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Acta Medica Mediterranea, 2016, 32: 2025
DENGUE FEVER IN IRAN. A CASE REPORT
IMAN GHASEMZADEH*, MANOOCHEHR DALAKI**, REZA SAFARI***
*
Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran - **Student Research
Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran - ***Province Health Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran
Abstract
Dengue fever is a viral disease transmitted by mosquitoes and is self-limiting in most cases but can be severe and fatal. This
disease is endemicto Southeast Asia and its outbreak occurs there every 2-3years. The present paper aims to show the occurrence of
isolated cases of this disease in Iran and prevents the wide spread and serious epidemic that may happen in the future through quick
diagnosis and other health measures. This study was based on a report about a 52-year-old man who suffered from fever and headache, maculopapularrashes on the chest and upper limbs, runny nose, and muscle pain three week safter returning from Bahra into
Iran and his tests confirmed leukopenia (2900) and thrombocytopenia (9700). The patient’s blood sample was sent to Pastor
Laboratory for dengue fever test and the result was positive. Although this is the third registered reported case in Iran, in this case,
unlike previous ones, patient had been bitten by an infected mosquito inside Iran. Generally, this disease should be strictly tested and
controlled in people who are returning from endemic areas, in the tropical regions and when it is raining, and in patients who exhibit
fever and other symptoms.
Keywords: Dengue fever, Bandar Abbas, Iran.
Received April 30, 2016; Accepted July 02, 2016
Introduction
Dengue fever is an infection caused by
Arboviruses. Involving different countries, it is considered a major public health problem all over the
world(1). Although dengue is one of the most important mosquito-borne viral diseases, it is clinically
seen as a nonspecific disease or Dengue
Hemorrhagic Fever (DHF), Dengue Shock
Syndrome (DSS), and dengue epidemic(2, 3).
However, this disease can emerge as unusual
manifestations such as hepatitis, encephalitis,
myocarditis, Reye’s syndrome, hemolytic-uremic
syndrome, and thrombocytopenic purpura(4). This
disease is so important that it is suggested that various plans should be made to prevent it because different countries are involved with it(5).
Nowadays many factors have increased the
prevalence of this disease such as international travels which can introduce new species to different
parts of the world. Other factors may include urbanization, crowd, overpopulation, and poverty (6).
Almost many new cases of this virus occur every
year(7). When the infection occurs, it can emerge as
an undifferentiated disease, dengue fever, or dengue
hemorrhagic fever(8). In this study, once incidence of
this disease has been reported in Iran.
Patient introduction
The patient is a 52-year-old man with mellitusdiabetes mellitus and high blood fats under no
medication. The patients, who is self-employed in
Bahrain (shopkeeper), had traveled to Iran about
2026
three weeks before the onset of symptoms. The
maincomplaint of the patient was fever which had
started two days before admission, with bilateral
frontal headache and skin rashes on the chest and
both upper limbs. Muscle pain, runny nose, and
pain in the right knee were mentioned by the patient
but there was no complaint about shortness of
breath, cough, sputum, abdominal pain, and vomiting. He did not have any record of diary consumption or contact with livestock and similar symptoms
were not observed in his family members. On physical examination, the patient appeared an ill middleaged man, with a tongue temperature of 38ºC (he
had taken acetaminophen at home) and a pulse rateof 89 beats perminute. Maculopapular rashes on the
chest and both upper limbs, stiff neck, exudate, and
right knee pain were observed, while lymphadenopathy, nasal ormucosalbleeding, and
organomegaly were not found. In addition, lungsounds and auscultation were normal. The examinations showed that patient’s blood sugar was 297
mg/dl and liver enzymes were at normal level.
Also, the tests results showed leukopenia, thrombocytopenia, ESR: 26, and CRP: 3+. Acidosis was not
confirmed in tests. In urinalysis, glucosoria was
confirmed but ketonuria was rejected and also there
was no evidence of infection. The result of malaria
RDT test was negative. To rule out meningitis, LP
(lumber puncture) test was asked to be performed
but the patient refused. Three days after hospitalization, patient’s fever stopped and his headache, body
pain, leukopenia, and thrombocytopenia gradually
got better. Finally, the patient was discharged with a
good general condition. The patient’s blood sample
was sent to the reference health laboratory in
Tehran for serologic test (ELISA). IgM was reported positive on the test result. Patient follow-up to 5
weeks indicated that he is in a good condition.
Iman Ghasemzadeh, Manoochehr Dalaki et Al
Another outbreak occurredin 2006 in Karachi
after a heavy rain, in which 62% ofpatients were
afflicted by the hemorrhagic dengue fever and 3%
of them died(13). The first case of dengue fever in
Iran was reported in 2008 from a 61-year-old man a
few days after his returning from a trip to
Malaysia(14). In a study conducted by Chinikar et al.
