes in serial measurements of packed-cell volume (hematocrit) or by the development of pleural effusions or ascites; or both. Hemorrhagic manifestations without capillary leakage do not constitute DHF. The term “dengue shock syndrome” (DSS) refers to a condition in which shock is present as well as all 4 DHF-defining criteria.
