뎅기열은 아시아, 남태평양 지역, 아프리카, 아메리카 대륙의 열대지방에 걸쳐 널리 발생하며, 이러한 유행지역으로부터 돌아온 여행자들에게 중요한 감염 질환의 하나로 부각되고 있다. 풍토지역을 방문하는 여행자의 점차적인 증가로 뎅기 바이러스에 대한 노출의 위험도가 증가하고 있으며, 이로 인해 해외에서 유입되는 뎅기 감염 사례가 증가하고 있다. 뎅기열은 다양한 임상 양상을 나타내며, 종종 예측할 수 없는 임상 증상과 결과를 초래하기도 한다. 대부분의 감염자들은 저절로 회복되거나 경한 증상을 보이지만, 일부에서는 뎅기 출혈열이나 뎅기 쇼크와 같은 심각한 경과를 보이기도 한다. 따라서 뎅기열 유행지역 방문자가 발열을 보이는 경우 뎅기열을 의심하는 것은 중요하며, 일단 의심이 되면 신속한 진단과 적절한 치료를 통해 합병증을 예방하는 것이 중요하다. 저자들은 뎅기열 유행지역을 여행한 소아에서 발열, 두통, 구역, 발진 등이 발생하여 시행한 혈청검사에서 뎅기열로 진단된 2례를 경험하였기에 보고하는 바이다.
뎅기열은 아시아, 남태평양 지역, 아프리카, 아메리카 대륙의 열대지방에 걸쳐 널리 발생하며, 이러한 유행지역으로부터 돌아온 여행자들에게 중요한 감염 질환의 하나로 부각되고 있다. 풍토지역을 방문하는 여행자의 점차적인 증가로 뎅기 바이러스에 대한 노출의 위험도가 증가하고 있으며, 이로 인해 해외에서 유입되는 뎅기 감염 사례가 증가하고 있다. 뎅기열은 다양한 임상 양상을 나타내며, 종종 예측할 수 없는 임상 증상과 결과를 초래하기도 한다. 대부분의 감염자들은 저절로 회복되거나 경한 증상을 보이지만, 일부에서는 뎅기 출혈열이나 뎅기 쇼크와 같은 심각한 경과를 보이기도 한다. 따라서 뎅기열 유행지역 방문자가 발열을 보이는 경우 뎅기열을 의심하는 것은 중요하며, 일단 의심이 되면 신속한 진단과 적절한 치료를 통해 합병증을 예방하는 것이 중요하다. 저자들은 뎅기열 유행지역을 여행한 소아에서 발열, 두통, 구역, 발진 등이 발생하여 시행한 혈청검사에서 뎅기열로 진단된 2례를 경험하였기에 보고하는 바이다.
Dengue fever is an important health problem for international travelers to all endemic areas. The steadily increasing numbers of tourists visiting endemic areas raise the risk of exposure, and imported dengue cases are increasingly observed in nonendemic area. Dengue has a wide spectrum of clinical ...
Dengue fever is an important health problem for international travelers to all endemic areas. The steadily increasing numbers of tourists visiting endemic areas raise the risk of exposure, and imported dengue cases are increasingly observed in nonendemic area. Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting, non-severe clinical course, a small proportion progress to severe disease such as dengue hemorrhagic fever or dengue shock syndrome. Therefore, it is important to suspect dengue fever in every febrile patient returning from the tropics. Whenever it is suspected, a quick diagnosis and adequate managements are essential to avoid complications. We report two cases of imported dengue fever in Korean children presenting with fever, headache, nausea, and rash.
Dengue fever is an important health problem for international travelers to all endemic areas. The steadily increasing numbers of tourists visiting endemic areas raise the risk of exposure, and imported dengue cases are increasingly observed in nonendemic area. Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting, non-severe clinical course, a small proportion progress to severe disease such as dengue hemorrhagic fever or dengue shock syndrome. Therefore, it is important to suspect dengue fever in every febrile patient returning from the tropics. Whenever it is suspected, a quick diagnosis and adequate managements are essential to avoid complications. We report two cases of imported dengue fever in Korean children presenting with fever, headache, nausea, and rash.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
문제 정의
따라서 뎅기열 유행지역 방문자가 발열을 보이는 경우 뎅기열을 의심하는 것은 중요하며, 일단 의심이 되면 신속한 진단과 적절한 치료를 통해 합병증을 예방하는 것이 중요하다. 저자들은 뎅기열 유행지역을 여행한 소아에서 발열, 두통, 구역, 발진 등이 발생하여 시행한 혈청검사에서 뎅기열로 진단된 2례를 경험하였기에 보고하는 바이다.
제안 방법
Blood culture was negative. Based on his symptoms, laboratory values and travel history to endemic area, we performed dengue specific IgM ELISA and RT-PCR. Dengue IgM-caputure ELISA was positive and RT-PCR was negative.
We used IgM capture ELISA and multiplex RT-PCR for confirmation of dengue virus infection. Detection of dengue IgM by ELISA was performed according to the Panbio Dengue IgM Capture ELISA (Panbio, Brisbane, Australia). Multiplex RT-PCR was performed using the primer pairs reported by Harris et al21).
대상 데이터
A 12-year-old boy was admitted with fever, nausea, headache and myalgia for 4 days. He traveled to the Philippines from July 21, 2012 to July 25, 2012.
A 13-year-old boy presented with fever, and headache for 5 days; nausea, vomiting, and abdominal discomfort for 2 days. He traveled to the Philippines from July 20, 2012 to July 25, 2012.
성능/효과
Our two patients were suspected of dengue fever based on their symptoms, laboratory values and travel history to the Philippines. And the results of dengue serological tests were positive but RT-PCR was negative. After the onset of illness, the virus can be detected in serum, plasma, circulating blood cells and other tissues for 4-5 days.
In conclusion, there is a need for pediatricians in non-endemic areas to understand the clinical feature, epidemiology, diagnosis and prevention of dengue fever among travelers. Also, it is important to suspect dengue fever in every febrile children returning from the endemic areas, particularly if thrombocytopenia, leukopenia, elevate serum aminotransferase and/or rash are present.
In WHO guidelines of 2009, a classification according to severity is outlined: Probable dengue or laboratory-confirmed dengue with and without warning sign, and severe dengue. Several clinical symptoms such as lethargy, abdominal tenderness, mucosal bleeding, liver enlargement, persistent vomiting, increased hemoconcentration with rapidly decreased platelet count were identified as possible predictors of a severe clinical course and defined as warning signs. Severe dengue is defined by one or more of the following: (i) plasma leakage that may lead to shock (dengue shock) and/ or fluid accumulation, with or without respiratory distress, and/or (ii) severe bleeding, and/or (iii) severe organ impairment1) .
참고문헌 (24)
World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control: World Health Organization Press, 2009.
Gubler DJ. The global emergence/resurgence of arboviral diseases as public health problems. Arch Med Res 2002;33:330-42.
Korea Centers for Disease Control and Prevention. Trends in imported cases of infectious diseases in Korea. Public Health Weekly Report, KCDC 2008;1.
Guzman MG, Kouri G, Bravo J, Valdes L, Vazquez S, Halstead SB. Effect of age on outcome of secondary dengue 2 infections. Int J Infect Dis 2002;6:118-24.
O'Brien DP, Leder K, Matchett E, Brown GV, Torresi J. Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units. J Travel Med 2006;13:145-52.
Barrera R, Amador M, MacKay AJ. Population dynamics of Aedes aegypti and dengue as influenced by weather and human behavior in San Juan, Puerto Rico. PLoS Negl Trop Dis 2011;5:e1378.
Lee CJ, Kim HR, Kim MJ. A case of imported dengue hemorrhagic fever. Korean J Infect Dis 1995;27:403-6.
Choi HH, Park JA, Kim JS, Hur YJ, Song MS, Hwang TG, et al. A case of an imported dengue hemorrhagic fever with spontaneous bleeding: case report and review of the literature. Korean J Pediatr Infect Dis 2011;18:207-11.
Choi SH, Kim YJ, Shin JH, Yoo KH, Sung KW, Koo HH. International travel of Korean children and dengue fever: A single institutional analysis. Korean J Pediatr 2010;53:701-4.
Cobra C, Rigau-Perez JG, Kuno G, Vorndam V. Symptoms of dengue fever in relation to host immunologic response and virus serotype, Puerto Rico, 1990-1991. Am J Epidemiol 1995;142:1204-11.
Jelinek T, Muhlberger N, Harms G, Corachan M, Grobusch MP, Knobloch J, et al. Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop. Clin Infect Dis 2002;35:1047-52.
Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S, et al. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J 2007;26:283-90.
Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 1997;176:313-21.
Harris E, Roberts TG, Smith L, Selle J, Kramer LD, Valle S, et al. Typing of dengue viruses in clinical specimens and mosquitoes by single-tube multiplex reverse transcriptase PCR. J Clin Microbiol 1998;36:2634-9.
Dung NM, Day NP, Tam DT, Loan HT, Chau HT, Minh LN, et al. Fluid replacement in dengue shock syndrome: a randomized, double-blind comparison of four intravenous-fluid regimens. Clin Infect Dis 1999;29:787-94.
AI-Helper
※ AI-Helper는 부적절한 답변을 할 수 있습니다.