title: Travel-acquired dengue infection: clinical spectrum and diagnostic aspects.
abstract: BACKGROUND
  Dengue fever is increasingly recognized in travelers returning from endemic areas with acute febrile illness; however, its true burden in nonendemic countries is unknown. Only few studies focus on clinical manifestations and serological findings in primarily nonimmune individuals.
  
  
  METHODS
  We analyzed the epidemiology, clinical manifestations and virological results in patients with imported acute dengue infection who presented at our travel clinic in Frankfurt am Main, Germany, between September 1998 and November 2000. An immunochromatographic test and an immunofluorescence assay were used for antibody testing.
  
  
  RESULTS
  Dengue fever was confirmed in 13 patients, thus being the second commonest tropical infection after malaria in patients with fever and a travel history to a tropical country (18 cases per 1,000 patient visits per year). Most patients had only spent a short time abroad, either in South Central or South East Asia or in the Caribbean.
  
  
  CONCLUSIONS
  The clinical features considered typical for dengue were not always present. Antibody assays were typically negative early in the course of disease, with seroconversion occurring only after cessation of clinical symptoms. A high index of suspicion is needed in these patients who often present without typical features of dengue and whose early antibody tests may be negative.
authors.affiliation: Clinic for Internal Medicine, Dept. of Infectious Disease, Frankfurt am Main, Germany. c.stephan@em.uni-frankfurt.de
authors.forename: C
authors.initials: C
authors.lastname: Stephan
authors.forename: R
authors.initials: R
authors.lastname: Allwinn
authors.forename: H R
authors.initials: HR
authors.lastname: Brodt
authors.forename: B
authors.initials: B
authors.lastname: Knupp
authors.forename: W
authors.initials: W
authors.lastname: Preiser
authors.forename: G
authors.initials: G
authors.lastname: Just-Nübling
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis*; D001208:Asia / Q000453:epidemiology; D017691:Caribbean Region / Q000453:epidemiology; D003715:Dengue / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D018450:Disease Progression; D005188:False Negative Reactions; D005260:Female; D005455:Fluorescent Antibody Technique; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests; D014195:Travel
chemical_list: D000914:Antibodies, Viral