Case Report

Dengue First Case Diagnosed in our Hospital

Carlos Al Sánchez Salguero*
Department of Pediatric Allergy Unit, University Hospital Puerto Real, Spain

*Corresponding author: Carlos Al Sánchez Salguero, Department of Pediatric Allergy Unit, University Hospital Puerto Real, Carretera Nacional IV, Km. 665, Puerto Real, Cádiz, 11510, Spain


Published: 03 Feb, 2017
Cite this article as: Salguero CAS. Dengue First Case Diagnosed in our Hospital. Ann Clin Case Rep. 2017; 2: 1255.

Abstract

Patient 7 years admitted with suspected Dengue Fever. Fever ten days of evolution, accompanied by anorexia, oppressive frontal headache, maculopapular rash, coinciding with the day of high fever, malaise, generalized weakness, and abdominal pain. Scanning devices without pathological findings systems. As background refer a trip to Brazil for a month and a half and coexistence with people diagnosed with dengue. The diagnosis confirmation was performed by PCR and serology (IgM and IgG) positive for dengue virus in two determinations.

Keywords: Dengue fever; Dengue hemorrhagic; Flaviviridae; Arbovirus; Imported diseases; International travel

Introduction

Dengue fever is caused by an arbovirus (Family Flavoviridae) (Figure 1) with 4 subtypes that do not induce cross-resistance between them. It is transmitted in the field domestic, person to person, through the female mosquito Aedes aegypti (primary vector) and Aedes albopictus (secondary vector) (Figure 2) [1].
It is endemic to urban, suburban and rural areas of tropical and subtropical areas of Central and South America, the Mediterranean, Southeast Asia and Western Pacific [2]. Currently, is a public health problem, by which infected annually 5.5% of the world population [3]. Cases diagnosed in our country are imported, but indigenous cases have been reported in European countries like Portugal and France [4].

Case Presentation

We report the case of a 7 year old boy who was admitted to the Infectious Diseases of our hospital for suspected dengue fever. Refer fever ten days of evolution is accompanied by oppressive frontal headache intermittent, evanescent maculopapular rash, anorexia, malaise, increased weakness in the last 48 hours and diffuse abdominal pain. As background refer stay in Brazil about forty days, where he has lived with people diagnosed with Dengue ago. Prior to the trip was vaccinated for yellow fever.
CBC: with prolonged in a patient who has traveled to an endemic country febrile syndrome the following additional tests were requested mild leukopenia; VSG, biochemistry, normal clotting; negative blood culture; normal urinary sediment and urine culture; PCR positive in two dengue virus determinations and serology for dengue virus, obtaining in the first determination (1st day of admission) negative IgM positive IgG; in the second determination (within 10 days of the first sample), IgM and IgG positive.
Patient outcome was favorable, no complications, and was treated with paracetamol and drip intravenous hydration.

Figure 1

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Figure 1
Dengue virus.

Figure 2

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Figure 2
Aedes Aegypti.

Discussion

The case presented is a serious primary infection of Dengue imported, the diagnosis was guided by the journey and history of epidemiological environment, but we believe important to remember that we should think of this disease in a patient with fever in the first 14 days after returning from a country endemic. The incubation period of the disease is between 3-14 days. The first infection will manifest as nonspecific febrile illness (80-90%) or classic dengue.
Reinfection with another strain can cause bleeding / hemodynamic disorders [5]. The classic dengue is characterized by high fever (40-41°C), frontal headache, retro-orbital pain / arthralgia pain, nausea / vomiting, maculopapular rash. In the convalescent weakness, malaise, anorexia, peeling palms and soles appears. In the investigations is lymphocytosis with neutropenia and leucopenia, thrombocytopenia and elevated transaminases [5].
Our patient had six of the above symptoms (fever, headache, muscle pain, rash, malaise and anorexia) with leukopenia confirmed by peripheral blood smear. Dengue hemorrhagic, has a mortality of 40%. The initial picture is similar to the classic Dengue, accompanied by hemorrhagic manifestations (digestive, skin, epistaxis), thrombocytopenia 20 mmHg), coldness, or mental disorder), than it is called as Dengue Shock [6]. Diagnosis of the disease is established through PCR and serology Dengue virus. Diagnosis depends PCR viral load and time elapsed [7]. During first 5-7 days of fever viremia exists therefore be PCR positive (100%). The probability of finding a positive PCR, after more than 24 hours without fever, drops to 0-20% 8. We believe that our case is interesting because two positive PCR determinations were obtained despite the patient had 10 days of disease evolution.
Serology by detection of specific antibodies is possible from 5th day two blood samples, taken at 0-4 days are necessary disease and 10-21 days for the final serological diagnosis, IgM seroconversion [8,9]. They have been described with other Flavivirus cross (Yellow fever patients vaccinated) reactions, so it is possible to find an early stage positive IgG IgM negative even [9,10].
In our case we got a first negative serologic determination IgM and IgG positive, and a second (10 days) with IgM and IgG positive, which can be explained by the above. The diagnostic criteria for the disease are divided into epidemiological (case confirmed in the area), clinical (fever, headache, retro-ocular pain, decay, myalgia, arthralgia, abdominal pain, maculopapular rash, slight haemorrhaging skin and mucous membranes) and laboratory (leucopenia prone lymphocytosis, normal platelets or decreased, normal hematocrit, normal) clotting [5,6,11]. With these criteria can differentiate between probable case (fever, two or more compatible clinical and epidemiological situation), confirmed case (Probable case with laboratory findings compatible), and diagnostic certainty (there is confirmation microbiological tests) as in our case [5,6,11]. There is no specific treatment of the disease, being this support with hydration and antipyretics. NSAIDs should not be administered as they can aggravate bleeding disorder [6]. In the case of hemorrhagic dengue / dengue shock hemodynamic support it will be held in a pediatric ICU [5].
There is currently no vaccination against Dengue virus. Primary prophylaxis is to avoid mosquito bites by using repellents containing N, N-dyethylmetatoluamida (DEET) to 40% (should not be used in children under 2 months) or picaridin, mosquito nets, clothing that covers the entire body and greater prevention new bites following first episode [11,12]. In countries where the disease is prevalent vital outbreak control and crossing data for better management and prevention of the spread of the disease [11].

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