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Six male volunteers, previously immunized with yellow fever vaccine, were inoculated subcutaneously with a live, attenuated dengue-2 virus (PR-159/S-1) candidate vaccine. Five recipients developed viremia 8 or 9 days after vaccination, which lasted 1 to 10 days. The onset of viremia was followed by fever in three people, transient leukopenia in four, and an erythematous rash in one. One volunteer developed an oral temperature of 38.8 degrees C with headache, myalgia, fatigue, and photophobia suggestive of mild dengue fever. All five viremic volunteers developed fourfold or greater rises in serum neutralizing antibody. The sixth volunteer, who had a low titer of preexisting dengue-2 neutralizing antibody, had no viremia, no symptoms, and a modest rise in hemagglutination inhibiting antibody. Virus isolates obtained from plasma retained the small-plaque and temperature-sensitive growth characteristics of the vaccine virus in vitro. In this study, the vaccine virus genetically stable and immunogenic and seemed sufficiently attenuated for additional testing in humans.
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PMID:Dengue-2 vaccine: virological, immunological, and clinical responses of six yellow fever-immune recipients. 721 69

The authors investigated the role of secondary immunologic response, virus serotype, age, and sex on the clinical manifestations of dengue fever in Puerto Rico. From surveillance data for 1990 and 1991, this study identified 3,926 laboratory-positive cases, including 889 for whom dengue immunologic status and symptoms could be ascertained. Of those, 622 cases were virologically confirmed, and 267 cases were serologically confirmed. More than 50% of all positive patients reported fever, chills, headache, eye pain, body pains, joint pains, nausea, vomiting, or skin rash. The frequency of reporting signs, symptoms, and hospitalization was significantly higher among persons with secondary infections diagnosed by serological methods. Only rash was more common among those with primary infections. Symptom reporting increased with age; body pains, joint pains, and rash were significantly more frequently reported by female patients. No significant difference in symptom frequency was found among the virologically confirmed cases, comparing primary and secondary cases or infections due to different serotypes. The data for serologically confirmed cases suggest that in Puerto Rico the manifestations of dengue fever are, as with dengue hemorrhagic fever in Asia, more prominent among those who are experiencing secondary infections, and this effect may be more marked in the younger age groups.
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PMID:Symptoms of dengue fever in relation to host immunologic response and virus serotype, Puerto Rico, 1990-1991. 748 67

A virological investigation was carried out to establish the etiologic agent of a febrile outbreak amongst a floating population of C.R.P.F. Jawans, stationed at Calcutta during May-July, 1993. The illness was associated with fever, severe headache, bodyache and arthralgia which lasted for 2-4 days in most of the cases. Fifty cases were examined clinically and blood samples (both acute and convalescent) were subjected to virological study. One mouse-pathogenic agent could be isolated in suckling mice and identified as DEN-3. Sero-investigation of 50 single sera by HI & CF method revealed evidence of presumptive dengue infection in 33, while sero-conversion could be noted in 10 out of 25 available paired sera tested. Results of MAC ELISA revealed evidence of primary dengue infection in 6 out of 12 acute phase sera examined. Thus, the study shows that the episode is strongly suggestive of primary dengue infection.
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PMID:Febrile episode among a floating population of C.R.P.F. Jawans stationed at Calcutta. 749 75

Dengue fever is a viral disease, transmitted to man via mosquito bites. It is endemic in tropical regions (10 million infected annually) and is characterized by high fever, headache, myalgia, lethargy, vomiting, rash and neutropenia. The upward trend in the number of young Israelis visiting tropical countries increases the number of those potentially exposed to this disease. We present 4 Israelis who returned with dengue fever from Thailand.
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PMID:[Dengue fever]. 755 5

Researchers reviewed the medical records of all cases of dengue and dengue-like illness in Fiji since 1971. During March-April 1990, in Fiji, interviews were conducted with 426 occupants of 81 randomly selected houses in Suva and its surrounding areas to examine the relationship between the incidence of true dengue and dengue-like illnesses and the reported incidence. 60% of the persons interviewed were Fijians and 31% were Indians. Health workers collected blood samples from acute cases. 36 strains of dengue 1 virus was isolated. A fever lasting more than 3 days accompanied by at least one of the following symptoms denoted dengue or dengue-like illness: headache, joint pains, muscle pains, rash, epigastric discomfort, and bleeding. There was an outbreak of clinical dengue 1 during 1989-1990 involving 3686 cases. The 1975 outbreak involved 1600-2400 cases of dengue hemorrhagic fever. The 1989-1990 incidence was higher among Fijians than Indians (60% vs. 37%). The dengue epidemic peaked in November 1989 (about 900 cases). The rate of dengue hemorrhagic fever was 8% (15 cases). Hemorrhage manifestations included nosebleeds (8 persons), gingival bleeding (2), vomiting of blood (2), blood in the urine (3), and passage of dark stools stained with blood (3). The case fatality rate was 8%. Hemorrhages of the stomach and lungs occurred in most fatal cases. 10 of the 15 fatal cases were aged 10-15 years. 182 (43%) of the respondents in the household survey had reported dengue-like illness in the last 6 months. Children were more likely to have had dengue than adults (51% of 0-9 year olds and 61% of 10-19 year olds vs. 32-33% for all other age groups). Among hospitalized dengue cases, 43% experienced hemorrhages.
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PMID:Dengue type 1 epidemic with haemorrhagic manifestations in Fiji, 1989-90. 761 60

