INFECTIOUS DISEASEDengue presents with fever
and dramatic bone pain in the
traveler.SYMPTOMS/EXAM
■ Incubation: 5–10 days
■ High fever
■ Saddleback pattern
■ Several days of fever, a period of improvement, followed by several
days of resumed symptoms
■ Flulike symptoms
■ Severe myalgias
■ Dramatic bone pain (“break-bone fever”)
■ Rash (scarlatiniform, maculopapular, or petechial)
■ Dengue hemorrhagic fever (DHF)
■ Occurs when exposed to second serotype
■ Increased vascular permeability and bleeding with thrombocytopenia
■ Grade 1: Platelets <100,000
■ +tourniquet test (petechiae below cuff) =98% PPV
■ Grade 2: Spontaneous bleeding
■ Grade 3: Circulatory failure
■ Grade 4: Profound shock
DIAGNOSIS
■ Clinical: Leukopenia and thrombocytopenia common
■ Definitive: Serologies
TREATMENT
■ Supportive
■ DHF mortality
■ 50% without care
■ <5% with care
A 35-year-old male presents with fever and the worst headache of his life
2 weeks after returning from a white-water rafting trip to Peru. Physical
exam reveals bilateral conjunctivitis. An LP shows aseptic meningitis. If un-
treated, what life-threatening syndrome may develop?
Weil syndrome.Leptospirosis
■ The mobile spirocheteLeptospira interrogans
■ #1 zoonosis affecting humans worldwide
■ Contaminated freshwater from the urine of rodents, livestock, or domestic
animals (through damaged skin or exposed mucous membranes)
■ Risk factors: Walking in creeks, rodents in food storage area
■ After periods of heavy rainfall/flooding
SYMPTOMS/EXAM
■ Incubation: 2–30 days
■ Acute (3–7 days)
■ Symptoms ranges from mild illness to abrupt high fever/chills, intense
HA (worst HA), severe myalgias. Conjunctival suffusion (redness with-
out exudates) is pathognomonic.