Vol 44 # 2 June 2012 - Kma.org.kw

June 2012
KUWAIT MEDICAL JOURNAL 146
Case Report
Dengue Fever among Travelers
Suha M AbdulSalam 1 , Muneera Y Al-Tarrah 2 , Faysal Alshalfan 3
1
Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait
2
Department of Medicine, Amiri Hospital, Kuwait
3
Department of Virology, Mubarak Al-Kabeer Hospital, Kuwait
Kuwait Medical Journal 2012; 44 (2): 146 - 148
ABSTRACT
Dengue fever, also known as break bone fever, is an acute
life-threatening febrile illness, which usually occur in the
tropical and subtropical areas. Travelers may both acquire
and spread dengue virus infection. We report a case of
Dengue fever in a traveler from an endemic area. In this
case report, we will emphasize the clinical manifestations
and diagnosis of dengue virus infection from other tropical
diseases affecting people who have recently travelled. It is
important that health care providers and travelers be aware
of such infections for proper management and prevention.
KEY WORDS: fever, mosquitos, tropical diseases
INTRODUCTION
Dengue fever is one of the tropical diseases reported
by travelers [1] . It is transmitted by Aedes mosquito.
Among 20 to 70 percent of 50 million travelers between
industrialized countries to developing countries each
year report some illness associated with their travel [1] .
Although most illnesses are mild, 8 percent require
medical care [2] . This depends on several factors. People
who visit family and local homes have an increased
chance of exposure to pathogens than tourists [1] .
After an incubation period of seven days, dengue
fever manifests as an influenza like illness with
fever, headache, and myalgia. In 50 percent of the
infected people, diffuse maculopapular rash and
petechial rash develop. Other clinical manifestations
include lymphadenopathy, mild respiratory and
gastrointestinal symptoms, in addition to hemorrhagic
manifestations [1,3] . Classic dengue fever in travelers
is self limiting and rarely fatal. It may require
hospitalization. We present a classic case of dengue
fever in a traveler from an endemic area.
CASE REPORT
A 63-year-old Canadian male of Pakistani origin
presented to our medical casualty with three days
history of high-grade fever, vomiting and diarrhea,
followed by altered mental status on the day of
admission. He was known to be diabetic, hypertensive
and was diagnosed to have bronchial asthma. His
family had noted a decrease in his conscious level for
one day before they sought medical advice. The patient
had come back from Pakistan a week ago. There were
no ill contacts at home. He gave history of a recent
urinary tract infection that was treated in Pakistan. He
also gave a history of anti-pyretic tablet consumption
(eight pills over two days) to relieve his fever.
On presentation, his temperature was 39.6 °C. His
respiratory rate and heart rate were 20 breaths, 94
beats per minute respectively. His blood pressure was
measured to be 153 / 85 mmHg. He was conscious,
but drowsy and disoriented. He appeared jaundiced.
His abdomen was distended secondary to a quickly
developing ascites. A diffuse, non- blanching, confluent
rash was present on his upper and lower limbs. (Fig. 1-
3) He had mild right upper quadrant tenderness. The
rest of his physical examination was unremarkable.
His laboratory work up revealed mild anemia, a
hemoglobin of 120 g/l, and thrombocytopenia with
a platelet count of 19,000. He had leucopenia with a
WBC count of 2.1 x 109/ml. His coagulation profile
was prolonged.
During the patient’s stay in the hospital, he
developed worsening of all his laboratory parameters.
He developed a marked drop in his hemoglobin to
90 g/l. His liver function tests and liver enzymes
were deteriorating. His total bilirubin (TBil) was 113
mmol/l, Aspartate Transaminase (AST) 2349 mmol/l,
Alanine Transaminase (ALT) 1567 mmol/l, Gamma
Glutamate (GGT) 191 mmol/l. His Albumin level
was 27 g/l. Serial screen for tropical diseases such
as malaria, typhoid fever and brucella was negative.
An enzyme-linked immunosorbent assay (ELISA)
Address correspondence to:
Dr Suha AbdulSalam, PO Box 13467, 71955 Kaifan, Kuwait. Tel: +965 99816273, E-mail: Suha1305@gmail.com