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| {{DiseaseDisorder infobox |
| | __NOTOC__ |
| Name = Dengue fever |
| | {{About1|Dengue virus}} |
| ICD10 = {{ICD10|A|90||a|00}} |
| | '''For patient information, click [[{{PAGENAME}} (patient information)|here]].''' |
| ICD9 = {{ICD9|061}} |
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| DiseasesDB = 3564 |
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| MedlinePlus = 001374 |
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| MeshName = Dengue |
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| MeshNumber = C02.782.417.214 |
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| }}
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| {{Taxobox | color=violet | |
| | name = ''Dengue virus''
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| | image = Dengue.jpg
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| | image_caption = A [[Transmission electron microscopy|TEM]] [[micrograph]] showing dengue virus.
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| | virus_group = iv
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| | familia = ''[[Flaviviridae]]''
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| | genus = ''[[Flavivirus]]'' | |
| | species = '''''Dengue virus'''''
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| }} | |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | |
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| {{Search infobox}} | | {{Dengue fever}} |
| {{CMG}} | | {{CMG}};{{AE}} {{KS}} |
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| ==Overview==
| | {{SK}} Dengue, Bonecrusher disease, Breakbone fever |
| '''Dengue fever''' ({{IPA2|'deŋgeɪ}}) and '''dengue [[hemorrhagic fever]]''' (DHF) are acute [[fever|febrile]] [[disease]]s, found in the tropics and Africa, with a geographical spread similar to [[malaria]].<ref>{{cite web |url= http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=dengue.htm|title= CDC - Yellow Book: [4] Dengue Fever - CDC Traveler's Health|accessdate=2007-05-20}}</ref> One major difference, however, is that malaria is often eradicated in major cities, where as dengue is often found in urban areas of developed tropical nations, like Singapore. Caused by one of four closely related [[virus]] [[serotype]]s of the genus ''[[Flavivirus]]'', family [[Flaviviridae]], each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the ''[[Aedes aegypti]]'' (rarely ''Aedes albopictus'') [[mosquito]], which feeds during the day<ref>[http://www.searo.who.int/en/Section10/Section332_12647.htm "Dengue Fever – Information Sheet"] - [[World Health Organization]]</ref>.
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| ==Signs and symptoms== | | ==[[Dengue fever overview|Overview]]== |
| This [[infectious disease]] is manifested by a sudden onset of [[fever]], with severe headache, muscle and joint pains ([[myalgia]]s and [[arthralgia]]s - severe pain gives it the name ''break-bone fever'' or ''bonecrusher disease'') and [[rash]]es; the dengue rash is characteristically bright red [[petechia]] and usually appears first on the lower limbs and the chest - in some patients, it spreads to cover most of the body. There may also be [[gastritis]] with some combination of associated abdominal pain, [[nausea]], [[vomiting]] or [[diarrhea]]. Patients with Dengue fever may also have a case of swollen [[lymph nodes]].
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| Some cases develop much milder symptoms which can, when no rash is present, be misdiagnosed as [[influenza]] or other viral infection. Thus travelers from tropical areas may inadvertently pass on dengue in their home countries, having not been properly diagnosed at the height of their illness. Patients with dengue can only pass on the infection through mosquitoes or blood products while they are still [[fever|febrile]].
| | ==[[Dengue fever historical perspective|Historical Perspective]]== |
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| The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the fever (the so-called "biphasic pattern"). Clinically, the [[platelet]] count will drop until the patient's temperature is normal.
| | ==[[Dengue fever classification|Classification]]== |
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| Cases of DHF also show higher fever, haemorrhagic phenomena, [[thrombocytopenia]], and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate.
| | ==[[Dengue fever pathophysiology|Pathophysiology]]== |
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| ==Diagnosis== | | ==[[Dengue fever causes|Causes]]== |
| The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with [[thrombocytopenia]] and relative [[leukopenia]].
