Abstract
Reported cases of dengue are rising in South Australia (SA) in travellers returning from dengue-endemic regions. We have undertaken a retrospective analysis to identify the clinical and laboratory characteristics of patients returning to SA with suspected dengue virus (DENV) infection. From 488 requests, 49 (10%) were defined by serology as acute dengue, with the majority of patients (75%) testing as non-structural protein 1 (NS1) and/or IgM positive. Dengue was most commonly acquired in Indonesia (42.9%) with clinical features of fever (95%), headache (41%) and myalgia/arthralgia (56%). The presence of rash (36%) and laboratory findings of neutropenia, leukopenia, thrombocytopenia, but not elevated C-reactive protein, were distinct from findings in DENV-seronegative patients. Available dengue seropositive samples were analysed by RT-PCR, with 14/32 (43.8%) positive by a serotype non-specific DENV assay, but 28/32 positive (87.5%) when also assessed by serotype-specific RT-PCR. Serotype analysis revealed the predominance of DENV-1 and DENV-2 and the presence of DENV-3, but not DENV-4 or Zika virus (ZIKV). Thus, dengue in returned travellers in SA presents in a manner consistent with World Health Organization (WHO) definitions, with symptoms, travel history and laboratory results useful in prioritising the likelihood of dengue. This definition will assist the future management in DENV-non-endemic regions, such as SA.
Highlights
Dengue is a mosquito-borne disease caused by four serotypes of dengue virus (DENV-1, DENV-2, DENV-3 and DENV-4), belonging to the Flavivirus genus
From 488 requests for DENV diagnostic testing processed between 1 January 2014 and 31 January 2015, 55 tests returned a positive result for at least one of IgG, IgM or non-structural protein 1 (NS1) (Table 2)
A single patient with no acute symptoms of dengue returned a positive test for DENV IgG only, on the background of a known previous DENV infection, and was excluded from the DENV-seropositive group
Summary
Dengue is a mosquito-borne disease caused by four serotypes of dengue virus (DENV-1, DENV-2, DENV-3 and DENV-4), belonging to the Flavivirus genus. The incidence of dengue has increased thirtyfold in the past 50 years, and the approximately 75% of the global population living within the Asia-Pacific region are potentially exposed to DENV [3,4]. The increase in global DENV incidence has been reflected in the trends in diagnosis of infections in travellers returning to Australia over the past decade [5]. The increased incidence of dengue in Australia, in the context of increased international travel to dengue-endemic areas, has made it essential for Australian doctors to be able to recognise and manage dengue, and differentiate DENV infection from other mosquito-borne travel-associated diseases with similar clinical presentations including malaria, yellow fever, chikungunya and more recently, Zika virus (ZIKV) [6,7]
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