Fabrizio Claudia, Lepore Luciana, Chironna Maria, Angarano Gioacchino, Saracino Annalisa
Clinic of Infectious Diseases, Policlinico University Hospital, Bari, Italy.
Regional Reference Laboratory for Arbovirosis, Hygiene Unit, Policlinico University Hospital, Bari, Italy.
New Microbiol. 2017 Jan;40(1):11-18. Epub 2017 Jan 5.
Dengue fever (DF), an arbovirosis caused by Dengue viruses (DV, serotypes 1-4), is responsible for an increasing number of travel-related acute febrile illnesses due to population growth, climate changes, spreading by viremic travellers, and improved laboratory diagnosis. The presence of efficient vectors (mosquito Aedes albopictus) has also been described in temperate regions including Italy which is considered the most heavily infected European country. Normally characterized by non-specific signs and symptoms, DF incidence is probably underestimated, especially in non-endemic countries, but the risk of severe forms is substantial. Between August and November 2013, five DF patients (4 males, age 23-38) were observed in the Infectious Disease Clinic (University of Bari, Southern Italy). All had just returned from DF endemic areas (2 French Polynesia, 3 Dominican Republic); 4/5 were hospitalized. Common clinical features included acute febrile syndrome, headache (2 with retro-orbital pain), rash (all patients), two with bleeding manifestations and one with gum bleeding. Laboratory tests demonstrated leukopenia (4 patients), elevated liver enzymes (3 patients), and thrombocytopenia (1 patient). Serum samples for DV antibodies and RNA detection were analyzed by the Regional Arbovirosis Reference Laboratory. Viral RNA was identified in 2/5 patients (DV-4) and seroconversion in the remaining cases. All patients made a complete recovery. Recent literature was reviewed, focusing on epidemiology and vector distribution (especially European and Italian territories), pathogenesis, clinical features, diagnosis, and treatment including vaccine strategies. The occurrence of 5 DF cases during the period of highest vector activity (June-November) in Italy emphasizes the risk of local outbreaks in temperate regions. This paper highlights the importance of clinical alert for dengue also in non-endemic countries.
登革热（DF）是由登革病毒（DV，血清型1 - 4）引起的虫媒病毒病，由于人口增长、气候变化、病毒血症旅行者传播以及实验室诊断技术的改进，与旅行相关的急性发热疾病的数量不断增加。在包括意大利在内的温带地区也发现了高效的病媒（白纹伊蚊），意大利被认为是欧洲感染最严重的国家。DF通常以非特异性体征和症状为特征，其发病率可能被低估，尤其是在非流行国家，但严重形式的风险很大。2013年8月至11月期间，在意大利南部巴里大学传染病诊所观察到5例DF患者（4名男性，年龄23 - 38岁）。所有患者均刚从DF流行地区返回（2例来自法属波利尼西亚，3例来自多米尼加共和国）；5例中有4例住院。常见的临床特征包括急性发热综合征、头痛（2例伴有眶后疼痛）、皮疹（所有患者）、2例有出血表现，1例牙龈出血。实验室检查显示白细胞减少（4例患者）、肝酶升高（3例患者）和血小板减少（1例患者）。区域虫媒病毒病参考实验室对DV抗体和RNA检测的血清样本进行了分析。在2/5的患者中鉴定出病毒RNA（DV - 4），其余病例出现血清转化。所有患者均完全康复。回顾了近期文献，重点关注流行病学和病媒分布（特别是欧洲和意大利地区）、发病机制、临床特征、诊断和治疗，包括疫苗策略。在意大利病媒活动最高的时期（6月至11月）出现5例DF病例，强调了温带地区局部爆发的风险。本文强调了在非流行国家对登革热保持临床警惕的重要性。