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| There exists a [[World Health Organisation|WHO]] [http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/index.html definition of dengue haemorrhagic fever] that has been in use since 1975; all four criteria must be fulfilled:
| | ==[[Dengue fever differential diagnosis|Differentiating Dengue fever from other Diseases]]== |
| # [[Fever]]
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| # [[Bleeding|Haemorrhagic]] tendency (positive [[tourniquet test]], spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody [[diarrhea]])
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| # [[Thrombocytopenia|Thrombocytopaenia]] (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
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| # Evidence of plasma leakage ([[hematocrit]] more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, [[pleural effusion]], [[ascites]], hypoproteinaemia)
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| '''Dengue shock syndrome''' is defined as dengue haemorrhagic fever plus:
| | ==[[Dengue fever epidemiology and demographics|Epidemiology and Demographics]]== |
| *Weak rapid pulse,
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| *Narrow pulse pressure (less than 20 mm Hg)
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| or,
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| *Hypotension for age;
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| *Cold, clammy skin and restlessness.
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| [[Serology]] and [[PCR]] (polymerase chain reaction) studies are available to confirm the diagnosis of dengue if clinically indicated. | | ==[[Dengue fever risk factors|Risk Factors]]== |
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| ==Treatment== | | ==[[Dengue fever natural history|Natural History, Complications and Prognosis]]== |
| The mainstay of treatment is supportive therapy. Increased oral fluid intake is recommended to prevent dehydration. Supplementation with [[Intravenous drip|intravenous fluids]] may be necessary to prevent [[dehydration]] and significant hemoconcentration if the patient is unable to maintain oral intake. A [[platelet]] [[blood transfusion|transfusion]] is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant bleeding.
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| The presence of [[melena]] may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion.
| | ==Diagnosis== |
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| It is very important to avoid [[aspirin]] and non-steroidal anti-inflammatory medications. These drugs are often used to treat pain and fever though in this case they may actually aggravate the bleeding tendency associated with some of these infections. Patients should receive instead [[acetaminophen]] preparations to deal with these symptoms [http://www.cdc.gov/NCIDOD/dvbid/dengue/dengue-hcp.htm] if dengue is suspected.
| | [[Dengue fever history and symptoms|History and Symptoms]] | [[Dengue fever physical examination|Physical Examination]] | [[Dengue fever laboratory tests|Laboratory Findings]] | [[Dengue fever other imaging findings|Other Imaging Findings]] | [[Dengue fever other diagnostic studies|Other Diagnostic Studies]] |
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| Having a strong immune system also benefits recovery from dengue.
| | ==Treatment== |
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| ==Emerging treatments== | |
| Emerging evidence suggests that [[mycophenolic acid]] and [[ribivirin]] inhibit dengue replication. Initial experiments showed a fivefold increase in defective viral RNA production by cells treated with each drug.<sup>[http://vir.sgmjournals.org/cgi/content/full/87/7/1947]</sup> ''In vivo'' studies, however, have not yet been done.
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| ==Epidemiology==
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| [[Image:Dengue06.png|left|thumb|250px|World-wide dengue distribution, 2006. Red: Epidemic dengue. Blue: ''Aedes aegypti''.]]
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| [[Image:Dengue distr.gif|left|thumb|250px|World-wide dengue distribution, 2000]]
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| The first epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s. The disease was identified and named in 1779. A global [[pandemic]] began in Southeast Asia in the 1950s and by 1975 DHF had become a leading cause of death among children in many countries in that region. Epidemic dengue has become more common since the 1980s - by the late 1990s, dengue was the most important mosquito-borne disease affecting humans after [[malaria]], there being around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year. There was a serious outbreak in Rio de Janeiro in February, 2002 affecting around one million people and killing sixteen.
