Volume 86, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Dengue hemorrhagic fever is characterized by the presence of a capillary leak syndrome. Its pathogenesis is presumed to differ from that of classical dengue fever (DF) and to be associated with secondary dengue infection. Returning travelers given a diagnosis of DF were evaluated for capillary leakage with abdominal sonography. Data were compared between travelers with primary/secondary infection defined by epidemiologic and serologic parameters. A total of 12 (34.3%) of 35 patients had sonographic signs of capillary leakage. Most (85%) patients with capillary leakage had classical DF. Capillary leak was diagnosed in 32% of primary dengue cases and in 40% of secondary dengue cases ( = 0.69). The two patients given a diagnosis of dengue hemorrhagic fever had primary infections. The high prevalence of capillary leakage among travelers, most of them with primary exposure to dengue, calls into question the importance of secondary infection in causing capillary leakage in dengue infection.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2002. Dengue/Dengue Hemorrhagic Fever. Fact Sheet no. 117. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/. Accessed November 25, 2010. [Google Scholar]
  2. Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO, ; GeoSentinel Surveillance Network, 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 10811088.[Crossref] [Google Scholar]
  3. World Health Organization, Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Available at: http://www.who.int/csr/resources/publications/dengue/012-23.pdf. Accessed November 25, 2010. [Google Scholar]
  4. World Health Organization, 2009. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Available at: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf. Accessed November 25, 2010. [Google Scholar]
  5. Froudarakis ME, , 2008. Diagnostic work-up of pleural effusions. Respiration 75: 413.[Crossref] [Google Scholar]
  6. Dunham EJ, Holmes EC, , 2007. Inferring the timescale of dengue virus evolution under realistic models of DNA substitution. J Mol Evol 64: 656661.[Crossref] [Google Scholar]
  7. Peters CJ, Fauci AS, Braunwald E, Kasper DL, Hauser SL, Jameson L, Loscalzo J, , 2008. Infections caused by arthropod- and rodent-borne viruses. . eds. Harrison’s Principles of Internal Medicine, 17th edition. New York: McGraw-Hill. [Google Scholar]
  8. Nimmannitya S, Cook GC, Zumla AI, , 2008. Dengue and dengue hemorrhagic fever. , eds. Manson’s Tropical Diseases, 22nd ed. New York: Elsevier Health Sciences, 750761. [Google Scholar]
  9. Tsai TF, Vaughn DW, Solomon T, Mandell GL, Bennett JE, Dolin R, , 2005. Flaviviruses (yellow fever, dengue, dengue hemorrhagic fever, Japanese encephalitis, West Nile encephalitis, St. Louis encephalitis, tick-borne encephalitis). , eds. Principles and Practice of Infectious Diseases, 6th ed. London: Churchill Livingstone. [Google Scholar]
  10. Venkata Sai PM, Dev B, Krishnan R, , 2005. Role of ultrasound in dengue fever. Br J Radiol 78: 416418.[Crossref] [Google Scholar]
  11. Balasubramanian S, Janakiraman L, Kumar SS, Muralinath S, Shivbalan S, , 2006. A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever. Indian Pediatr 43: 334339. [Google Scholar]
  12. Rigau-Pérez JG, , 2006. Severe dengue: the need for new case definitions. Lancet Infect Dis 6: 297302.[Crossref] [Google Scholar]
  13. Statler J, Mammen M, Lyons A, Sun W, , 2008. Sonographic findings of healthy volunteers infected with dengue virus. J Clin Ultrasound 36: 413417.[Crossref] [Google Scholar]
  14. Kao CL, King CC, Chao DY, Wu HL, Chang GJ, , 2005. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. J Microbiol Immunol Infect 38: 516. [Google Scholar]
  15. Schwartz E, Schwartz E, , 2009. Dengue fever. , ed. Tropical Diseases in Travelers. Boston: Blackwell Publishing, 5164.[Crossref] [Google Scholar]
  16. Wittesjö B, Eitrem R, Niklasson B, , 1993. Dengue fever among Swedish tourists. Scand J Infect Dis 25: 699704.[Crossref] [Google Scholar]
  17. Wichmann O, Gascon J, Schunk M, Puente S, Siikamaki H, Gjørup I, Lopez-Velez R, Clerinx J, Peyerl-Hoffmann G, Sundøy A, Genton B, Kern P, Calleri G, de Górgolas M, Mühlberger N, Jelinek T, ; European Network on Surveillance of Imported Infectious Diseases, 2007. Severe dengue virus infection in travelers: risk factors and laboratory indicators. J Infect Dis 195: 10891096.[Crossref] [Google Scholar]
  18. Itoda I, Masuda G, Suganuma A, Imamura A, Ajisawa A, Yamada K, Yabe S, Takasaki T, Kurane I, Totsuka K, Negishi M, , 2006. Clinical features of 62 imported cases of dengue fever in Japan. Am J Trop Med Hyg 75: 470474. [Google Scholar]
  19. Huhtamo E, Vuorinen S, Uzcátegui NY, Vapalahti O, Haapasalo H, Lumio J, , 2006. Fatal dengue virus infection in a Finnish traveler. J Clin Virol 37: 323326.[Crossref] [Google Scholar]
  20. Schwartz E, Mileguir F, Grossman Z, Mendelson E, , 2000. Evaluation of ELISA-based sero-diagnosis of dengue fever in travelers. J Clin Virol 19: 169173.[Crossref] [Google Scholar]
  21. Rosen L, , 1977. The emperor’s new clothes revisited, or reflections on the pathogenesis of dengue hemorrhagic fever. Am J Trop Med Hyg 26: 337343. [Google Scholar]
  22. Halstead SB, Mahalingam S, Marovich MA, Ubol S, Mosser DM, , 2010. Intrinsic antibody-dependent enhancement of microbial infection in macrophages: disease regulation by immune complexes. Lancet Infect Dis 10: 712722.[Crossref] [Google Scholar]
  23. Edelman R, , 2007. Dengue vaccines approach the finish line. Clin Infect Dis 45: (Suppl 1): S56S60.[Crossref] [Google Scholar]
  24. Stephenson JR, , 2005. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ 83: 308314. [Google Scholar]

Data & Media loading...

  • Received : 26 Nov 2010
  • Accepted : 14 Nov 2011
  • Published online : 01 Mar 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error