Dengue is a mosquito-transmitted acute disease caused by any of four virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) and characterized by the sudden onset of fever, headache, myalgia, rash, nausea, and vomiting. The disease is endemic in most tropical areas of the world and has occurred in U.S. residents returning from travel to such areas. This report summarizes information about cases of imported dengue among U.S. residents during 1993 and 1994.
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PMID:Imported dengue--United States, 1993-1994. 773 51

Dengue is an important insect-borne viral disease, transmitted in the Western hemisphere by the A. aegypti mosquito. It is endemic in the Caribbean with sporadic outbreaks in different regions. Cases in the United States are mostly imported cases but can be seen in the Gulf states as well as the Southeast. Dengue is most frequently a self-limiting illness characterized by sudden onset of fever, chills, headache, retroocular pain, general malaise, myalgias, arthralgias, and a skin rash. In a small group of patients, the same viruses may cause dengue hemorrhagic fever and dengue shock syndrome. In the Western hemisphere, dengue with hemorrhagic manifestations and dengue with shock syndrome have been documented frequently in adults. There are four serotypes of dengue viruses and all have been documented to be present in the Western hemisphere. The clinical illness is similar for any of the four serotypes; after infection there is lifelong homotypic immunity and heterotypic immunity for several months. The diagnosis of dengue is based on clinical findings and can be confirmed by serologic tests or virus isolation. There is no specific treatment for dengue; hydration is important as well as aggressive fluid management if hypotension develops. It is important to avoid aspirin and salicylates. The best treatment is prevention through mosquito control and public education to eradicate the breeding grounds for the mosquito.
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PMID:Dengue in the Western Hemisphere. 791 2

Serologically confirmed cases of dengue fever among Swedish tourists were studied retrospectively. Dengue fever was found to be the most commonly diagnosed imported arbovirus disease in Sweden during the period December 1989-November 1990. 24 cases were diagnosed. The geographical epidemiology showed that 17/23 who answered a questionnaire were infected in Thailand, most often during spring and early summer. 17 patients were admitted to hospital. All patients had high fever. Other common symptoms were myalgia, headache, fatigue/prostration and erythema. All patients but 1 with a long-standing ataxia recovered without sequelae. Low white blood cell and platelet counts were registered in all sampled patients. Depressed sodium levels and elevated liver enzymes were seen regularly. Dengue virus type 1 was isolated from 2 patients who suffered from dengue haemorrhagic fever grade II in the course of their primary dengue virus infection.
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PMID:Dengue fever among Swedish tourists. 805 9

BACKGROUND. Dengue is an acute febrile illness caused by several arthropod-born viruses and characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia and lymphadenopathy. Its diagnosis is based on knowledge of the geographic distribution of dengue viruses. CASE REPORTS Case no 1: A 11 year-old boy suffered from sudden onset of fever accompanied by retro-orbital headache, arthralgia and diffuse myalgia. There was no rash. Hemogram showed: hemoglobin: 11.6 g%; leukocytes: 3,400/mm3 (PMN: 76%); platelets: 190,000/mm3. A diagnosis of viral infection was considered, but, as the boy had recently been to the French West-Indies, a serologic study was performed. This was negative 2 days after the onset of disease and positive (specific IgM for the 4 dengue types), 13 days later. Case no 2: A 7 year-old boy suffered from sudden onset of fever. Severe calf muscle pain 4 days later led to his admission. Creatine phosphokinase activity was very high: 83,100 units (N: 30-120). Hemogram showed: hemoglobin: 11.4 g%; leukocytes: 2,500/mm3 (PMN: 60%); platelets: 124,000/mm3. A diagnosis of acute myositis was considered, but as the patient had recently visited Venezuela, a serologic study was performed. This was negative 8 days after the onset of disease and positive (specific IgM for the 4 dengue types) 16 days later. CONCLUSION. The first case is characteristic of the classical form of dengue fever. The second patient presented with very localized myalgia. The diagnosis in both cases was facilitated by the knowledge that the patient had recently stayed in an endemic area.
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PMID:[Dengue. Apropos of 2 cases]. 805 73

Dengue is known to produce a syndrome involving muscles, tendons and joints. The hallmark of this syndrome is severe myalgia but includes fever, cutaneous rash, and headache. The neuromuscular aspects of this infection are outlined only in isolated reports, and the muscle histopathological features during myalgia have not been described. In order to ascertain the actual neuromuscular involvement in dengue and better comprehend the histological nature of myalgia, we performed a clinical and neurological evaluation, a serum CPK level and a muscle biopsy (with histochemistry) in 15 patients (4 males), median age 23 years (range 14-47) with classic dengue fever, serologically confirmed, during the brazilian dengue epidemics from September 1986 to March 1987. All patients had a history of fever, headache and severe myalgia. Upon examination 4 had a cutaneous rash, 3 had fever, and 3 a small hepatomegaly. The neurological examination was unremarkable in all and included a manual muscle test. CPK was mildly elevated in only 3 patients. Muscle biopsy revealed a light to moderate perivascular mononuclear infiltrate in 12 patients and lipid accumulation in 11. Mild mitochondrial proliferation was seen in 3, few central nuclei in 3, rare foci of myonecrosis in 3, and 2 patients had type grouping. Dengue in our patients, produced myalgia but no detectable muscle weakness or other neuromuscular involvement. The main histopathological correlation with myalgia seems to be a perivascular mononuclear infiltrate and lipid accumulation.
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PMID:Dengue. Muscle biopsy findings in 15 patients. 827 73


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