(2013) in Iran, blood samples from 300 patients that
had been tested for Crimean Congo hemorrhagic
fever between 2000 and 2012 were again tested for
dengue fever. The result of serology in 15 patients
(5%) and serology and PCR in 3 patients (1%) was
reported positive. According to this study, 8 patients
had a history of travel to endemic countries and 6
patients were a native of Sistan & Baluchistan
Province, which neighbors Pakistan.
Althoughthis is the third reported case in Iran,
given the incubation period of this disease and the
duration the patient has been in Iran, it is strongly
under question that whether an infected mosquito
inside Iran has stung the patient or not. However,
previous studies indicate that there were cases in
which the disease had been transmitted by infected
mosquitoes from other countries. Studies also suggest that there may be un reported and undetected
subclinical cases in Iran. Given the periodic
oubreaks of this disease every 2 to 3 years in South
east Asia and recent outbreak sinneighboring countries, physicians are recommended pay a special
attention to the above-mentioned epidemiological
symptoms in patients especially in the tropical
regions and when it is raining in order to prevent
the wide spread and serious epidemic that may happen in the future through quick diagnosis and other
health measures.
References
Discussion and conclusion
1)
Dengue fever is a viral disease which is
endemicto Southeast Asia and there is an epidemic
of this disease there every 2-3 years(9). The first
oubreak of dengue fever occurred in 1989 in Sri
Lanka. In 1980, the hemorrhagic type of dengue
fever was found in China, Indonesia, Thailand, and
Malaysia(10). Recently, epidemic of this diseases has
been reported from India (1990)(11). The first documented report of this disease was in Pakistan in
1985 and its first epidemic occurred there 10 years
later (1994-1995)(12).
2)
3)
4)
Flati G, Andrén-Sandberg Å, La Pinta M, Porowska B,
Carboni M. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment.
Pancreas. 2003; 26(1): 8-14.
Pang T, Cardosa MJ, Guzman MG. Of cascades and
perfect storms: the immuno pathogenesis of dengue
haemorrhagic fever-dengue shock syndrome
(DHF/DSS). Immunology and cell biology. 2007;
85(1): 43-5.
Lee K, Lee W-H, Liu J-W, Yang KD. Acute myocarditis
in dengue hemorrhagic fever: a case report and review
of cardiac complications in dengue-affected patients.
International Journal of Infectious Diseases. 2010;
14(10): e919-e22.
Mourão MPG, Lacerda MVGd, Bastos MdS,
Dengue fever in Iran. A case report
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
Albuquerque BCd, Alecrim WD. Dengue hemorrhagic
fever and acute hepatitis: a case report. Brazilian
Journal of Infectious Diseases. 2004; 8(6): 461-4.
Gubler DJ. Dengue and dengue hemorrhagic fever.
Clinical microbiology reviews. 1998; 11(3): 480-96.
Jelinek T. Dengue fever in international travelers.
Clinical Infectious Diseases. 2000; 31(1): 144-7.
Murray NEA, Quam MB, Wilder-Smith A.
Epidemiology of dengue: past, present and future
prospects. Clinical epidemiology. 2013; 5: 299.
Gubler D, Clark G. Dengue/dengue hemorrhagic fever:
the emergence of a global health problem. Emerging
infectious diseases. 1995; 1(2): 55.
Vijayakumar T, Chandy S, Sathish N, Abraham M. Is
dengue emerging as a major public health problem?
Indian Journal of Medical Research. 2005; 121(2): 100.
Organization WH. Dengue haemorrhagic fever: diagnosis, treatment and control: World Health
Organization; 1986.
Srivastava V, Suri S, Bhasin A, Srivastava L,
Bharadwaj M. An epidemic of dengue hemorrhagic
fever and Dengue shock syndrome in Delhi: a clinical
study. Annl Trop Paediatr. 1990; 10(4): 329-34.
Qureshi J, Notta N, Salahuddin N, Zaman V, Khan J.
An epidemic of Dengue fever in Karachi-associated
clinical manifestations. JPMA The Journal of the
Pakistan Medical Association. 1997; 47(7): 178-81.
Ahmed S, Arif F, Yahya Y, Rehman A, Abbas K, Ashraf
S, et al. Dengue fever outbreak in Karachi 2006-a
study of profile and outcome of children under 15 years
of age. JPMA The Journal of the Pakistan Medical
Association. 2008; 58(1): 4.
Chinikar S, Ghiasi SM, Moradi A, Madihi SR.
Laboratory Detection Facility of Dengue Fever (DF) in
Iran: The First Imported Case. The internet journal of
infection diseases. 2010; 8(1): 1-2.
Chinikar S, Ghiasi SM, Shah-Hosseini N, Mostafavi E,
Moradi M, Khakifirouz S, et al. Preliminary study of
dengue virus infection in Iran. Travel medicine and
infectious disease. 2013; 11(3): 166-9.
2027
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Corresponding author
IMAN GHASEMZADEH
Infectious and Tropical Diseases Research Center, Hormozgan
University of Medical Sciences, Bandar Abbas
(Iran)