sign in sign up
<<
Home , Dengue fever

Communicable Diseases Communiqué NOVEMBER 2015, Vol. 14(11)

1 ZOONOTIC AND -BORNE DISEASES

a Dengue in returned travellers

In recent years there has been a dramatic increase she consulted her general practitioner who in the prevalence of dengue in observed a fine petechial over her lower legs. countries. This has resulted in more cases amongst Blood tests revealed (28 x 109/L) travellers returning home from the dengue-endemic and elevated transaminases (ALT 181 IU/L, AST regions: South-East Asia, the Western Pacific, the 292 IU/L). A diagnosis of dengue fever was made Americas (Central and the northern parts of South by RT-PCR and serology. America), Central, West and East Africa and the Eastern Mediterranean. The NICD has documented 4) A 10-year-old girl returned from 10 days 17 laboratory-confirmed dengue cases up to and prior to onset of symptoms which included high including October during 2015. All cases were fever, and rash. Blood collected three amongst travellers returning from known dengue- days after onset of illness tested positive for dengue endemic countries, including Thailand, India, by RT-PCR. , Papua New Guinea and Uganda. In The of fever in a traveller October 2015, acute dengue was returning from Asia, South- and Central America, confirmed in four travellers returning to South West, Central and East Africa includes , Africa from Papua New Guinea, India and Thailand. dengue, hepatitis A, , invasive bacterial We describe these four cases, all of whom diarrhoea, rickettsial , or causes not recovered without . related to travel. The typical clinical presentation in uncomplicated dengue includes fever, severe 1) A 27-year-old man from Gauteng became ill after headache, pain behind the eyes, muscle and joint visiting Papua New Guinea in mid-October 2015. He pains, , , swollen glands and a reported an -like illness and skin rash. . The NICD provides laboratory Blood tests demonstrated a thrombocytopenia (128 diagnostics for dengue. The timing of sample x109/L and leucopenia (0.5 x 109/L). Negative collection after disease onset is important for the smear, and PCR tests excluded malaria as a interpretation of laboratory results. The presence of diagnosis. Blood collected three days after symptom dengue is consistent with acute-phase onset tested positive by RT-PCR for dengue, infection and is typically detectable within 1 to 2 confirming an acute dengue infection. days following infection and up to 9 days after disease onset. to the may 2) A 39-year-old female South African traveller be detected by day 3 – 7 after symptom onset. If returned from Thailand on 17 October 2015 and initial tests are negative, a convalescent developed fever, headache, photophobia, severe blood sample with the second specimen collected lower back and joint pain. The patient presented two weeks after the acute phase of infection will demonstrate seroconversion. Serology may be with a macular rash on the face and body. She was useful if blood was not collected during the viremic admitted to a Cape Town hospital on 22 October (acute) phase of infection. 2015. Abnormal blood findings included leucopenia 9 (3.5 x 10 /L) and elevated transaminases (ALT At a public health level, viraemic travellers returning 280 IU/L) on admission. Blood collected on day five from endemic areas present a risk of introducing post-onset (24 October) tested positive by RT-PCR, dengue into non-endemic countries where the confirming acute dengue fever. specific vectors are present. While dengue is not found in South Africa, the vector of 3) A 62-year-old female spent two weeks in India’s dengue fever, aegypti is present in certain westernmost state Gujarat, visiting her relatives in regions of South Africa, namely the KwaZulu-Natal the cities of Vadodara and Surat. On her way from coastline. Vadodara to Mumbai she experienced a single febrile episode, followed by weakness, nausea, gastric distress, and mild muscle pain. She was Source: Centre for Emerging and Zoonotic Diseases, given antibiotics (ofloxacin) and stayed in a hotel in NICD-NHLS Mumbai to recover before returning to South Africa. Upon arrival in East London on 29 October 2015,

1