Title: Tropical Medicine in Your Backyard<br/>Author: Andrea Tenner<br/><a href='http://umem.org/profiles/faculty/1069/'>[Click to email author]</a><hr/><p>
<strong><em>Case Presentation:</em> </strong>A 63 year old woman from Texas with no recent international travel presents to the ED with persistent fatigue which onset a month ago and is associated with anorexia and occasional fevers and chills. She has been to her family doctor who tested her for a number of viral illnesses and was told she had West Nile virus.</p>
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<strong><em>Clinical Question:</em></strong></p>
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What other febrile illness could this be?</p>
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<strong><em>Answer:</em></strong></p>
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This patient had dengue. Dengue is now endemic in the US, and locally-acquired cases have been reported in Florida, Texas and Hawaii. The fatigue and anorexia are typical and can last for weeks after other symptoms have resolved. </p>
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West Nile virus testing may be falsely positive when another flavivirus is present such dengue, yellow fever or Japanese encephalitis. </p>
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<strong><em>Bottom Line:</em></strong></p>
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Other possible illnesses like dengue should be considered in patients who have tested positive for West Nile virus.</p>
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<strong>University of Maryland Section of Global Emergency Health</strong></p>
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<strong>Author: </strong>Jenny Reifel Saltzberg, MD, MPH</p>
<fieldset><legend>References</legend>
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Sharp TM, et al. Fatal hemophagocytic lymphohistiocytosis associated with locally acquired dengue virus infection - New Mexico and Texas, 2012. MMWR Morb Mortal Wkly Rep. 2014 Jan 24;63(3):49-54. <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6303a1.htm?s_cid=mm6303a1_w">http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6303a1.htm?s_cid=mm6303a1_w</a></p>
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Centers for Disease Control and Prevention. Dengue and Dengue Hemorrhagic Fever: Information for Health Care Practitioners. <a href="http://www.cdc.gov/dengue/resources/Dengue&DHF%20Information%20for%20Health%20Care%20Practitioners_2009.pdf">http://www.cdc.gov/dengue/resources/Dengue&DHF%20Information%20for%20Health%20Care%20Practitioners_2009.pdf</a></p>
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