title: Dengue virus infection in travellers returning to Berlin, Germany: clinical, laboratory, and diagnostic aspects.
abstract: BACKGROUND
  Dengue is a mosquito-borne viral infection endemic throughout the tropics and subtropics. The global prevalence of dengue has grown dramatically in recent years and it has been recognized as a potential hazard to tourists.
  
  
  OBJECTIVE
  In this study, we analyzed the epidemiology, clinical manifestations, laboratory features and serological/virological results in a series of German travellers returning to Berlin with acute dengue virus infection.
  
  
  METHODS
  Laboratory-confirmed dengue virus infections among German travellers returning to Berlin were studied retrospectively during the period of 1993-2001. Seventy-one patients tested positive for dengue fever and were included in this study.
  
  
  RESULTS
  The majority of patients (77.5%) contracted the disease in South Central and South East Asia. The most important clinical characteristics were fever and prostration (100%), headache, predominantly frontal or retroorbital (86%), arthralgia (79%), morbilliform rash (66%) and myalgia (48%). The most meaningful laboratory results were: marked leucopenia (72%), thrombocytopenia (70-89%), hyponatremia (41%) and increased hepatic enzymes ALAT (41%), ASAT (45%) and LDH (62%). Dengue virus infection was diagnosed by means of a matching clinico-epidemiological history and positivity of specific serology and/or virus isolation. Hemorrhagic phenomena appeared in 10 of the 71 patients (14%), out of which one was diagnosed with DHF according to WHO criteria. All patients recovered fully.
  
  
  CONCLUSIONS
  Pretravel advice should be given to all travellers to dengue-endemic areas. DF must be included in the differential diagnosis of patients returning febrile from tropical areas.
authors.affiliation: Medical Clinic, Department of Infectious Diseases, Charité, Humboldt University, 13353, Berlin, Germany. dieter.teichmann@khdn.de
authors.forename: Dieter
authors.initials: D
authors.lastname: Teichmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Göbels
authors.forename: Matthias
authors.initials: M
authors.lastname: Niedrig
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001604:Berlin / Q000453:epidemiology; D003715:Dengue / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D003716:Dengue Virus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014195:Travel