Volume 86, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We conducted a nationwide study at six tertiary hospitals from December 2008 through November 2009 to investigate etiologies of febrile illnesses in Bangladesh. Febrile patients meeting a clinical case definition were enrolled from inpatient and outpatient medicine and pediatric units. We assessed 720 febrile patients over 12 months; 69 (9.6%) were positive for IgM antibodies against dengue virus by enzyme-linked immunosorbent assay, and four malaria patients (0.56%) were confirmed with immuno-chromatography and microscopic slide tests. We identified dengue cases throughout the year from rural (49%) and urban areas (51%). We followed-up 55 accessible dengue-infected patients two months after their initial enrollment: 45 (82%) patients had fully recovered, 9 (16%) reported ongoing jaundice, fever and/or joint pain, and one died. Dengue infection is widespread across Bangladesh, but malaria is sufficiently uncommon that it should not be assumed as the cause of fever without laboratory confirmation.


Article metrics loading...

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

Full text loading...



  1. Chan-Tack KM, Bartlett J, . Fever of Unknown Origin. Emedicine. Available at: http://emedicine.medscape.com/article/217675-overview. [Google Scholar]
  2. World Health Organization Bangladesh. Communicable Diseases. Available at: http://www.whoban.org/communicable_dis.html. [Google Scholar]
  3. Pacific Disaster Management Information Network. Asia-Pacific Disease Outbreak/Surveillance Report. Dengue Affects 114 People in Bangladesh–64 Patients Still Receiving Treatment. Source: Matamat.com, June 30, 2004, http://www.matamat.com/fullstory.php?gd=34&cd=2004-06-30. Available at: http://www.who.int/disasters/repo/13755.pdf. [Google Scholar]
  4. World Health Organization Bangladesh, 2003. Dengue Fever and Dengue Haemorrhagic Fever. Available at: http://www.whoban.org/communicable_dis_dengue.html. [Google Scholar]
  5. Amin MM, Hussain AM, Nahar K, Chowdhury IA, Murshed M, Chowdhury SA, , 2000. Sero-diagnosis of dengue infections in four metropolitan cities of Bangladesh. Dengue Bull 24. Available at: http://www.searo.who.int/en/Section10/Section332/Section522_2506.htm. [Google Scholar]
  6. Bangladesh Bureau of Statistics, 2009. Statistical Yearbook of Bangladesh 2008. 28th Edition. Available at: www.bbs.gov.bd. [Google Scholar]
  7. World Health Organization Bangladesh. Malaria. Available at: http://www.whoban.org/communicable_dis_malaria.html. [Google Scholar]
  8. Haque U, Ahmed SM, Hossain S, Huda M, Hossain A, Alam MS, Mondal D, Khan WA, Khalequzzaman M, Haque R, , 2009. Malaria prevalence in endemic districts of Bangladesh. PLoS ONE 4: e6737.[Crossref] [Google Scholar]
  9. Alam P, , 2008. Malaria Country Report Bangladesh. Available at: http://www.actmalaria.net/downloads/pdf/info/2008/Bangladesh%20Malaria%20Country%20Profile%202008.pdf. [Google Scholar]
  10. Zaman RU, Alamgir ASM, Rahman M, Azziz-Baumgartner E, Gurley ES, Sharker MAY, Brooks WA, Azim T, Fry AM, Lindstrom S, Gubareva LV, Xu X, Garten RJ, Hossain MJ, Khan SU, Faruque LI, Ameer SS, Klimov AI, Rahman M, Luby SP, , 2009. Influenza in outpatient ILI case-patients in national hospital-based surveillance, Bangladesh, 2007–2008. PLoS ONE 4: e8452.[Crossref] [Google Scholar]
  11. Haque U, Huda M, Hossain A, Ahmed SM, Moniruzzaman M, Haque R, , 2009. Spatial malaria epidemiology in Bangladeshi highlands. Malar J 8: 185.[Crossref] [Google Scholar]
  12. Meenaa M, Joshi D, Joshia R, Sridhar S, Waghdhare S, Gangane N, Kalantri SP, , 2009. Accuracy of a multispecies rapid diagnostic test kit for detection of malarial parasite at the point of care in a low endemicity region. Trans R Soc Trop Med Hyg 103: 12371244.[Crossref] [Google Scholar]
