Dengue

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CliniCal Review

Diagnosis and management of dengue
Maria Glória Teixeira, Mauricio L Barreto

Instituto de Saúde Coletiva, FederalUniversity of Bahia, Rua Basílio
da Gama s/n, Canela, 40110-040
Salvador, Bahia, Brazil
Correspondence to: M G Teixeira
magloria@ufba.br
Cite this as: BMJ 2009;339:b4338
doi: 10.1136/bmj.b4338Dengue 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 werereported
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 hasincreased 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
Organizationestimates 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 anytendency
to decrease.
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,

Box 1 | WHO’s casedefinitions for dengue fever 9
Probable case
An acute febrile illness with two or more of the following manifestations:
• Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagicmanifestations,
leucopenia; plus
Supportive serology test results (a reciprocal haemagglutination-inhibition antibody titre
≥1280, a comparable IgG enzyme linked immunosorbent assay (ELISA) titre or apositive
IgM antibody test on a late acute or convalescent-phase serum specimen); or
Occurrence at the same location and time as other confirmed cases of dengue fever
Confirmed case
• A case...