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| Significant outbreaks of dengue fever tend to occur every five or six years. There tend to remain large numbers of susceptible people in the population despite previous outbreaks because there are four different strains of the dengue virus and because of new susceptible individuals entering the target population, either through childbirth or immigration.
| | [[Dengue fever medical therapy|Medical Therapy]] | [[Dengue fever primary prevention|Primary Prevention]] | [[Dengue fever secondary prevention|Secondary Prevention]] | [[Dengue fever cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Dengue fever future or investigational therapies|Future or Investigational Therapies]] |
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| There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue hemorrhagic fever is more likely to occur in patients who have secondary infections by [[serotype]]s different from the primary infection. One model to explain this process is known as [[antibody-dependent enhancement]] (ADE), which allows for increased uptake and [[virion]] replication during a secondary infection with a different strain. Through an immunological phenomena, known as [[original antigenic sin]], the [[immune system]] is not able to adequately respond to the stronger infection, and the secondary infection becomes far more serious.<ref>Rothman, Alan L. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=379334 ''Dengue: defining protective versus pathologic immunity''. ('''Full text-html''')] J Clin Invest. 2004 April 1; 113(7): 946–951</ref> This process is also known as superinfection (Nowak and May 1994; Levin and Pimentel 1981).
| | ==Case Studies== |
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| In Singapore, there are about 4,000-5,000 reported cases of dengue fever or dengue haemorrhagic fever every year. In the year 2003, there were 6 deaths from dengue shock syndrome. It is believed that the reported cases of dengue are an underrepresentation of all the cases of dengue as it would ignore subclinical cases and cases where the patient did not present for medical treatment. With proper medical treatment, the mortality rate for dengue can therefore be brought down to less than 1 in 1000.
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| ==Prevention==
| | [[Dengue fever case study one|Case #1]] |
| ===Vaccine development===
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| There is no commercially available [[vaccine]] for the dengue [[flavivirus]]. However, one of the many ongoing vaccine development programs is the Pediatric Dengue Vaccine Initiative which was set up in 2003 with the aim of accelerating the development and introduction of dengue vaccine(s) that are affordable and accessible to poor children in endemic countries.<ref>{{cite web|url=http://www.pdvi.org/|title=Pediatric Dengue Vaccine Initiative website}}</ref> Thai researchers are testing a dengue fever vaccine on 3,000-5,000 human volunteers within the next three years after having successfully conducted tests on animals and a small group of human volunteers.<ref>{{cite web|url=http://english.people.com.cn/200509/05/eng20050905_206569.html|publisher=People's Daily Online|title=Thailand to test Mahidol-developed dengue vaccine prototype|date=2005-09-05|accessdate=2006-10-08}}</ref> and a number of other vaccine candidates are entering phase I or II testing.<ref>{{cite journal|title=Dengue vaccines approach the finish line|author=Edelman R|journal=Clin Infect Dis|volume=45|issue=S1|year=2007|pages=S56–S60|doi=10.1086/518148}}</ref>
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| ===Mosquito control=== | | ==See Also== |
| [[Image:A aegypti eradication.jpg|left|thumb|300px|A field technician looking for [[larva]]e in standing water containers during the 1965 ''[[Aedes aegypti]]'' eradication program in Miami, Florida. In the 1960s, a major effort was made to eradicate the principal urban vector mosquito of dengue and yellow fever viruses, A. aegypti, from southeast United States.<br/>
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| <small>Courtesy: Centers for Disease Control and Prevention Publich Health Image Library</small>]]
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| Primary prevention of dengue mainly resides in eliminating or reducing the mosquito vector for dengue. Public spraying for mosquitoes is the most important aspect of this vector. Application of [[larvicide]]s such as Abate® to [[standing water]] is more effective in the long term control of mosquitoes. Initiatives to eradicate pools of standing water (such as in flowerpots) have proven useful in controlling mosquito-borne diseases. Promising new techniques have been recently reported from Oxford University on rendering the Aedes mosquito pest sterile.
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| Recently, researchers at the Federal University of Minas Gerais, in Brazil, have developed a world-awarded new technology to monitor and control the mosquito, using traps, chemical attractants, handheld computers and GPS georeferenced maps. The [http://www.midengue.com.br MI Dengue] system can show precisely where the mosquitoes are inside the urban area, in a very short period of time.
