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Infectious Disease with Pain: Dengue fever

 曾騰駒(Teng-Chu Tseng);陳立羣(Li-Ching Chen)
Dengue fever (DF) is the most import arbovirus illness worldwide, with an estimated incidence of nearly 100 million cases every year. The common symptoms of DF include fever, rash, malaise, nausea, vomiting, and myalgia. Although it is generally a mild and self-limited disease, about one-third of patients develop severe complications, such as dengue hemorrhagic fever or dengue shock syndrome. Pain is an important component of the World Health Organization (WHO) dengue diagnostic criteria. In the WHO 2009 guidelines, the diagnostic criteria for DF comprised fever along with two symptoms out of nausea and vomiting, rash, aches and pains, positive tourniquet test, leucopenia, and any warning sign. Possible warning signs included abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, hepatomegaly, and an crease in hematocrit with a rapid decrease in platelet count. DF patients may present with an acute abdomen, causing a diagnostic dilemma. The serious acute surgical complications of DF include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. The reason that DF patients can present with an acute abdomen is unclear. Serological tests might not provide an early diagnosis; however, dengue nonstructural protein I (NSI) antigen detection can be used to detect DF early in the disease. The headaches in patients with DF have been described as severe and frontal with retroocular pain. The DF headache has some features in common with migraine; it most commonly causes throbbing pain and is usually associated with nausea, photophobia, and phonophobia. However, the presence of other DF clinical signs, such as fever and muscle pain, allows an easy distinction between these two conditions. In conclusion, although DF usually presents as a febrile viral illness, it can present as an acute abdominal emergency, mimicking acute appendicitis. It is important to consider DF as a differential diagnosis for acute abdomen in patients returning from dengue endemic regions. Meanwhile, headache is one of the most frequent and disabling symptoms in dengue infection. Therefore, when encountering headache or acute abdominal emergencies in endemic areas, we should be aware of the possibility of DF.