title: Management of dengue in Australian travellers: a retrospective multicentre analysis.
abstract: OBJECTIVE
  To describe the epidemiology, clinical and laboratory features and outcomes of dengue in returned Australian travellers, applying the revised WHO dengue classification (2009) to this population.
  
  
  METHODS
  Retrospective case series analysis of confirmed dengue cases hospitalised at one of four Australian tertiary hospitals, January 2012 - May 2015.
  
  
  METHODS
  Clinical features, laboratory findings and outcomes of patients with dengue; dengue classification according to 2009 WHO guidelines.
  
  
  RESULTS
  208 hospitalised patients (median age, 32 years; range, 4-76 years) were included in the study. Dengue was most frequently acquired in Indonesia (94 patients, 45%) and Thailand (40, 19%). The most common clinical features were fever (98% of patients) and headache (76%). 84 patients (40%) met the WHO criteria for dengue with warning signs, and one the criteria for severe dengue; the most common warning signs were mucosal bleeding (44 patients, 21%) and abdominal pain (43, 21%). Leukopenia (176 patients, 85%), thrombocytopenia (133, 64%), and elevated liver enzyme levels (154, 76%) were the most common laboratory findings. 46 patients (22%) had serological evidence of previous exposure to dengue virus. WHO guidelines were documented as a management benchmark in ten cases (5%); 46 patients (22%) received non-steroidal anti-inflammatory drugs (NSAIDs).
  
  
  CONCLUSIONS
  A significant proportion of returning Australian travellers hospitalised for dengue have unrecognised warning signs of severe disease. Many received NSAIDs, which can increase the risk of haemorrhage in dengue. As travel to Asia from Australia continues to increase, it is vital for averting serious outcomes that clinicians can recognise and manage dengue.
authors.affiliation: Austin Health, Melbourne, VIC alakaytai@gmail.com.
authors.forename: Alex Yc
authors.initials: AY
authors.lastname: Tai
authors.affiliation: Royal Darwin Hospital, Darwin, NT.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: McGuinness
authors.affiliation: Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC.
authors.forename: Roselle
authors.initials: R
authors.lastname: Robosa
authors.affiliation: Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC.
authors.forename: David
authors.initials: D
authors.lastname: Turner
authors.affiliation: Royal Darwin Hospital, Darwin, NT.
authors.forename: G Khai Lin
authors.initials: GK
authors.lastname: Huang
authors.affiliation: Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC.
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
authors.affiliation: Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Korman
authors.affiliation: Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC.
authors.forename: Irani
authors.initials: I
authors.lastname: Thevarajan
authors.affiliation: Austin Health, Melbourne, VIC.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stewardson
authors.affiliation: Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Padiglione
authors.affiliation: Austin Health, Melbourne, VIC.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Johnson
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003716:Dengue Virus; D019468:Disease Management; D005260:Female; D005334:Fever / Q000453:epidemiology; D006261:Headache / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007214:Indonesia; D007970:Leukopenia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013785:Thailand; D013921:Thrombocytopenia / Q000453:epidemiology; D014195:Travel; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal