ABSTRACT
BACKGROUND Dengue fever (DF) is an acute Flavivirus infection transmitted by several species of Aedes mosquitoes. Dengue virus (DENV) has four antigenically related serotypes, DENV-1, DENV-2, DENV-3, and DENV-4. Infection with any one of the four serotypes can produce a broad spectrum of clinical illness, including asymptomatic infection, mild febrile illness, classic DF, and dengue hemorrhagic fever (DHF) including dengue shock syndrome (DSS). DENV most often produces a self-limited, febrile illness, DF, which is characterized by fever, headache, eye pain, myalgia, arthralgia, and rash. In its most severe form, DENV infection can lead to DHF/DSS, which can rapidly progress to death. Fatality rates in patients with severe dengue vary from less than 1% to more than 30%, depending on diagnostic acumen and availability of intravenous fluids and blood for treatment of hypovolemic shock caused by plasma leakage and hemorrhage (1). These dangerous forms of the disease occur in an estimated 5% to 10% of dengue patients, and children are particularly at risk in countries with endemic circulation of multiple DENV serotypes. Patients with severe dengue require hospitalization, and 30% to 40% of such children progress to DSS. Lifelong immunity to the infecting DENV serotype occurs among those who recover from the infection.
