Dengue: a review.

Millions of dengue cases occur worldwide each year. Most recently, an outbreak occurred in Texas. Though usually a nonspecific febrile illness that resolves with supportive therapy, the clinical spectrum ranges from asymptomatic to severe hemorrhage and sudden fatal shock. The potential exists for the introduction of dengue virus into other parts of the United States, and for secondary transmission in areas with vector mosquitoes, because of increased travel to and from regions of the Americas where dengue is endemic. The discovery of Aedes (Ae) albopictus strains adapted to temperate conditions makes this threat much greater. With global warming, a more rapid distribution of the Aedes species may occur, moving northward, encompassing larger population centers and leading to increased vectorborne diseases. Control of dengue currently requires control of the principal vector mosquitoes. Vaccine development continues, but at present the only way to avoid dengue in an area where it is endemic or epidemic is to use repellents and mosquito barriers. Lifesaving intervention and management of a patient with dengue and its complications depend upon a complete history, to include travel and physical examination with a high level of suspicion. Physicians and other health care providers should learn to recognize this disease. Once a person is infected, the key to survival is early diagnosis and appropriate treatment for the severe, life-threatening complications of dengue hemorrhagic fever and dengue shock syndrome.