Dengue might be under-recognized in the U.S., and clinicians should request diagnostic testing of suspected dengue cases and report confirmed cases to state and local health departments, according to the CDC.
A report in the Jan. 24 issue of the Morbidity and Mortality Weekly Report describes a woman who lived in Texas and was infected with dengue virus after traveling to New Mexico in 2012. She died from a rare complication of dengue called hemophagocytic lymphohistiocytosis.
Approximately 95% of persons with dengue will experience an acute febrile illness without clinically significant hemorrhage or plasma leakage, the authors wrote. Because of nonspecific signs and symptoms, such cases can be misdiagnosed as influenza, West Nile Virus infection or another common acute febrile illness.
Although the patient described in this report initially received a diagnosis of WNV infection because of a weakly positive serologic test result, the result likely was produced by cross-reactive anti-dengue virus immunoglobulin M antibody.
Clinicians should be aware of this possible cross-reaction when evaluating patients with suspected WNV infection, especially those with recent travel to the tropics. Physicians and public health professionals in the United States should be vigilant for dengue, particularly in the context of ongoing WNV outbreaks and where competent dengue-virus vectors (e.g. Aedes aegypti and Aedes albopictus mosquitos) are present.
This case may suggest that there are more unrecognized cases of dengue in the United States, according to the authors. Although dengue outbreaks recently have occurred in Florida, Texas and Hawaii, the largest disease burden in the U.S. will continue to be in travelers, according to the CDC. Individuals who travel to areas where dengue is common should protect themselves from mosquito bites to reduce their risk of infection.
Clinicians in the United States should be aware of dengue and request diagnostic testing that includes both molecular and serologic diagnostics for patients with dengue-like symptoms, the authors wrote. Competent dengue-virus vectors are present in most states, and importation of dengue virus via travelers has resulted in recent dengue outbreaks in Florida, Hawaii and Texas. All suspected dengue cases should be reported to state and local health departments.