Dengue fever in febrile returning travellers to a UK regional infectious diseases unit

Abstract 

Background. Dengue occurs in many tourist destinations, and is increasingly imported by returning travellers. We review the epidemiology and clinical features of confirmed dengue in returning travellers presenting to a UK regional infectious diseases unit.

Methods. A retrospective, case-record review of febrile returning travellers, admitted to Leicester Royal Infirmary during 2000–2002. The presenting clinical features of patients with positive dengue serology were compared to those who had negative serological tests.

Results. Dengue, including two cases of dengue haemorrhagic fever (DHF) and 1 shock syndrome, was diagnosed in 16 of approximately 250 (6.4%) hospitalised returning travellers. 10/16 (62.5%) patients returned from Asia. There was no difference in symptoms between those with or without serological evidence of dengue. Dengue was associated with thrombocytopenia (p=0.001), leucopenia (p=0.03) and elevated alanine transminase (p=0.01). Following multivariate analysis, dengue was associated with first time travel to an endemic area (odds ratio 10.9, 95% CI 1.21–99.9), early onset of symptoms after return (OR 1.91, 95% CI 1.07–3.43), duration of time overseas (OR 1.08, 95% CI 1.01–1.15) and thrombocytopenia (OR 29.4, 95% CI 1.8–494).

Conclusions. Dengue is an important cause of illness in hospitalised febrile returning travellers. It should be considered in first-time travellers, with thrombocytopenia and negative malaria films who present with symptoms soon after return.

Keywords:  Dengue, Returning travellers