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Capillary Leakage in Travelers with Dengue Infection: Implications for Pathogenesis

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  • Center for Geographic Medicine and Department of Medicine “C”, Department of Imaging, and the Central Virology Laboratory, and Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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 (P = 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.

Author Notes

*Address correspondence to Eli Schwartz, Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: elischwa@post.tau.ac.il

Authors’ addresses: Eyal Meltzer and Eli Schwartz, Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, E-mails: emeltzer@post.tau.ac.il and elischwa@post.tau.ac.il. Zahava Heyman, Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, E-mail: Zehava.Heiman@sheba.health.gov.il. Hanna Binn, Central Virology Laboratory, Ministry of Health, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, E-mail: Hanna.Bin@sheba.health.gov.il.

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