First Iranian Imported Case of Dengue
A 58-year-old woman was referred to Mehr hospital in Tehran with fever and body pain associated with skin rashes from 4 days prior to admission, which no response to outpatient therapy. She had traveled to Malaysia 10 days before illness. Her past medical and family histories were unremarkable. On physical examination she was febrile; oral T = 40°C, pulse rate was 95/min, respiratory rate was 20/min and blood pressure was 100/80 mmHg. Physical examination of heart, lungs, abdomen, extremities and neurologic examination were normal. She had mild dehydration and few maculopopular skin rashes over the trunks were appeared since 1 day before admission. Laboratory analysis on admission was as follow:\nHemoglobin = 12.4 g/dl, hematocrit = 38%, white blood cell count (WBC) =1600/mm3 with 42% neutrophil and 58% lymphocytes, platelet count (Plt) =99,000/mm3, ESR = 15 mm/h, urine analysis (U/A) showed microscopic hematuria, liver function test was normal, Wright and 2ME tests were negative. Chest X-ray, electrocardiography and adominopelvic sonogeraphy were normal. She was admitted and has been treated with intravenous fluid replacement. She was under close observation for vital signs, fluid and electrolyte balance and bleeding precaution. Dengue immunologic and confirmatory test was requested.\nTwenty-four hours later, patient became afebrile and vital signs were normal. Complete blood count showed: WBC = 2200, Plt = 91000, Hct = 39% and U/A was normal. On the third day, her general condition gradually improved and platelet count increased to 123,000/mm3 and WBC count to 3500/mm3. Laboratory evaluation for dengue fever was performed by Pasteur institute in Tehran, Iran. The result was as follow:\nThe patient was positive for immunoglobulin M (IgM) and negative for immunoglobulin G (IgG) antibodies to dengue by ELISA. Serum RT-PCR for dengue virus was positive. Due to good general condition and improvement specific antiviral treatment was not started. The patient was discharged on the fourth day with good general condition and platelet count of 127,000/mm3 and WBC count of 4400. One week after discharge she was healthy on follow-up.