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| ===Personal protection===
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| Personal prevention consists of the use of [[mosquito net]]s, [[Insect repellent|repellents]] containing NNDB or [[DEET]], covering exposed skin, use of [[DEET]]-impregnated bednets, and avoiding endemic areas. This is also important for [[malaria]] prevention.
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| == Potential antiviral approaches ==
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| In cell culture experiments<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15795296 Inhibition of dsdengue virus serotypes 1 to 4 in vero cell cultures with morpholino oligomers.] Kinney RM et al, PMID: 15795296. Retrieved [[8 October]] 2006. </ref> and mice <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17344287 Antiviral effects of antisense morpholino oligomers in murine coronavirus infection models.] Burrer R et al., PMID: 17344287. Retrieved [[2 April]] 2007.
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| </ref> [[Morpholino]] antisense oligos have shown specific activity against Dengue virus.
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| The [[yellow fever]] [[vaccine]] (YF-17D) is a related Flavivirus, thus the [[chimera|chimeric]] replacement of yellow fever vaccine with dengue has been often suggested but no full scale studies have been conducted to date.<sup>[http://www.jem.org/cgi/content/full/203/2/413]</sup>
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| In 2002 the Swiss pharmaceutical company [http://www.novartis.com Novartis] and the Singapore Economic Development board created the Novartis Institute for Tropical Diseases [http://www.nitd.novartis.com (NITD)]. NITD is a public-private partnership that researches neglected tropical diseases. NITD's dengue unit is researching an anti-viral drug to treat or prevent dengue fever.
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| In 2006, a group of Argentine scientists directed by Andrea Gamarnik discovered the molecular replication mechanism of the virus, which could be attacked by disruption of the [[RNA polymerase|polymerase]]'s work.<ref>Claudia V. Filomatori, Maria F. Lodeiro, Diego E. Alvarez, Marcelo M. Samsa, Lía Pietrasanta, and Andrea V. Gamarnik. ''A 5' RNA element promotes dengue virus RNA synthesis on a circular genome''. Genes & Development, August 2006.</ref>
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| In 2007 the World Community Grid launched a project where by computer modeling of the Dengue Fever Virus (and related viruses) thousands of small molecules are screened for their potential anti-viral properties in fighting the Dengue Fever Virus. This project by use of computer simulations seeks out medicines to directly attack the virus once a person is infected. This is a distributed process project similar to SETI@Home where the general public downloads the World Community Grid agent and the program (along with thousands of other users) screens thousands of molecules while their computer would be otherwise idle. If the user needs to use the computer the program sleeps. There are several different projects running, including a similar one screening for anti-AIDS drugs. The project covering the Dengue Fever virus is called "Discovering Dengue Drugs – Together." The software and information about the project can be found at:
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| *[http://www.worldcommunitygrid.org World Community Grid web site]
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| == Recent outbreaks ==
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| [[Image:Luchemos todos contra el dengue.jpg|thumb|right|280px|A public service ad teaching people how to prevent dengue and yellow fever, in Encarnación, Paraguay (2007)]]
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| {{2005 dengue outbreak tally}}
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| During the first months of 2007 over 16,000 cases have been reported in Paraguay, of which around 100 have been detected as DHF cases. This new epidemic is expected to continue in Paraguay for several months, given the forecast of continuous rain all through the summer. Ten deaths have also been reported, including recently a high ranking member of the Ministry of Health. The epidemic has been the root of a scandal in the Paraguayan Department of Health, where one official has resigned because he had approved the use of expired batches of insecticide to control the mosquito vectors of dengue.<ref>{{cite web|publisher=BBC News|date=2 March 2007|url=http://news.bbc.co.uk/2/hi/americas/6407287.stm|title=Dengue sparks Paraguay emergency|accessdate=2007-06-19}}</ref><ref name="Paraguay2007">{{cite web|url=http://news.bbc.co.uk/2/hi/americas/6422319.stm|publisher=BBC News|date=6 March 2007|accessdate=2007-06-19|title=Paraguay dengue official sacked}}</ref> The disease has propagated to Argentina (where it is not considered endemic), in almost all cases by people who recently arrived from Paraguay.<ref>Clarín, 22 February 2007. [http://www.clarin.com/diario/2007/02/22/sociedad/s-02906.htm Hay 93 casos de dengue].</ref> In the Brazilian state of Mato Grosso do Sul, which borders on Paraguay, the number of cases in March 2007 is estimated to be more than 45,000.<ref name="Paraguay2007"/> Epidemics in the states of Ceará, Pará, São Paulo, and Rio de Janeiro have taken the Brazilian national tally of cases this year to over 70,000, with upwards of 20 deaths. The proportion of cases registered as DHF is reported to be higher than in previous years.