  13. World Health Organization and Foundation for Innovative New Diagnostics, 2010. Malaria Rapid Diagnostic Test Performance: Summary Results of WHO Malaria RDT Product Testing, Rounds 1 and 2 (2008–2009). Geneva: World Health Organization. Available at: http://www.finddiagnostics.org/export/sites/default/resource-centre/reports_brochures/docs/roundI-II_summary-final.pdf. [Google Scholar]
  14. Gubler DJ, Suharyono W, Sumarmo Wulur H, Jahja E, Saroso JS, , 1979. Virological surveillance for dengue haemorrhagic fever in Indonesia using the mosquito inoculation technique. Bull World Health Organ 57: 931936. [Google Scholar]
  15. Mondini A, Neto FC, , 2007. Socioeconomic variables and dengue transmission. Rev Saude Publica 41: 923930.[Crossref] [Google Scholar]
  16. Gubler DJ, , 2002. Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol 10: 100103.[Crossref] [Google Scholar]
  17. Gubler DJ, , 2004. Cities spawn epidemic dengue viruses. Nat Med 10: 129130.[Crossref] [Google Scholar]
  18. Guha-Sapir D, Schimmer B, , 2005. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol 2: 1.[Crossref] [Google Scholar]
  19. Tripathi P, Kumar R, Tripathi S, Tambe JJ, Venkatesh V, , 2008. Descriptive epidemiology of dengue transmission in Uttar Pradesh. Indian Pediatr 45: 315318. [Google Scholar]
  20. Victor TJ, Malathi M, Asokan R, Padmanaban P, , 2007. Laboratory-based dengue fever surveillance in Tamil Nadu, India. Indian J Med Res 126: 112115. [Google Scholar]
  21. Chareonsook O, Foy HM, Teeraratkul A Silarug N, , 1999. Changing epidemiology of dengue hemorrhagic fever in Thailand. Epidemiol Infect 122: 161166.[Crossref] [Google Scholar]
  22. Eram S, Setyabudi Y, Sadono TI, Sutrisno DS, Gubler DJ, Sulianto SJ, , 1979. Epidemic dengue hemorrhagic fever in rural Indonesia: clinical studies. Am J Trop Med Hyg 28: 711716. [Google Scholar]
  23. Rigau-Pérez JG, Clark GG, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV, , 1998. Dengue and dengue haemorrhagic fever. Lancet 352: 971977.[Crossref] [Google Scholar]
  24. Ooi EE, Gubler DJ, , 2008. Dengue in Southeast Asia: epidemiological characteristics and strategic challenges in disease prevention. Cad Saude Publica 25: 115124.[Crossref] [Google Scholar]
  25. Almeida AS, Medronho RA, Valencia LI, , 2009. Spatial analysis of dengue and the socioeconomic context of the city of Rio de Janeiro (southeastern Brazil). Rev Saude Publica 43: 666673.[Crossref] [Google Scholar]
  26. Ault SK, , 1994. Environmental management: a re-emerging vector control strategy. Am J Trop Med Hyg 50: 3549. [Google Scholar]
  27. Pongsumpun P, Garcia Lopez D, Favier C, Torres L, Llosa J, Dubois MA, , 2008. Dynamics of dengue epidemics in urban contexts. Trop Med Int Health 13: 11801187.[Crossref] [Google Scholar]
  28. Favier C, Schmit D, Muller-Graf CDM, Cazelles B, Degallier N, Mondet B, Dubois MA, , 2005. Influence of spatial heterogeneity on an emerging infectious disease: the case of dengue epidemics. Proc Biol Sci 272: 11711177.[Crossref] [Google Scholar]
  29. Gubler DJ, , 1998. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 11: 480496. [Google Scholar]
  30. Strickman D, Sithiprasasna R, Kittayapong P, Innis BL, , 2000. Distribution of dengue and Japanese encephalitis among children in rural and suburban Thai villages. Am J Trop Med Hyg 63: 2735. [Google Scholar]
  31. Gubler DJ, Suharyono W, Lubis I, Eram S, Sulianti SJ, , 1979. Epidemic dengue hemorrhagic fever in rural Indonesia. Am J Trop Med Hyg 28: 701710. [Google Scholar]
  32. Silva-Nunes M, Souza VA, Pannuti CS, Sperança MA, Terzian AC, Nogueira ML, Yamamura AM, Freire MS, Silva NS, Malafronte RS, Muniz PT, Vasconcelos HB, Silva EV, Vasconcelos PF, Ferreira MU, , 2008. Risk factors for dengue virus infection in rural Amazonia: population-based cross-sectional surveys. Am J Trop Med Hyg 79: 485494. [Google Scholar]
