1/8. A fever from the tropics.Shirley is a 42 year old woman who has rung you 5 days after returning from a 3 week resort holiday in malaysia and thailand. You saw her before her trip and administered a hepatitis a vaccine and advised her that she did not require anti malarial drugs as she was only going to large cities and beach resorts. She says she has had a high fever, headache and body aches for several days and that she feels exhausted, but is well enough to come to the surgery. When you see her later that morning, she looks fairly well, although she is moving rather gingerly. She says she has been resting, is drinking lots of fluids, has some anorexia, but no other significant symptoms. Examination reveals a temperature of 38 degrees C and she has a fine morbilliform rash on her body, limbs and neck. There are no other abnormal findings.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
2/8. First isolation of dengue 3 in brazil from an imported case.The authors report the isolation of dengue 3 virus for the first time in brazil. The patient, resident in Limeira-SP, traveled to nicaragua on May 16th, 1998, where he stayed for two months. Starting on August 14 th he had fever, headache, myalgia, arthralgia, retro-orbital pain and diarrhea. He returned to brazil on August 16th and was hospitalized in the next day. The patient had full recovery and was discharged on August 20th. The virus was isolated in C6/36 cell culture inoculated with serum collected on the 6th day after the onset of the symptoms. The serotype 3 was identified by indirect immunofluorescence assays performed with type-specific monoclonal antibodies. This serotype was further confirmed by polymerase chain reaction analysis. The introduction of a new dengue serotype in a susceptible population is a real threat for the occurrence of severe forms of the disease. The isolation and identification of dengue virus are important in order to monitoring the serotypes circulating in brazil and to take the measures necessary to prevent and control an epidemic.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
3/8. Dengue fever mimicking plasma cell leukemia.Extreme plasmacytosis in peripheral blood is a rare finding most often associated with plasma cell leukemia but rarely with other malignancies, infectious diseases, or drug reactions. We report the case of a 40-year-old man who was a US expatriate working and traveling in East asia. He presented with complaints of fever, myalgia, headache, vomiting, and diarrhea of 3 days' duration. An initial evaluation revealed elevated liver function tests, thrombocytopenia (68 x 10(3)/microL), and a white blood cell count of 5.8 x 10(3)/microL with 19% plasma cells (1100/microL), 9% abnormal plasmacytoid lymphocytes (520/microL), 37% polymorphonuclear leukocytes, 3% band forms, 27% lymphocytes, 4% monocytes, and 1% eosinophils. An extensive evaluation was performed, including infectious disease serologies, a bone marrow biopsy, and flow cytometry. During the course of 3 days, his symptoms and hematologic findings improved dramatically. Serologic results were reactive for dengue (immunoglobulin m [IgM] positive, reciprocal IgG titer, 655 360), consistent with a secondary infection of unknown serotype. He remains well 4 years later. To our knowledge, plasmacytosis to this degree has not been described in dengue fever, but atypical lymphocytosis is common. In patients from dengue-endemic areas, even extreme plasmacytosis should be assessed to determine whether it is transient and related to an acute illness before proceeding to an extensive evaluation.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
4/8. Dengue fever: diagnostic importance of a camelback fever pattern.We present a case of imported dengue fever in a 52-year-old man acquired during a recent trip to ecuador. fever in a returning traveler from tropical areas often presents a diagnostic problem for clinicians. Our patient presented with severe arthralgias and myalgias and had a camelback/saddleback fever pattern accompanied by relative bradycardia, which was a clue to the diagnosis. He had conjunctival suffusion and the truncal rash, but adenopathy was not present. He also had a generalized headache and abdominal pain. Nonspecific laboratory abnormalities included leukopenia, lymphopenia, atypical lymphocytes, thrombocytopenia, and mildly increased serum transaminases. Clinicians should consider dengue fever in the differential diagnosis in travelers returning from dengue fever endemic areas of Southeast asia, latin america, and africa. Although early findings are nonspecific, a truncal rash accompanied by leukopenia and thrombocytopenia, if followed by biphasic fever pattern (ie, camelback/saddleback fever curve with relative bradycardia), suggest dengue fever as the primary diagnostic consideration.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
5/8. Severe, persisting, steroid-responsive Dengue myositis.OBJECTIVES: Short-term, general muscle affection is frequent in Dengue infection, but severe, persisting, myositis has not been reported. STUDY DESIGN: Case report. RESULTS: The patient is a 38 years old, hiv-negative male who developed sudden-onset fever up to 40.0 degrees C, headache, and sore eyes upon looking into light when on holidays in thailand. One day after onset severe myalgias occurred in the shoulder girdle and hip girdle muscles. Clinical examination was normal, but blood work revealed elevated creatine-phosphokinase, glutamate-oxalate transaminase, and glutamate pyruvate transaminase, leucopenia and thrombocytopenia. antibodies against Dengue viruses type 2 and 4 were positive and classical Dengue fever was diagnosed. The infection resolved upon symptomatic therapy, but myalgias, responsive only to opiates, resolved persistently not before the administration of corticosteroids, 2 months after onset. CONCLUSIONS: The case shows that Dengue fever may also cause persisting, severe, myositis for weeks, which do not respond to non-steroidal analgesics, but promptly to corticosteroids.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
6/8. Dengue fever with papilledema: a case of dengue-3 virus infection in central nervous system.BACKGROUND AND OBJECTIVES: Neurological manifestations of dengue fever are rarely reported during acute illness and clinical presentation commonly observed is of acute encephalitis or one of the post-infectious immune mediated manifestations. We describe a case of dengue fever having mild encephalopathy and papilledema at presentation. CASE REPORT: Twenty-year-old female presented with fever, headache and vomiting. On examination she did not have classical signs of dengue fever and was found to have bilateral papilledema on fundus examination. Detailed work-up did not reveal any other cause of papilledema. diagnosis of dengue fever was established by blood IgM antibody test on day 7 of illness. Retrospective analysis of CSF (drawn on day 5 of illness) by RT-PCR assay showed a characteristic band of dengue-3 virus. papilledema was transient and subsided following symptomatic treatment. The patient recovered from acute illness and follow-up was unremarkable. CONCLUSION: Especially in dengue endemic areas, in the patients having acute febrile illness with subtle signs and symptoms suggestive of CNS involvement, dengue virus infection should also be ruled out early in the clinical course.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
7/8. Dengue fever among Swedish tourists.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.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
8/8. Primary sequence of the envelope glycoprotein of a dengue type 2 virus isolated from patient with dengue hemorrhagic fever and encephalopathy.Dengue viruses exist in nature as a collection of highly similar but not identical members (quasispecies). In order to correlate the presence of viral quasispecies with rare occurrence of unusual clinical manifestations in dengue-infected individuals, a dengue type 2 virus was isolated from the peripheral blood of a 12-year-old boy who presented with fever, headache, drowsiness and tonic seizure of the left arm, and subsequently manifested symptoms and signs of dengue hemorrhagic fever. Analysis of the envelope glycoprotein sequence of the encephalopathy-associated virus and two other dengue type 2 viruses from the same epidemic season in Chiang Mai, thailand revealed that all three viruses belonged to the subtype IIIa of the five-subtype phylogenetic nomenclature system for dengue type 2 virus. The encephalopathy-associated dengue virus was more divergent from the others and was characterized by an Ala-->Val substitution at the position 173 of the envelope glycoprotein. This substitution mapped to the central domain 1 which was not known to be involved directly in envelope-receptor interaction.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |