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1998 Presentations for the Poster and Vignette Sessions
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TRAVEL FEVER. Kathleen E. Walsh, DO. University of Wisconsin Hospital and Clinics, Madison, WI.

Case: A 39 year old female presented to the University Health Services with a complaint of watery diarrhea, high fever, headache and photophobia x 5 days. The patient had recently traveled to El Salvador, staying with local families in a small rural village. The patient drank bottled water, had no direct exposure to animals and ate locally prepared foods. Additional exposures include wading barefoot in a local river. At presentation the patient stated that the watery diarrhea (4-6 bowel movements/day) began near the end of her stay in El Salvador and persisted upon her return to the United States. Eight to nine days after returning, she developed a high fever (102 F), chills, sweats, severe global headache, myalgia, low back pain, anorexia and malaise. The patient's vital signs were BP116/84, P 60, T 98.0, R 18, Wt. 137lbs. Her physical exam was unremarkable. Initial laboratory values revealed a platelet count of 85,000 and WBC of 2.0. The patient was administered IV fluids with labs redrawn the following day demonstrating a decline in platelet count from 85,000 to 65,000. The patient was then sent to the ER where on presentation the patient's physical complaints had subsided significantly over the last 24 hours. ER laboratory values were WBC 2.4 (38% Neutr., 47% Lymph, 6% Atypical Lymph.) Hct.35, Platelet 64,000, INR 1.1, Chem 7 and LFT's wnl with slight increase in AST at 49, Fibrinogen 235, D-Dimer .25-.50, and a negative malarial smear. Acute serology for dengue fever was drawn the following day and sent to the CDC. Results were positive for the IgM antibody, indicating a recent infection. The patient was provided with supportive therapy and her symptoms continued to subside over the following two months.

Discussion: Dengue fever is an acute febrile illness caused by a Flaviviridae virus. The disease is characterized by sudden onset of high fever with a biphasic (saddleback) pattern, chills, severe headache, skin rash and general malaise. Four serotypes are known, designated dengue types 1 through 4. Transmission is principle by the Aedes aegypti mosquito. Dengue hemorrhagic fever, the most serious form of the disease is characterized by fever, a platelet count of under 100,000, hemorrhagic manifestations and "leaky" capillary syndrome. Treatment of dengue fever is support therapy with IV fluids and pain medication. Dengue is probably the greatest mosquito-borne disease risk to travelers. The need for a dengue vaccine is increasingly becoming important for the traveler as well as endogenous populations.

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