Doctors missing severe dengue warning signs


Australians returning from overseas with severe dengue are at risk of being harmed because they are not being managed appropriately, experts warn.

The retrospective study of over 200 confirmed cases of dengue admitted to a major teaching hospital in Australia between 2012 and 2015 found fluid balance was monitored carefully in only 14% of patients.

This was despite 40% of patients meeting the 2009 World Health Organization (WHO) criteria for dengue with warning signs of severe disease.

Warning signs included haematuria, bleeding gums, epistaxis, vaginal bleeding, gastrointestinal bleeding, persistent vomiting and abdominal pain.

“Even more worrying was that NSAIDs were prescribed to treat fever in 22% of cases, exposing patients to risks of further bleeding complications and renal impairment,” the authors wrote.

There was documented reference to the WHO guidelines for managing dengue in only 5% of cases.

Given the increasing popularity of travel to southeast Asia and the absence of local Australian guidelines, the study concluded all health professionals should be aware of and apply the 2009 WHO guidelines.

An accompanying editorial in The MJA said doctors had to be alert for the possibly of dengue in returning travellers with febrile conditions.

“Referral for specialist opinion and confirmation of dengue virus infection by rapid diagnostic tests, such as non-structural antigen 1 assay, are appropriate when there are doubts about the diagnosis.”

The study found the most common presenting symptoms were fever, headache, myalgia, arthralgia and retro-orbital pain.

Most patients were young (median age 32 years) and had been ill for about four days.

Common laboratory finding were leukopenia, thrombocytopenia and elevated alanine transaminase (ALT) levels.

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