**vector**: aedes mosquitoes ; especially A aegypti, als A albopictus and A. polynesiensis **region**: north QLD, Tropical and subtropical **virus**: RNA flavivirus (Dengue fever virus) # Signs and symptoms - acute febrile illness (3-14 days incubation) - many cases are asymptomatic or mild, some severe - general symptoms: - retroorbital headache - malaise - severe myalgia - arthralgias - rash - nausea/vomiting - specific / severe symptoms: - *haemorrhage* (dengue haemorrhagic fever) - petechiae - *shock* (dengue shock syndrome **Three phases:** 1. Febrile phase 1. fever, headache, myalgias, *petechiae*, easy bruising, epistaxis, mucosal bleeding 2. **positive tournequet test** 2. ==Critical Phase== after fever breaks 1. GI haemorrhage 2. plasma leakage into chest and peritoneal cavities 3. abdo pain, ascites, dysponea 4. need fluids 3. Recovery phase 1. begin to feel better as capillary leakage stops ## features of haemorrhagic fever - mucosal or GIT bleeding (haematemesis or malena) - [[Petechiae]]/eccymosis/ purpura - positive tourniquet test - hepatomegaly or jaundice - signs of plasma leakage (ascites, pleural effusion, oedmea) - haemodynamic compromise and shock # testing - bloods show leukopenia and thrombocytopaenia - hepatitis is common - increased haematocrit and decreased albumin suggest capillary leakage and impending shock - IgM and IgG serology and PCR testing availble # Management - supportive - paracetamol - avoid NSAIDs (secondary thrombocytopaenia) - IVF and bloods if progresses to critical phase