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| === Americas ===
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| * Puerto Rico: <ref name=PRoutbreak>{{cite news
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| | title = Dengue fever surging in Puerto Rico
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| | language = English
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| | publisher = MSNBC, Telemundo
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| | date = Aug. 08, 2007
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| | url = http://www.msnbc.msn.com/id/20181559/
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| | accessdate = 2007-26-09}}</ref>(August 2007) 2,343 confirmed cases of dengue.
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| * Dominican Republic: <ref name=DRoutbreak>{{cite news
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| | last = Batista
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| | first = L.
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| | coauthors = A Santiago Díaz
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| | title = Más de 4,968 afectados por dengue.
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| | language = Spanish
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| | publisher = Diario Libre
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| | date =
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| | url = http://www.diariolibre.com/app/article.aspx?id=82889
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| | accessdate = 2006-10-19}}</ref>(August – October 2006) 4,968 cases with 44 dead.
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| * Cuba: Media reports <ref name=cubaoutbreak1>{{cite news
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| | title = Protecting the Revolution
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| | publisher = Strategypage.com
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| | date = September 17, 2006
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| | url = http://www.strategypage.com/htmw/htiw/articles/20060917.aspx
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| | accessdate = 2006-10-07}}</ref><ref name=cubaoutbreak2>{{cite news
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| | last = Acosta
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| | first = Dalia
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| | title = War on Mosquitoes Continues During Global Summit
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| | publisher = Inter Press Service
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| | date = 2006-09-12
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| | url = http://www.ipsnews.net/news.asp?idnews=34694
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| | accessdate = 2006-10-07}}</ref><ref name=cubaoutbreak3>{{cite news
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| | title = Cuba wages war on tiny enemy
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| | publisher = Independent Online, South Africa
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| | date = September 25, 2006
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| | url = http://www.int.iol.co.za/index.php?set_id=1&click_id=31&art_id=qw1159129981777B214
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| | accessdate = 2006-10-07 }}</ref><ref name=cubaoutbreak4>{{cite news
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| | title = Cuba waging war against dengue fever
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| | publisher = Miami Herald
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| | date = October 7, 2006
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| | url = http://www.miami.com/mld/miamiherald/news/world/cuba/15700825.htm
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| | accessdate = 2006-10-07 }}</ref> (dated September and October 2006) speculate on an outbreak although there is no official report.
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| === Asia Pacific ===
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| * Australia: 2006 March 15, 2 confirmed cases at Gordonvale, Cairns, Queensland.
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| * China: September 2006, 70 cases since June in Guangzhou,Guangdong.<ref>[http://www.taipeitimes.com/News/world/archives/2006/08/29/2003325364 China, Dengue Fever Cases Jump], ''Taipei Times'', 29 August, 2006.</ref>
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| * Cook Islands: <ref name=cookislandsoutbreak>{{cite news
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| | title = 460 people in Cook Islands affected by Dengue Fever outbreak
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| | publisher = Radio New Zealand International
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| | date = 15 January, 2007
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| | url = http://www.rnzi.com/pages/news.php?op=read&id=29493
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| | accessdate = 2007-01-15 }}</ref>(October 2006-January 2007) 460 cases.
