Abstract
Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early case identification and timely initiation of treatment for patients with severe dengue can reduce medical complications and mortality. To determine clinical management and reporting practices, and assess knowledge of dengue and its management, a survey was sent to 2,512 physicians with a medical license in Puerto Rico. Of the 2,313 physicians who received the survey, 817 (35%) completed the questionnaire. Of the respondents, 708 were currently practicing medicine; 138 were board certified (Group 1), 282 were board eligible (Group 2), and 288 had not finished residency (Group 3). Although respondents clinically diagnosed, on average, 12 cases of dengue in the preceding three months, 31% did not report any suspected cases to public health officials while about half (56%) reported all cases. Overall, 29% of respondents correctly identified early signs of shock and 48% identified severe abdominal pain and persistent vomiting as warning signs for severe dengue with the proportion of correct respondents highest in Group 1. Reportedly about sixty percent (57%) appropriately never give corticosteroids or prophylactic platelet transfusions to dengue patients. One third (30%) of respondents correctly identified administration of intravenous colloid solution as the best treatment option for dengue patients with refractory shock and elevated hematocrit after an initial trial of intravenous crystalloids, and nearly one half (46%) correctly identified administration of a blood transfusion as the best option for dengue patients with refractory shock and decreased hematocrit after a trial of intravenous crystalloids. Even though dengue has been endemic in Puerto Rico for nearly 4 decades, knowledge of dengue management is still limited, compliance with WHO treatment guidelines is suboptimal, and underreporting is significant. These findings were used to design a post graduate training course to improve the clinical management of dengue.
Highlights
Dengue is a mosquito-borne disease caused by any one of four dengue virus (DENV) types -1, -2, -3, and -4
In 2007, there were 8,051 physicians residing in Puerto Rico who had a Drug Enforcement Administration (DEA) number and active license to practice medicine in Puerto Rico, according to the Puerto Rico Department of Health (PRDH) (Figure 1)
The remaining 5,997 physicians consisted of 5,635 generalists involved in primary and emergency care of dengue patients and 362 specialists, most notably cardiologist and pulmonologists who are most likely to work in intensive care units in Puerto Rico, and intensive care physicians
Summary
Dengue is a mosquito-borne disease caused by any one of four dengue virus (DENV) types -1, -2, -3, and -4. Each DENV is capable of causing the full spectrum of disease from an asymptomatic infection to severe, life-threatening illness including dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) [1]. There is currently no vaccine available to prevent dengue and vector control measures to prevent DENV transmission have not been sustainable or effective [2,3]. Once a person has dengue, there is no licensed antiviral medication to treat or prevent severe manifestations of the disease. Implementation of other secondary prevention measures including timely identification of dengue cases and initiation of intensive supportive treatment can reduce case fatality rates from 10% to less than 1% among severe cases [4,5,6,7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
