07/02/13 22:24 Page 1 of 5 Eurosurveillance, Volume 18, Issue 6, 07 February 2013 Rapid communications CLINICAL PRESENTATION AND LABORATORY FINDINGS FOR THE FIRST AUTOCHTHONOUS CASES OF DENGUE FEVER IN MADEIRA ISLAND, PORTUGAL, OCTOBER 2012 M J Alves ( ) 1 , P L Fernandes 2 , F Amaro 1 , H Osório 1 , T Luz 1 , P Parreira 1 , G Andrade 2 , L Zé-Zé 1 , H Zeller 3 1. Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Águas de Moura, Portugal 2. Laboratório de Patologia Clínica, Hospital Dr. Nélio Mendonça, Funchal, Região Autónoma da Madeira, Portugal 3. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden Citation style for this article: Alves MJ, Fernandes PL, Amaro F, Osório H, Luz T, Parreira P, Andrade G, Zé-Zé L, Zeller H. Clinical presentation and laboratory findings for the first autochthonous cases of dengue fever in Madeira island, Portugal, October 2012. Euro Surveill. 2013;18(6):pii=20398. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20398 Date of submission: 22 January 2013 An outbreak of dengue fever in Madeira island was reported in 2012. Clinical and laboratory findings of the first two laboratory-confirmed autochthonous cases are reported. Both cases had fever (≥38 °C) and petechial rash. Symptoms also included myalgia, asthenia, nausea, vomiting, anorexia, diffuse abdominal pain, and diarrhoea. The two cases were confirmed by serology and one tested positive for a dengue viral sequence. Dengue virus serotype DEN-1 was identified with probable Central or South American origin. Dengue virus (family Flaviviridae, genus Flavivirus) is the aetiological agent of dengue fever, a mosquito-borne infection endemic in the tropics and subtropics. The National Institute of Health Dr. Ricardo Jorge (INSA) performs reference laboratory diagnosis of dengue in Portugal. Human cases identified annually in this laboratory are imported from endemic areas. In terms of number of positive samples, these areas include by order of importance, mainly Brazil, but also Timor- Leste, India, Cape Verde, Mexico, Thailand, Angola, Pakistan and Vietnam. In the beginning of October 2012, for the first time, two autochthonous cases of dengue fever from Madeira archipelago, Portugal were diagnosed. These signaled the beginning of an outbreak and the latest published data includes 2,144 reported autochthonous cases of dengue fever in Madeira island [1]. Clinical and laboratory findings of these first two cases are reported. Case reports Case 1 On 20 September, 2012 a 16 year-old woman developed febrile illness with temperature up to 38.5°C, nausea, vomiting, anorexia, diffuse abdominal pain and diarrhoea. Five days later she presented at the local hospital, with prostration, and, in the second day after admission developed petechial rash at the upper and lower limbs that spread to the lower abdomen within 24 hours. The patient, who lives in Caniço in the neighbourhood of the town of Funchal and studies in Funchal, mentioned traveling to Algarve, south of mainland Portugal, six weeks before and had not been vaccinated against flaviviruses such as yellow fever, tick-borne encephalitis and Japanese encephalitis viruses. The first laboratory findings in the hospital showed thrombocytopenia with minimal platelet count (65x10 9 /L, norm: 150– 400x10 9 /L), leucopenia (2.4x10 9 /L, norm: 4.5–13.5x10 9 /L) and elevated transaminases (alanine/glutamic pyruvic transaminase (ALT/GPT): 117U/L, norm: 17–63 U/L; aspartate/glutamic-oxaloacetic (AST/GOT): 95 U/L, norm: 10–50 Back to Table of Contents Next