Classic dengue primarily occurs in nonimmune, nonindigenous adults and children. Illness begins abruptly with a minor stage of 2-4 days duration followed by rapid deterioration. Increased vascular permeability, bleeding, and possible DIC may be mediated by circulating dengue antigen-antibody complexes, activation of complement, and release of vasoactive amines. In the process of immune elimination of infected cells, proteases and lymphokines may be released and activate complement coagulation cascades and vascular permeability factors. Cases along the Texas-Mexico border have been cited recently.
Ethnicity is nonspecific, but the disease s distribution is geographically determined.
Fewer cases have been reported in the black population than in other races. In endemic areas, a high prevalence of immunity in adults may limit outbreaks to children. Usefulness of these changes as a marker of cardiac involvement is unclear. Correct electrolyte abnormalities and acidemia. Implement therapy for DIC if indicated.