Clinical Review

Diagnosis and management of dengue

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b4338 (Published 18 November 2009) Cite this as: BMJ 2009;339:b4338
  1. Maria Glória Teixeira, associate professor of epidemiology and public health, and infectious diseases doctor ,
  2. Mauricio L Barreto, professor of epidemiology
  1. 1Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama s/n, Canela, 40110-040 Salvador, Bahia, Brazil
  1. Correspondence to: M G Teixeira magloria{at}ufba.br

    Summary points

    • Dengue affects over 70 countries in four continents and results in about 22 000 deaths annually

    • Prompt, adequate clinical management reduces deaths from dengue haemorrhagic fever

    • Diagnostic testing for the detection of the NS1 antigen facilitates the diagnosis of dengue in patients with fever

    • During an epidemic, additional resources and procedures are needed to enable people with fever to access health care easily, otherwise the care of routine patients will be affected

    Dengue has been reported in almost 70 countries, with about five million cases reported between 2000 and 2007 (figs 1 and 2).1 In 2002, at the peak of the current pandemic, over 1.2 million cases were reported worldwide. Until the end of the 1980s South East Asia and the Western Pacific region were the regions most affected by dengue. In recent years, however, the incidence of dengue has increased in the Central and South America region, which now accounts for 70% of all cases reported worldwide. Mortality from dengue has varied greatly across countries, but the World Health Organization estimates that about 22 000 deaths are associated with dengue every year.1 2 Despite efforts to control the main vector (the mosquito Aedes aegypti), the incidence of the disease has not shown any tendency to decrease.

    Presence of dengue worldwide and areas infested by the main vector, Aedes aegypti

    Number of cases and notifying countries affected, 1955-2005

    Dengue is predominantly a childhood disease in South East Asia but an adult disease in most North and South American countries.3 4 However, since 2007, Brazil (the country responsible for more than 70% of cases of dengue in the Americas) has experienced an unexpected increase in the incidence of the disease in people aged under 15 years.4 5

    This article reviews the diagnosis and treatment of dengue …

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