Fast Five Quiz: Mosquito-Borne Diseases

Michael Stuart Bronze, MD


May 06, 2020

Dengue is the most common arthropod-borne viral (arboviral) illness in humans. Patients with dengue will have a history of living in, or recent travel to, a region where the disease is endemic. The incubation period is 3-14 days (average, 4-7 days); symptoms that begin more than 2 weeks after a person departs from an endemic area are probably not due to dengue.

Many patients experience a prodrome of chills, erythematous mottling of the skin, and facial flushing. The prodrome may last for 2-3 days. Classic dengue fever begins with sudden onset of fever, chills, and severe (termed breakbone) aching of the head, back, and extremities, as well as other symptoms. Fever that lasts longer than 10 days is probably not due to dengue. Rash in dengue fever is a maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands of skin sparing.

Pain and other accompanying symptoms may include any of the following:

  • Fever

  • Headache

  • Retro-orbital pain

  • General body pain (arthralgias, myalgias)

  • Nausea and vomiting (diarrhea is rare)

  • Rash

  • Weakness

  • Altered taste sensation

  • Anorexia

  • Sore throat

  • Mild hemorrhagic manifestations (eg, petechiae, bleeding gums, epistaxis, menorrhagia, hematuria)

  • Lymphadenopathy

Because the signs and symptoms of dengue fever are nonspecific, attempting laboratory confirmation of dengue infection is important. Laboratory criteria for diagnosis include one or more of the following:

  • Demonstration of a fourfold or greater change in reciprocal immunoglobulin G (IgG) or IgM antibody titers to one or more dengue virus antigens in paired serum samples

  • Demonstration of dengue virus antigen in autopsy tissue via immunohistochemistry or immunofluorescence or in serum samples via enzyme immunoassay

  • Detection of viral genomic sequences in autopsy tissue, serum, or cerebrospinal fluid samples via RT-PCR

  • Less commonly, isolation of dengue virus from serum, plasma, leukocytes, or autopsy samples

Dengue fever is usually a self-limiting illness. No specific antiviral treatment is currently available for dengue fever. Single-dose methylprednisolone has shown no mortality benefit in the treatment of dengue shock syndrome.

Read more about dengue.


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