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| * India: 2006 September, more than 400 cases and 22 deaths were reported due to dengue fever in New Delhi. <ref> http://www.iht.com/articles/ap/2006/10/02/asia/AS_GEN_India_Dengue_Outbreak.php International Herald Tribune, Associated Press News, Published: October 2, 2006 & Accessed on: October 2, 2006]</ref> By October 7, 2006, reports were of 3,331 cases of the mosquito-borne virus and a death toll of 49. <ref>[http://news.yahoo.com/s/afp/20061007/wl_asia_afp/indiahealthdengue_061007200413 India says dengue outbreak serious as death toll rises] Pratap Chakravarty, news.yahoo.com, 7 October 2006. Retrieved 8 October 2006. </ref>
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| * Indonesia: 2004 80,000 infected with 800 deaths.
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| * Malaysia: January 2005 33,203 cases.
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| * Pakistan: 2006 Over 3230 cases, 50 deaths.
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| ** Karachi 2006 October, the number of infected patients rose to 1836 of which 30 had died.
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| ** Lahore, 2006 October 23, the disease shifted to Lahore during the holidays with the luggage of some people travelling to their homes to celebrate Eid. The number of infected patients is 400 by October 31, of which 4 had died.
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| * Philippines: <ref name=philippinesoutbreak>{{cite news
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| | last = Santos
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| | first = Tina
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| | title = DOH names dengue-hit areas in metropolis
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| | publisher = Philippine Daily Inquirer
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| | date = September 10, 2006
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| | url = http://newsinfo.inq7.net/inquirerheadlines/metro/view_article.php?article_id=20064
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| | accessdate = 2006-10-07 }}</ref>(January - August 2006) 13,468 cases with 167 dead.
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| * Singapore: 2007 more than 4029 cases, 8 deaths at 29 Sept.. 2005 at least 13 deaths. 2004 9460 cases. 2003, 4788 cases.
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| * Thailand: 2005 May, 7200 infected. At least 12 dead.
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| ==History==
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| ===Etymology of "dengue"===
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| The origins of the word are not clear, but one theory is that it is derived from the Swahili phrase "Ka-dinga pepo", which describes the disease as being caused by an evil spirit.<ref>[http://www.cbwinfo.com/Biological/Pathogens/DENV.html Chemical and Biological Warfare Agents]</ref> The Swahili word "dinga" may possibly have its origin in the Spanish word "dengue" (fastidious or careful), describing the gait of a person suffering dengue fever,<ref>[http://www.etymonline.com/index.php?term=dengue Etymonline entry]</ref> or, alternatively, the Spanish word may derive from the Swahili.<ref>{{cite journal | author = | title = etomologia: dengue | journal = Emerging Infectious Diseases | year = 2006 | volume = 12 |number= 6 | pages = 893 | url=http://www.cdc.gov/ncidod/eid/vol12no06/pdfs/etymology.pdf }}</ref>
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| ===History of the Disease===
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| Outbreaks ''resembling'' dengue fever have been reported throughout history.<ref name=Gubler_1998>{{cite journal |author=Gubler D |title=Dengue and dengue hemorrhagic fever |journal=Clin Microbiol Rev |volume=11 |issue=3 |pages=480-96 |year=1998 |id=PMID 9665979}}</ref> The first definitive case report dates from 1789 and is attributed to [[Benjamin Rush]], who coined the term "breakbone fever" (because of the symptoms of [[myalgia]] and [[arthralgia]]). The viral [[etiology]] and the transmission by mosquitoes were only deciphered in the 20th century. Population movements during World War II spread the disease globally.
