title: 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.
authors.affiliation: Infectious Diseases Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Stephenson
authors.forename: John
authors.initials: J
authors.lastname: Roper
authors.forename: Maria
authors.initials: M
authors.lastname: Fraser
authors.forename: Karl
authors.initials: K
authors.lastname: Nicholson
authors.forename: Martin
authors.initials: M
authors.lastname: Wiselka