  33. Kuniholm MH, Wolfe ND, Huang CY, Mpoudi-Ngole E, Tamoufe U, Burke DS, Gubler DJ, , 2006. Seroprevalence and distribution of flaviviridae, togaviridae, and bunyaviridae arboviral infections in rural Cameroonian adults. Am J Trop Med Hyg 74: 10781083. [Google Scholar]
  34. Tewari SC, Thenmozhi V, Katholi CR, Manavalan R, Munirathinam A, Gajanana A, , 2004. Dengue vector prevalence and virus infection in a rural area in south India. Trop Med Int Health 9: 499507.[Crossref] [Google Scholar]
  35. Isaacs N, , 2006. Measuring inter epidemic risk in a dengue endemic rural area using Aedes larval index. Indian J Community Med 31: 204205. [Google Scholar]
  36. Paramasivan R, Thenmozhi V, Hiriyan J, Dhananjeyan KJ, Tyagi BK, Dash AP, , 2006. Serological and entomological investigations of an outbreak of dengue fever in certain rural areas of Kanyakumari district, Tamil Nadu. Indian J Med Res 123: 697701. [Google Scholar]
  37. Mammen MP, Jr Pimgate C, Koenraadt CJ, Rothman AL, Aldstadt J, Nisalak A, Jarman RG, Jones JW, Srikiatkhachorn A, Ypil-Butac CA, Getis A, Thammapalo S, Morrison AC, Libraty DH, Green S, Scott TW, , 2008. Spatial and temporal clustering of dengue virus transmission in Thai villages. PLoS Med 5: e205.[Crossref] [Google Scholar]
  38. Samuel PP, Thenmozhi V, Tyagi BK, , 2007. A focal outbreak of dengue fever in a rural area of Tamil Nadu. Indian J Med Res 125: 179181. [Google Scholar]
  39. Yunus EB, Banu D, Talukder KR, Chowdhury MJ, Bangali AM, Montanari RM, , 2002. Sero-epidemiological study of dengue/dengue haemorrhagic fever in a metropolitan hospital in Bangladesh. Dengue Bull 26: 16. [Google Scholar]
  40. Rasul CH, Ahasan HA, Rasid AK, Khan MR, , 2002. Epidemiological factors of dengue hemorrhagic fever in Bangladesh. Indian Pediatr 39: 369372. [Google Scholar]
  41. Hung NT, Lan NT, Lei H, Lin Y, Lien LB, Huang K, Lin C, Ha DQ, Huong VTQ, My LT, Yeh TM, Huang J, Liu C, Halstead SB, , 2005. Association between sex, nutritional status, severity of dengue hemorrhagic fever, and immune status in infants with dengue hemorrhagic fever. Am J Trop Med Hyg 72: 370374. [Google Scholar]
  42. Neto VSG, Rebêlo JMM, , 2004. Epidemiological characteristics of dengue in the Municipality of São Luís, Maranhão, Brazil, 1997–2002. Cad Saude Publica 20: 14241431. [Google Scholar]
  43. Reiskind MH, Baisley KJ, Calampa C, Sharp TW, Watts DM, Wilson ML, , 2001. Epidemiological and ecological characteristics of past dengue virus infection in Santa Clara, Peru. Trop Med Int Health 6: 212218.[Crossref] [Google Scholar]
  44. Management Information System (MIS), Director General of Health Services, Ministry of Health and Family Welfare, Government of the Peoples' Republic of Bangladesh. Health Bulletin, 2009. Available at: http://www.dghs.gov.bd/app_pages/client/File_Upload_Show.aspx?val=1. [Google Scholar]
  45. Yunus EB, Bangali AM, Mahmood AMH, Rahman MM, Chowdhury AR, Talukder KR, , 2001. Dengue outbreak 2000 in Bangladesh: from speculation to reality and exercises. Dengue Bull 25: 1520. [Google Scholar]
  46. Ahmed M, Hossain MA, Haque R, Huq U, Hossain S, Khan WA, Mondol D, , 2008. Malaria Baseline Socioeconomic and Prevalence Survey 2007. Bangladesh: Research and Evaluation Division, BRAC and International Centre for Diarrhoeal Disease Research, Bangladesh. [Google Scholar]
  47. Ahmed SM, Haque R, Haque U, Hossain A, , 2009. Knowledge on the transmission, prevention and treatment of malaria among two endemic populations of Bangladesh and their health-seeking behavior. Malar J 8: 173.[Crossref] [Google Scholar]