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| == See also ==
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| * [[Tropical disease]] | | * [[Tropical disease]] |
| * 2006 dengue outbreak in Pakistan
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| * 2005 dengue outbreak in Singapore
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| * 2006 dengue outbreak in India
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| * [[Chikungunya]] | | * [[Chikungunya]] |
| * Joseph Franklin Siler | | * [[Joseph Franklin Siler]] |
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| ==Footnotes== | | ==External links== |
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| {{Reflist|2}}
| | * [http://www.cdc.gov/ncidod/dvbid/dengue/index.htm CDC on Dengue Fever] |
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| ==References==
| | [[Category:Biological weapons]] |
| * [http://www.elsevier-international.com/catalogue/title.cfm?ISBN=0702026409 Manson's Tropical Diseases]
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| * [http://www.ppidonline.com/ Mandell's Principles and Practices of Infection Diseases]
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| * [http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine]
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| * [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine]
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| * [http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine]
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| * [http://www.nlm.nih.gov/medlineplus/ency/article/001374.htm]
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| * Theiler, Max and Downs, W. G. 1973. ''The Arthropod-Borne Viruses of Vertebrates: An Account of The Rockefeller Foundation Virus Program 1951-1970''. Yale University Press.
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| * Downs, Wilbur H., et al. 1965. ''Virus diseases in the West Indies''. Special edition of the ''Caribbean Medical Journal'', Vol. XXVI, Nos. 1-4, 1965.
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| * Earle, k. Vigors. 1965. "Notes on the Dengue epidemic at Point Fortin." The ''Caribbean Medical Journal'', Vol. XXVI, Nos. 1-4, pp. 157-164.
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| * Hill, A. Edward. 1965. "Isolation of Dengue Virus from a Human Being in Trinidad." ''Virus diseases in the West Indies''. The ''Caribbean Medical Journal'', Vol. XXVI, Nos. 1-4, pp. 83-84; "Dengue and Related Fevers in Trinidad and Tobago." ''Ibid'', pp. 91-96.
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| ==External links==
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| *[http://www.cdc.gov/ncidod/dvbid/dengue/index.htm CDC site on Dengue Fever].
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| *[http://www.dengueinfo.org/ Dengueinfo.org] - Resources & depository of Dengue Virus genomic sequences for biomedical researchers.
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| *[http://www.midengue.com.br/ M.I. Dengue] - Brazilian world awarded system to monitor and control the Dengue Mosquito
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| {{Viral diseases}}
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| [[Category:Viral diseases]] | |
| [[Category:Flaviviruses]] | | [[Category:Flaviviruses]] |
| [[Category:Tropical disease]]
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| [[Category:Hemorrhagic fevers]] | | [[Category:Hemorrhagic fevers]] |
| [[Category:Insect-borne diseases]] | | [[Category:Insect-borne diseases]] |
| [[Category:Biological weapons]] | | [[Category:Neglected diseases]] |
| | [[Category:Tropical disease]] |
| | [[Category:Viral diseases]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Neglected diseases]] | | [[Category:Hematology]] |
| [[Category:Mature chapter]] | | [[Category:Cardiology]] |
| | | [[Category:Gastroenterology]] |
| [[ar:دنجي]] | |
| [[zh-min-nan:Thian-káu-jia̍t]]
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| [[bg:Денга]]
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| [[ca:Dengue]]
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| [[da:Denguefeber]]
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| [[de:Dengue-Fieber]]
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| [[es:Dengue]]
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| [[eo:Dengo]]
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| [[fr:Dengue]]
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| [[hr:Dengue groznica]]
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| [[id:Demam berdarah]]
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| [[ia:Dengue]]
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| [[it:Dengue]]
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| [[ms:Demam Denggi]]
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| [[nl:Dengue]]
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| [[ja:デング熱]]
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| [[no:Dengue]]
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| [[pl:Denga]]
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| [[pt:Dengue]]
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| [[si:ඩෙංගි උණ]]
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| [[sk:Horúčka dengue]]
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| [[sr:Денга грозница]]
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| [[fi:Denguekuume]]
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| [[sv:Denguefeber]]
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| [[ta:டெங்கு காய்ச்சல்]]
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| [[th:โรคไข้เลือดออก]]
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| [[vi:Sốt xuất huyết Dengue]]
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| [[zh:骨痛熱症]]
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| {{SIB}}
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| {{WH}}
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| {{WS}}
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