DENGUE

In a recent issue of annals of emergency medicine a french group in Martinique has reviewed the symtoms of patients with dengue fever on arrival to the ED. It seems to be endemic over there so the authors can present data from a large series of 715 patients who presented with febrile illness and a serologically confirmed diagnosis of dengue fever.

Results
The results are in the tables on the right. It confirms what we know, or should know, dengue fever is the dog’s breakfast.

It is an imitator disease, with a wide range of clinical presentations with vague symptoms that can easily be misinterpreted for one of many less serious infections like the flu, common gastroenteritis etc.

The results also remind us that a significant part of these patients become really sick really fast, with a significant mortality.

With more people travelling in parts of the world where dengue is common we should probably expect to see more of them in western EDs.

Own experience
One of the most dramatic presentations of fulminant critical illness I have ever witnessed was the one middle-aged lady who developed dengue shock syndrome in our northern european ED.

She walked into the ED with common flu-like symtoms and was triaged to the crowded waiting room. After 15 minutes she collapsed in her chair. After another 15 minutes she was in the resus bay with full-on hemorrhagic shock with petechiae and profuse bleeding everywhere. She was remarkably resistant to any shock resuscitation we could provide and was dead within two hours after registering in the ED.

Only afterwards did someone pick up on the info that she had recently come back from Thailand, to where she travelled several times per year. The dengue diagnosis was confirmed by serology post mortem.

Shock and awe.

The study is here.

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