  48. Wijeyaratne PM, Valecha N, Joshi AB, Singh D, Pandey S, . An Inventory on Malaria Drug Resistance in Bangladesh, Bhutan, India and Nepal. June 2004. Activity Report 130. Available at: www.bvsde.paho.org/bvsacd/ehp/ar-130.pdf. [Google Scholar]
  49. Schreiber KV, , 2001. An investigation of relationships between climate and dengue using a water budgeting technique. Int J Biometeorol 45: 8189.[Crossref] [Google Scholar]
  50. World Health Organization Regional Office for South-East Asia. Reported Cases of DF/DHF in Selected Countries in SEA Region (1985–2005). Available at: http://www.searo.who.int/EN/Section10/Section332_1101.htm. [Google Scholar]
  51. Roca-Feltrer A, Schellenberg JRM, Smith L, Carneiro I, , 2009. A simple method for defining malaria seasonality. Malar J 8: 276.[Crossref] [Google Scholar]
  52. Mabaso FM, Vounatsou P, Midzi S, Silva J, Smith T, , 2006. Spatio-temporal analysis of the role of climate in inter-annual variation of malaria incidence in Zimbabwe. Int Ints J Biometeorol 45: 8189. [Google Scholar]
  53. Innis BL, Nisalak A, Nimmannitya S, Kusalerdchariya S, Chongswasdi V, Suntayakorn S, Puttisri P, Hoke CH, , 1989. An enzyme-linked immunosorbent assay to characterize dengue infections where dengue and Japanese encephalitis co-circulate. Am J Trop Med Hyg 40: 418427. [Google Scholar]
  54. Ruechusatsawat K, Morita K, Tanaka M, Vongcheree S, Rojanasuphot S, Warachit P, Kanai K, Thongtradol P, Nimnakorn P, Kanungkid S, Igarashi A, , 1994. Daily observation of antibody levels among dengue patients detected by enzyme-linked immunosorbent assay (ELISA). Jpn J Trop Med Hyg 22: 912.[Crossref] [Google Scholar]
  55. Khan E, Mehraj V, Nasir A, Khan NA, Billoo B, Moatter T, Hasan R, , 2009. Evaluation of two ELISA assay kits against RT-PCR for diagnosis of dengue virus infection in a hospital setting in Karachi, Pakistan. J Pak Med Assoc 59: 390394. [Google Scholar]
  56. Vazquez S, Hafner G, Ruiz D, Calzada N, Guzman MG, , 2007. Evaluation of immunoglobulin M and G capture enzyme-linked immunosorbent assay Panbio kits for diagnostic dengue infections. J Clin Virol 39: 194198.[Crossref] [Google Scholar]
  57. Branch SL, Levett PN, , 1999. Evaluation of four methods for detection of immunoglobulin M antibodies to dengue virus. Clin Diagn Lab Immunol 6: 555557. [Google Scholar]
  58. Sang CT, Cuzzubbo AJ, Devine PL, , 1998. Evaluation of a commercial capture enzyme-linked immunosorbent assay for detection of immunoglobulin M and G antibodies produced during dengue infection. Clin Diagn Lab Immunol 5: 710. [Google Scholar]
  59. Cuzzubbo AJ, Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Aaskov J, Dung NM, Devine PL, , 1999. Comparison of PanBio dengue duo enzyme-linked immunosorbent assay (ELISA) and MRL dengue fever virus immunoglobulin M capture ELISA for diagnosis of dengue virus infections in Southeast Asia, 1999. Clin Diagn Lab Immunol 6: 705712. [Google Scholar]
  60. Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Dung NM, Kneen R, Cuzzubbo A, Devine PL, , 1999. Rapid serologic diagnosis of dengue virus infection using a commercial capture ELISA that distinguishes primary and secondary infections. Am J Trop Med Hyg 60: 693698. [Google Scholar]
  61. Swaminathan S, Batra G, Khanna N, , 2010. Dengue vaccines: state of the art. Expert Opin Ther Pat 20: 819835.[Crossref] [Google Scholar]
  62. Durbin AP, Whitehead SS, , 2010. Dengue vaccine candidates in development. Curr Top Microbiol Immunol 338: 129143. [Google Scholar]
  63. World Health Organization, 2010. Guidelines for the Treatment of Malaria, Second Edition. Geneva: World Health Organization. Available at: http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf. [Google Scholar]

Data & Media loading...

  • Received : 01 Apr 2011
  • Accepted : 09 Oct 2011
  • Published online : 01 Jan 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