Board Review: Attack of the Bugs
A 25-year-old male presents to the ED with fever associated with severe arthralgias and a retro-orbital headache for the past 3 days after returning from a trip to Thailand. On exam he appears flushed and uncomfortable. Labs are notable for thrombocytopenia. What is the treatment for this diagnosis?
B. Antibiotic Therapy
C. Anti-retroviral Therapy
D. Supportive Care
Answer is D. This patient has symptoms concerning for Dengue fever given his recent travel from an area endemic to the flavivirus transmitted by Aedes aegypti or Aedes albopictus mosquitoes. This is often referred to as “breakbone” fever giventhe significant arthralgias that result. Supportive care is the mainstay of treatment including intravenous fluid resuscitation to treat intravascularvolume depletion. Hemorrhagic shock is the feared complication of Dengue and may warrant blood transfusion.
Nedjadi, T., El-Kafrawy, S., Sohrab, S.S. et al. Tackling dengue fever: Current status and challenges. Virol J 12, 212 (2015). https://doi.org/10.1186/s12985-015-0444-8
Reviewing travel-related illnesses? See this prior EM Daily post about malaria: https://emdaily.cooperhealth.org/content/emconf-malaria-review